Questions on Pancreas                                 Whipple Operation steps                             Pancreas q 21-25

Pancreatic Carcinoma                                    Pancreatitis                                                      Pancreatic trauma

Q26 )  Ideal time for CECT in severe acute pancreatitis is
A. After 72 hours
B. After 48 hours
C. 24 hours
D. At admission

Q27) All are true about pancreatic protocol CT except (AIIMS 2012) 

a) > 90% unresectable lesions picked up by CT

b) Dual phase CT with cuts taken at 40 secs and 70 secs

c) Liver metastasis detected in early arterial phase




26)  a

After 72 hours 

Mild acute pancreatitis 

  1. enlargement of the pancreas with loss of definition of the borders of the pancreas. 
  2.  Thickening of the right or left anterior pararenal fascia 

Severe Acute pancreatitis 

 Main determinant of clinical outcome is the degree of systemic organ disturbance, particularly during the early hours and days after admission to hospital

More than half of all deaths in AP occur within the first 2 weeks of illness  and are usually a consequence
of multiple organ failure

The revised Atlanta Classification 
3  grades of severity of pancreatitis:

Mild AP—characterized by the absence of organ failure or local

Moderately severe AP—defined by the presence of transient organ failure (resolving within 48 hours) or local complications developing in the absence of organ failure

Severe AP—defined by the presence of persistent organ failure
(>48 hours) with or without local complications

Since the diagnosis of acute pancreatitis is usually made on clinical and laboratory findings, an early CT is only recommended when the diagnosis is uncertain, or in case of suspected early complications such as bowel perforation or ischemia.

An early CT may be misleading regarding the morphologic severity of the pancreatitis, because it may underestimate the presence and amount of necrosis.

27) c

Pancreatic protocol CT involves  imaging  at  the  pancreatic  phase (i.e.,  approximately  45  seconds  after  contrast  administration)  and  at  the  portal  venous  phase  (i.e.,  approximately 70  seconds  after  contrast  administration). It is useful for detection of adenocarcinoma of pancreas. 

Metastatic lesions are seen in  the  portal  venous  phase,  because  the  lesions  are  not  typically  well  vascularized.

  Arterial  phase images  are  principally  used  to  distinguish  metastatic  disease from  benign  vascular  lesions,  such  as  hemangiomas,  or  to  better define  the  arterial  anatomy  of  the  liver.

Non contrast phase used for 

Evaluation  of  pancreatic calcifications  and  allows  localization  of  the  precise  levels  for imaging  on  the  post contrast  study. 

Early arterial phase 

Evaluation  of  pancreatic  vasculature  without  interference  from  venous  opacification. 

Late Arterial Phase

 Distinguish pancreatic  neoplasms  from  adjacent  normal   pancreatic  tissue It  also  is useful  to  evaluate  hypervascular  liver  metastases  as  seen  in patients  with  neuroendocrine  tumors   of  the  pancreas. 

Portal Phase

Evaluate  for  hypovascular  liver  metastases 

Ref Blumgart 

What our members think
Don`t copy text!