Abdomen Pancreas

The pancreas initially arises from the _______________ as two buds on either side of the developing duodenum

endoderm

The ventral bud forms:

• Pancreatic head

• Uncinate Process

• Main Pancreatic Duct

The Dorsal bud forms:

• Portion of the head

• Neck

• Body

• Tail

• Portion of main pancreatic duct

• Accessory pancreatic duct

True or false: the pancreas is a retroperitoneal organ

True; however a small portion of the tail lies within the peritoneal cavity

True or false: the pancreas doesn’t have a capsule

True

The pancreas is ___(1)______ to the stomach and it located between the _(2)__ loop of the ___(3)______ and the ____(4)______ hilum

1) posterior

2) C

3) Duodenum

4) Splenic

Be able to identify this image taken in a transverse plane

The pancreas sits horizontally in the abdominal cavity so in order to get a long axis image the sonographer must scan in the __________ plane

Transverse

Look over this image

We look for the vessels to find the pancreas

label this image

What are the five sections of the pancreas?

1) Uncinate Process

2) Head

3) Neck

4) Body

5) Tail

What is the uncinate process?

The section of the head of the pancreas that hooks towards the posterior aspect of the abdomen 

• It may or may not wrap around the SMA and SMV all variations are normal

This portion of the pancreas sits within the C loop of the duodenum

Pancreatic head

What occurs posterior to the neck of the pancreas?

The main portal vein confluence

This portion of the pancreas lies posterior to the stomach

Body

label

What are the measurements of the pancreatic Head?

2 - 3.5 cm AP

What are the measurements of the pancreatic neck?

1.5 - 2.5 cm AP

What are the measurements of the pancreatic Body?

2 - 3 cm AP

What are the measurements of the pancreatic tail?

1 - 2 cm

True or false: The pancreas is both an endocrine and exocrine gland

true

What is the difference between endocrine and exocrine glands?

Endocrine glands are ductless and drain directly into bloodstream. Exocrine glands release product into a ductal system

Islets of Langerhans are clusters of cells that carry out the __________ functions of the pancreas

Endocrine

What are the 4 cells that make up the islets of Langerhans

• Alpha 

• Beta

• Delta

• F (AKA: PP - pancreatic polypeptide

____(1)_________ cells produce glucagon which acts on the liver and stimulates the conversion of ____(2)_______ into ____(3)_______ which is then released into the blood stream ___(4)_____ blood glucose levels

1) Alpha cells

2) Glycogen

3) Glucose

4) raising

Which endocrine cell lowers blood sugar levels by producing and releasing stored insulin

Beta cells

Which endocrine cells produce the hormone somatostatin?

Delta Cells

Which hormone acts as an inhibition to other hormones so that if blood sugar levels drop this hormone will be released in increased amounts

Somatostatin

Which endocrine cells produce Pancreatic Polypeptide?

F cells

________________ which inhibits gallbladder contraction and the secretion pancreatic digestive juices

Pancreatic polypeptide

List the cells that make up the Islets of Langerhans and which hormone they are each associated with

• Alpha cells - Glucagon

• Beta Cells - Insulin

• Delta cells - Somatostatin

  • PP or F cells - Pancreatic Polypeptide

Which function of the pancreas is an exocrine function?

It’s involvement in the digestive process

These cells in the pancreas are responsible for exocrine functions

Acinar cells

The enzymes released by the _________ cells are responsible for the breakdown and digestion of fat, carbs, protein and acids

acinar cells

Amylase, lipase, sodium bicarbonate, Trypsin, Chymotripsin, Carboxypeptidase, Nucleases are ______(1)___________ released by __(2)______

1) digestive enzymes

2) Acinar cells

Enzymes, along with pancreatic juices, drain into the ductal system of the pancreas. Microscopic ducts merge along the length of the pancreas, forming the _____________ AKA ______________

Main pancreatic duct AKA duct of wirsung

Most of the population also has an accessory duct AKA _____________

Duct of Santorini

________________ is the most common pancreatic anomaly

Pancreatic Divisum - failure of fusion of the ventral and dorsal pancreatic ducts

What is this image pointing to?

The pancreatic duct

This anomaly is more common in males and has been associated with complete or partial absence of the duodenum

Annular Pancreas

When pancreatic tissue is located in other organs. This anomaly is known as:

Ectopic Pancreatic Tissue

The pancreatic head recieves blood via the:

• Gastroduodenal artery (GDA) & Superior Mesenteric Artery (SMA)

The ___________ further branches into anterior and Posterior Inferior Pancreaticduodenal artery

SMA

The ___________ further branches into anterior & posterior superior pancreaticduodenal artery

gastroduodenal artery (GDA)

The body and tail of the pancreas recieve blood from the:

Splenic artery

__________ has many branches supplying blood as it travels the length of the pancreas superiroly

Splenic artery

Blood is drained from the pancreas body and tail via the:

Splenic vein & eventually SMV

Pancreatic blood drainage is into the:

Portal venous system

pancreas laboratory values: If which two enzymes increase does it mean there is a problem within the pancreas?

Amylase & Lipase

What does Amalyse help digest? What does Lipase help digest?

Amylase = carbs

Lipase = fats

Techniques to implement to try to troubleshoot overlying bowel gas

• have the patient push their belly out

• Ask the patient to take a deep breath

• Give the patient 3 - 4 small glasses of water assuming NPO is not needed

• Turn patient to LLD position

True or false: The normal pancreas should visualize as homogenous with medium to bright echotexture

True

This duct may be visualized and noted if dilated. Typically measures 2mm or less

Main pancreatic duct

What is the yellow arrow pointing to?

Duct of Wirsung

What are the yellow arrows pointing to?

Posterior wall of stomach (BE CAREFUL not to confuse with MPD)

In order to obtain a longitudinal image of the pancreas the probe is positioned in the ___________ scan plane at the level of the _____________

Transverse; xiphoid process

Which round anechoic structures can be visualized within the pancreatic head

Gastroduodenal artery (GDA) & Common Bile Duct (CBD)

Usually within the pancreatic head the gastroduodenal artery is ___(1)________ and the common bile duct is _____(2)______. But, if you are unsure which is which what is an easy solution?

1) anterior

2) posterior

*Turn on color doppler if you are unsure which is which. GDA should appear red

identify all structures

A) left liver lobe

B) gastroduodenal artery

C) common bile duct

D) Main portal confluence

E) Splenic vein

F) SMA

G) IVC

H) Aorta

Which is shown in this image?

a longitudinal view of the CBD entering the pancreatic head. Pancreatic head outlined in orange

The pancreas should be evaluated in both the transverse and sagittal planes. How are sagittal sections of the pancreas evaluated?

by sweeping through the pancreas from right to left

identify the sagittal image.

Red = ?

Blue = ?

Black = ?

Red = MPV

Blue = pancreatic Head

Black = IVC

Label the Sagittal Image

Black = ?

Blue = ?

Red = ?

Black = Pancreatic Neck

Blue = SMV

Red = Uncinate Process

Label the sagittal image

Black = ?

Blue = ?

Red = ?

Yellow = ?

Black = Pancreatic body

Blue = SMA

Red = Celiac trunk

Yellow = Aorta

Where was this image taken from?

Shows sagittal pancreatic body more towards patients left

What is this image showing?

Sagittal pancreatic tail