ABD I - Pathology of Pancreas

Agenesis and hypoplasia

congenital abnormality that may exist but cant be diagnosed by ultrasound alone

Annular pancreas

Congenital abnormality that does not migrate left and can encircle duodenum causing atresia

Ectopic

Most common anomaly

Cysts

Congenital anomoly that results from anomalous development of pancreatic ducts (3-5cm)

Fibrocystic disease

Hereditary disorder of exocrine gland where pancreas has small cysts and acini and ducts are dilated and replaced by fibrous tissue

Pancreatitis

Inflammation of panc that occurs when panc is damaged and tissue may be digested by its own enzymes

alcoholism

Pancreatitis is often related to biliary tract disease and _____

40-60%

Gb stones are present in ____ of pancreatitis patients

Aneursyms

General complications of pancreatitis common in splenic artery

Acute pancreatitis

Inflammatory reaction with destruction of panc substance, necrosis of vessels and lipolytic enzymes and damage to acinar tissue

Biliary tract disease

Most common cause of acute pancreatitis

Acute pancreatitis

A pt has severe constant pain radiating to back after a large meal with elevated amylase, lipase, and leukocytosis. Sono has focal enlargement, hypoechoic edema, irregular borders, loss of splenic vein and IVC, and enlarged panc duct with peripancreatic fluid collections

24, 79-94

Amylase increases within ___ hrs, lipase increases within ___hrs

Lesser sac

Most common site for extrapancreatic fluid collections and edema

Hemorrhagic pancreatitis

Rapid progression of acute pancreatitis resulting in tissue destruction and fat necrosis in focal areas

Hemorrhagic pancreatitis

Pt has intense pain radiating to back with shock, ileus, and decrease in hematocrit and serum calcium. Sono shows well defined homogeneous mass in are of panc that leads to cystic appearance with age

Phelgmonous pancreatits

Diffuse inflammatory edema of soft tissue that may proceed to necrosis and sappuration (to form pus)

Phlegmoneous pancreatitis

Pt comes in with hypoechoic mass with through transmission

Chronic pancreatitis

Recurrent acute pancreatitis causing continued parenchymal destruction associated with chronic alcoholism and hypercalcemia and hyperlipidemia

Chronic pancreatitis

A man comes in with epigastric pain and jaundice secondary to CBD obstruction and increase amylase and lipase. Sono shows smaller gland, increased echogenicity, irregular borders, and dilated duct.

Papilla

Most common site of obstruction in chronic pancreatitis

pseudocysts or thrombus

Patients with chronic pancreatitis may develop _____ of splenic or portal vein

10-20%

Pseudocysts develop in ___ of patients with acute pancreatitis

4-6

Pseudocysts develop ____ after the onset of pancreatitis

Pseudocysts

Multi- or unilocular collection of fluid that arise from loculation of inflammatory processes, necrosis or hemorrhage associated with pancreatitis

Pseudocysts

Occurs when pancreatic enzymes escape from the gland and breakdown tissue to form a sterile abscess

Lesser sac

Pseudocysts are commonly seen in the ____

Always

Pseudocysts are ____ acquired from trauma, acute or chronic pancreatitis

Pseudocyst

A patient comes in with a round or oval well-defined mass, sonolucent, with debri in posterior aspect, possible septations, and through transmission

Rupture

Most common complication of pancreatic pseudocyst (5%) causing shock and pertonitis

50%

Mortality rate of spontaneous rupture of a pseudocyst

Congenital cysts

are a result of anomalous development of the pancreatic duct

Acquired cysts

retention, parasitic, or neoplasm cysts that contain enzymes or are continuous with the pancreatic duct

Microcystic adenoma (serous cystadenoma)

Rare, benign tumor that is well circumscribed and consists of a large mass with multiple tiny cysts

Macrocystic adenoma (mucinous cystadenoma/cystadenocarcinoma)

Malignant or benign with malignant potential cysts occurring in the body or tail

Cystadenomacarcinoma

A woman comes in with irregular lobulated cyst with thick walls containing thick mucinous fluid, internal septations, or mural nodules. She has wt loss, abdominal mass, and jaundice

Cystadenoma

A middle aged women comes in with elevated amylase and sono shows a coarsely loculated anechoic mass with posterior enhancement and thick walls

Intraductal papillary mucinous tumor

a form of mucinous cystic neoplasm originating from panc duct and slowly grows

Endocrine pancreatic neoplasms

arise from islet cells and may be functional or nonfunction with a slow growth rate

Insulinoma

Most common functioning islet tumor (60%)

92%

Percent of islet tumors that are malignant

Insulinomas

Small well-encapsulated with good vascular supply occuring in patients with hyperinsulinism and hypoglycemia

Gastrinoma

Most malignant islet cell tumor caused by non-insulin scecreting tumors, exceeding the amounts of gasrin

Insulinoma

A 60 year old pt comes in with hypoglycemia, palpitations, headache, confusion and sweating

Zollinger-Ellison syndrome

Gastrinomas can produce

Vipomas

Islet tumor associated with GB dilation, distended bowel loops

Adenocarcinoma

Most common primary neoplasm that involves exocrine and accounts for 5% of all cancer deaths and is the most common cause of mortalityj

Adenocarcinoma

You see the Courvoisier’s sign in 25% of patients with

60-70%

How often does adenocarcinoma appear in the head

Lymphoma

Most common parapancreatic neoplasm

Lymphangiomas

Thin walled homogeneous small cysts with septa, thick walls, and calcifications

Cystic teratomas

Found in young adults with mixed echogenic pattern of cystic, solid, fat, and calcifications