Penny (Abd.) - Pancreas

What is the pancreas between?

duodenum and spleen

Parts of the pancreas

head, neck, body, tail

What is the posteromedial extension of the head that some people have?

uncinate process

Is pancreas intraperitoneal or retroperitoneal?

retroperitoneal

exocrine function of pancreas

transports digestive juices

endocrine function of pancreas

releases hormones directly into the bloodstream

is the pancreas MORE SO an exocrine or endocrine gland?

exocrine

What are the 3 enzymes the pancreas produces and what do they do?

Amylase - digests carbs and converts starch to sugar

Lipase - digests fats and converts them to fatty acids

Sodium bicarbonate - neutralizes stomach acid

Pancreatic enzymes drain from the pancreas into the..

main pancreatic duct

aka duct of Wirsung

What is the accessory duct of the pancreas called?

Duct of Santorini

What does the minor pancreatic duct/duct of santorini drain into?

the minor duodenal papilla

What does the major pancreatic duct/duct of wirsung drain into?

ampulla of vater

aka hepatopancreatic ampulla

Where does the sphincter of oddi lay?

major duodenal papilla (papilla of Vater)

What controls the opening/closing of the sphincter of oddi?

cholecystokinin

What cells carries out the endocrine functions?

islets of langerhans

What are islet cells composed of?

alpha, beta, delta cells

What do alpha, beta, and delta cells do?

alpha: secrete glucagon

beta: makes insulin

delta: makes somatostatin

What hormones do the islets produce?

insulin and glucagon

What does glucagon promote the release of?

glucose by the liver

which increases blood sugar levels

What does insulin stimulate?

the body to use up glucagon to produce energy

What is the blood supply to the head of the panc?

gastroduodenal artery

What is the blood supply to the body and tail of the panc?

splenic artery and SMA

What 4 veins drain the panc?

- splenic vein

- SMV

- IMV

- portal vein

What is the echogenicity of the pancreas compared to liver and spleen?

more echogenic

what is the echogenicity of the pancreas in peds?

slightly hypoechoic due to less fat

In trans, what are the anterior and posterior anechoic structures near the pancreas?

Anterior: gastroduodenal a

Posterior: cbd

What is the normal size for the panc duct?

2mm or less

What is the normal measurement of the panc head/body?

2-3cm

What should the tail measure?

1-2cm

How can you differentiate the splenic artery and main panc duct? They run parallel

Use color doppler

What is the most common congenital variant of the pancreas?

pancreatic divisum

What is pancreatic divisum?

failure of the two pancreatic ducts to fuse

duct of wirsung is shortened, and the duct of santorini is forced the drain more than usual

What can pancreatic divisum lead to?

acute and chronic pancreatitis

What is annular pancreas?

head of pancreas surrounds the duodenum

What is gallstone pancreatitis associated with?

gallstones and obstruction of the panc duct

What is hemorrhagic pancreatitis associated with?

bleeding around panc

HIGH MORTALITY

What is autoimmune pancreatitis?

a form of chronic pancreatitis, body attacks itself

What is groove pancreatitis?

uncommon form of chronic pancreatitis

- found in the head

- inflammation of CBD + duodenum

What is necrotizing pancreatitis?

- form of acute pancreatitis

- necrosis of pancreas parenchyma

- HIGH MORTALITY

What is interstitial edematous pancreatitis?

- most common form of acute pancreatitis

- inflammation of pancreas parenchyma and surrounding tissue

Define: inflammation of the pancreas due to leakage of pancreatic enzymes. the enzymes can destroy the pancreas tissue

acute pancreatitis

What are 2 common causes of acute pancreatitis?

- alcohol abuse

- biliary tract disease such as stones

What labs rise with acute pancreatitis?

- amylase first

- lipase next

What is the most helpful lab finding for acute pancreatitis?

lipase!!!

What is peripancreatic fluid called?

phlegmon

What can focal pancreatitis look like?

only a certain segment is enlarged, usually hypoechoic

- it may look like a mass!

What is a pancreatic psuedocyst?

With moderate and severe pancreatitis, the body attempts to encapsulate the damaging enzymes that leak from the pancreas, forming a psuedocyst

What's the most common site for a pancreatic psuedocyst?

lesser sac - which is btwn pancreas and stomach

pancreatic psuedocyst appearance

- anechoic mass

- post. enhancement

How will the pancreas appear with diffuse acute pancreatitis?

enlarged, hypoechoic pancreas

What are the 2 most common vascular complications of pancreas?

- thrombosis of splenic vein

- psuedoaneurysm of the splenic artery

What's the most common cause of chronic pancreatitis?

alcohol abuse

Sono appearance of chronic pancreatitis

- heterogenous

- HYPERechoic

- poor margins

- calcifications

- possible biliary duct dilation

- possible psuedocyst

- possible portosplenic vein thrombosis

Can chronic pancreatitis occur in only a segment of the pancreas?

yes

What is the most common primary pancreatic cancer?

Pancreatic adenocarcinoma

aka pancreatic ductal adenocarcinoma

Is pancreatic adenocarcinoma usually found in men or women?

men

What are 4 risk factors for pancreatic carcinoma?

- cigarette smoking

- diabetes mellitus

- chronic pancreatitis

- high fat diet

What is the most common location of pancreatic adenocarcinoma?

head

What can happen if the cancer is located in the head?

- obstruct the CBD

- courvoisier gb

What is it called when obstruction occurs in the panc duct and CBD?

double-duct sign

What surgical procedure do pancreatic adenocarcinoma patients get?

whipple procedure

- aka pancreaticduodenectomy

What does the whipple procedure remove? 4

- head of panc, gb, bile ducts, and prox duodenum

How do microcystic/serous cystadenomas appear?

solid, small, benign

How do macrocystic/mucinous cystadenomas appear?

multilocular, large, malignant

What is it called when mucinous cystadenomas become cancerous?

mucinous cystadenocarcinoma

Where are cystadenocarcinomas most commonly found?

body and tail

What is it called when there is a tumor inside the islet of Langerhans cells? (2)

- islet cell tumors or pancreatic nueroendocrine tumor

What are 2 types of islet cell tumors? which is more common?

- insulinoma and gastrinoma

- insulinoma is more common

What's the difference in appearance from insulinoma vs gastrinoma?

insulinomas = solitary (just one)

gastrinoma = multiple

What can gastrinomas cause?

Zollinger-Ellison syndrome

- excessive secretion of stomach acid that creates peptic ulcers

What can insulinomas cause?

hypoglycemia

What is the whipple triad?

a group of clinical indicators for a functional insulinoma

- hypoglycemia

- low fasting glucose

- relief with intravenous glucose administration

What is the appearance of islet cell tumors?

- small, hypoechoic mass

- may contain calcifications

- may have hypervascularity

What 3 conditions could cause panc cysts?

- Von-hippel Lindau

- Cystic fibrosis

- ADPKD

What also happens during 80% of pancreas transplants?

patients undergo a renal transplant as well

What side of the body is the pancreas and kidney put on?

kidney = left

panc = right

Explain an endocrine bladder drainage

(a type of panc transplant)

- The vasculature of the panc is attached to the common iliacs

- donor duodenum is anastomosed to bladder

- bladder is used to expel panc secretions

2 drawbacks of endocrine bladder drainage

dehydration and bladder irritation

Explain an exocrine enteric drainage

- donor's duodenum is anastomosed to a loop of jejunum

- splenic a and SMA are connected to donor's iliac arteries

- called a Y graft

What is the more common type of panc transplant?

exocrine enteric drainage

Where and how is the enteric exocrine drainage pancreas placed?

RUQ, vertical