Pancreas

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dorkfork
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289881
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Pancreas
Updated:
2014-11-23 13:08:06
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  1. The kidneys are located in the ______________ cavity.
    retroperitoneal
  2. The kidneys and adrenal glands are located in the ___________ space. The anterior border of this space is called ________________.
    • Perinephric or perirenal space
    • Gerota's fascia is the anterior boarder
  3. The hypoechoic structures located in the renal medulla are: __________________
    Renal pyramids
  4. At the level of the renal hilum, list the anterior/posterior position of the renal vessels and ureter.
    • Anterior: renal artery
    • Mid: renal vein
    • Posterior: ureter
  5. List the further divisions of the renal artery and their location within the renal parenchyma.
    • Renal pelvis: segmental arteries
    • Renal pyramid: interlobar arteries
    • Cortex: arcuate arteries
    • Very outter rim: interlobular
  6. Describe the sonographic patterns associated with unilateral renal agenesis.
    Causes compensatory hypertrophy of contralateral kidney
  7. Describe the sonographic patterns associated with fetal lobulation.
    One or more rounded contour abnormalities
  8. Describe the sonographic characteristics of the hypertrophied Column of Bertin.
    • <3cm
    • Can vary w/scan plane (iso to hypoechoic)
  9. Most common urinary tract anomaly
    Duplicated collecting system
  10. Describe the sonographic characteristics and clinical symptoms associated with duplicated collecting system.
    • Incomplete: 2 separate collecting systems, 2 ureters, Common orifice
    • Complete: 2 separate collecting systems, 2 ureters, 3 jets
    • superior system susceptible to obstructions
    • Look for ureterocele>> cyst within bladder
  11. Describe the clinical symptoms and sonographic characteristics of a pelvic kidney.
    Hx pelvic mass, renal infections, stones, & hydronephrosis due to short course of ureter
  12. Describe the clinical symptoms and sonographic characteristics related to horseshoe kidney.
    • Lack of complete separation of kidneys
    • 90% fused @ lower pole
    • Isthmus anterior to AO
  13. Complications of horseshoe kidney:
    UPJ obstruction, renal stone formation, renal infection
  14. Describe the clinical symptoms and sonographic characteristics related to congenital UPJ obstruction.
    • Symptoms: Typically symptomatic in childhood, chronic back and flank pain, hx renal infections or stones
    • Pattern: Distended renal pelvis and calyces with normal ureter
  15. What are the normal measurements of the adult kidney? What is the “average” renal length?
    • 9-13 L x 2.53 AP x 4-5 T
    • ~10 L
  16. Most frequent cause of acute renal failure:
    Prerenal azotemia producing renal hypoperfusion
  17. Symptoms of acute renal failure:
    • Sudden decrease in renal function
    • Hemorrhage, low cardiac output
    • Dehydration, pancreatitis, burns, trauma
    • Acute tubular necrosis, glomerulonephritis
    • Oliguria
  18. Labs associated with acute renal failure:
    Sudden increase in BUN and creatinine
  19. Prerenal azotemia RI value:
    • RI < 0.7
    • Associated with: acute renal failure
  20. Intrinsic renal disease RI value:
    • > 0.7
    • Associated with: acute renal failure
  21. Most frequent cause of chronic renal failure:
    Diabetes and HTN
  22. Causes of chronic renal failure
    • Diabetes
    • HTN
    • Glomerulonephritis
    • Cystic renal disease (PCKD)
  23. Symptoms and lab values associated with chronic renal failure:
    • Physical symptoms are vague
    • Labs: increased serum BUN and creatinine
  24. Sonographic pattern of chronic renal failure:
    • Hyperechoic cortex
    • Loss of corticomedulary junction
  25. Labs associated with RCC:
    • RBC casts in urine
    • Increased BUN and creatinine
  26. Stages of RCC
    • Stage 1 < 7 cm
    • Stage 2 > 7 cm
    • Stage 3 IVC invasion
    • Stage 4 Invasion of lymph nodes and organs
  27. Large RCC pattern
    • Normally hyperechoic but may present iso or hypoechoic
    • May contain calcifications or areas of necrosis
  28. Doppler evaluation of RCC
    • Shift > 2.5 kHz
    • Large systolic/diastolic flow differential
    • Flow usually in peripheral
  29. Common site of metastasis of RCC
    • Through renal vein into IVC
    • Check contralateral kidney
    • Hepatic and retroperitoneal lymph node metastasis
  30. Transitional cell carcinoma is also known as:
    Renal urothelial CA
  31. What are the differences between papillary and non papillary TCC?
    • Papillary: lower grade with slower rate of renal involvement
    • Non-papillary: more invasive infiltrating adjacent renal parenchyma and more distant sites
  32. Most frequent location of TCC:
    Urinary bladder
  33. Microscopic hematuria:
    with in the kidney
  34. Gross hematuria:
    with in ureter or bladder
  35. Pattern of papillary vs. non papillary TCC:
    • Papillary type: hypoechoic mass within renal sinus which may cause hydro
    • Angiogenesis excludes blood clot, sloughed papilla and fungus ball
  36. What are the clinical symptoms and sonographic features of lymphoma?
    • Metastatic process
    • Most frequently occurs with Non-Hodgkins Lymphoma
    • Symptoms: Hematuria, flank pain and or mass
    • Pattern: 1+ discrete hypo/anechoic mass, Diffuse infiltration = hypoechoic
  37. Most frequent benign neoplasm of the kidney:
    Angiomyolipoma
  38. What is angiomyolipoma associated with:
    Tuberous sclerosis
  39. Bladder Tapenade:
    • Bladder fills with blood
    • True surgical emergency
  40. What are the sonographic patterns associated with urachal anomalies including patient urachus and urachal diverticula?
    • In women: secondary to infection of periurethral glands, some due to trauma in child birth
    • Clinical symptoms:Soft anterior vaginal mass
    • Pattern: Cystic/complex mass that communicates with urethra
  41. What are the clinical symptoms and sonographic characteristics of MCDK or renal dysplasia?
    • Symptoms: Pediatric: flank mass; Bilateral: renal failure; Unilateral: asymptomatic
    • Pattern:Typical unilateral, rarely bilateral or focal unilateral, multiple cysts of various sizes; adults>> wall calcifications
  42. What is the most common renal infection?
    Acute pyleonephritis
  43. What are the clinical symptoms and sonographic characteristics of acute pyelonephritis?
    • ~15-30yo females
    • Symptoms:UTI, fever, flank pain, urgency, frequency
    • Lab values: Urinalysis>> bacteriuria, pyuria, positive urine culture, normal RFTs (BUN/creatinine)
    • Pattern: Mild cases = normal pattern, Renal enlargement with compression of sinus, Loss of corticomedullary junction; Hypoechoic pattern = edema; Hyperechoic = hemorrhage; Emphysematous = localized or diffuse air pockets
  44. What are the sonographic patterns associated with renal abscess and perinephric abscess?
    • Symptoms: Hx of diabetes, infection related to renal stones, prolonged UTI, immune system compromised, Diffuse or localized flank pain, Fever, increased WBC count
    • Pattern: Hypoechoic, thick walled mass in renal parenchyma, May contain septa, internal debris, or gas pockets
  45. What are the clinical symptoms and sonographic patterns related to renal hematoma?
    • Renal injury due to blunt/sharp trauma
    • Symptoms: Hx of malignancy, hydro, or cysts, Minimal bleeding = localized or diffuse pain, Massive trauma= severe pain, decreased hematocrit, symptoms of shock, ARF
    • Pattern: Echogenic, complex, cystic (new to old), Major lacerations>> echogenic line,Doppler>> used to look for disruption of flow
  46. Perirenal hematoma:
    fracture of capsule
  47. Urinoma:
    fracture of collecting system
  48. What are the clinical symptoms and sonographic characteristics of renal stones?
    • Symptoms: Size does not correlate with severity of symptoms, Obstructing = sudden severe pain, Micro or gross hematuria
    • Pattern: Hyperechoic with shadowing, Twinkle artifact( To optimize: *decrease gain *increase color scale (60-80) * threshold @ 90% (color scale))
  49. Most common location = ureter adjacent to ureter-renal pelvis junction
  50. What are the clinical symptoms and sonographic features related to obstructive renal disease?
    • Causes: stones, strictures, infections, malignancy, BPH (most common)
    • Symptoms: Vary with cause, Bilateral obstruction = renal failure
    • Pattern: Prominent, anechoic calyces within renal sinus, Viscous urine (fluid/fluid level)
    • RI > 0.7 or difference greater than 0.1 compared to unaffected kidney
    • Asymmetric or absent jet
  51. What are the clinical symptoms and sonographic patterns related to bladder diverticula?
    • Secondary to bladder outlet obstruction
    • Symptoms: Dysuria, UTI
    • Pattern: Cystic pouches extending from wall, Demonstrate neck of diverticula merging with bladder, Demonstrate jets to r/o obstruction
  52. Most frequnt cause of bladder outlet obstruction:
    BPH
  53. What are the sonographic features of bladder outlet obstruction?
    • Increased WBC or hematuria
    • Pattern:Large overextended bladder, Possible sludge, Obtain post void images
  54. What are the clinical symptoms and sonographic patterns associated with cystitis?
    • In women>> introduction of rectal bacteria into urethra
    • In men>> prostatitis, bladder outlet obstruction
    • Pattern: Chronic pattern: diffuse or focal wall thickening; Interstitial: smaller than normal bladder
  55. The SMA is located ______ in relation to the splenic vein.
    Posterior
  56. The splenic vein is located ______ in relation to the body of the pancrea.
    Posterior
  57. The LRV is lovated _____ in relation to the SMA.
    Posterior
  58. The RRA is located ______ posterior to the IVC
    posterior
  59. The GDA is located ______ in relation to the pancreatic head.
    anterolateral
  60. The CBD is located ______ in relation to the pancreatic head.
    posteriolateral
  61. List the 3 tributaries of the celiac trunk:
    Hepatic artery, LGA, splenic artery
  62. The main pancreatic duct is termed ________ and enters the duodenum via the _______.
    Duct of Wirsung; sphincter of Odi
  63. Normal pancreatic duct measurement
    2-2.8mm
  64. The accessory pancreatic duct is called ________.
    The duct of Santerini
  65. The SMV is located ____ in relation to the uncinate process.
    anterior
  66. Three vessels that form the MPV
    Splenic vein, SMV and IMV
  67. Products secreted via the circulatory system
    insulin and glucagon
  68. Portal splenic confluence is located ______ in relation to the neck of the pancreas.
    posterior
  69. Most frequent cause of acute pancreatitis
    Alcoholism/ biliary tract disease
  70. Symptoms and lab values associated with acute pancreatitis:
    • Severe epigastric pain, nausea, vomiting, abdominal distention
    • Labs: increased serum and urine amylase, increase WBC count, increased BR if obstructed
  71. Pattern of acute vs. chronic pancreatitis:
    • Acute: normal in less severe cases; enlarged and hypoechoic due to edema, lt PE, dialated pancreatic duct >2mm
    • Chronic: Hyperechoic die to fibrous tissue deposition, small, calcifications, tortuous ducts
  72. Symptoms and labs associated with chronic pancreatitis:
    • Mild epigastric pain, back pain, 10% develope diabetes
    • Labs: decreased serum and urine amylase
  73. Most common cystic mass of the pancreas
    Pancreatic pseudocyst
  74. Symptoms and labs associated with pancreatic pseudocyst:
    • Pain, fever, ileus (2-3 weeks after episode), nausea, vommiting, palpable mass
    • Labs: increased amylase, increased ALP if obstructed
  75. Pseudocyst sonographic pattern:
    Unilocular, irregular boarders, 1-10cm, most common location= tail
  76. Most common neoplasm of the pancreas:
    Pancreatic CA
  77. Lab values associated with pancreatic cancer:
    Increased ALK Phos x4, increased total BR (increased direct BR if obstruction)
  78. Courvosier's sign:
    Enlarged GB due to neoplasm distal to cystic duct (Pancreatic CA in the head of the panc)
  79. Islet cell tumor
    • Most frequent= insulinoma (90% benign)
    • Symptoms: hyperglycemia, hyperinsulinemia
    • Sonograhic pattern: hypoechoic mass in body/tail with well defined borders

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