Ch 12 Pancreas

the pancreas is an ___________ organ except for a small part of the ______

retroperitoneal , head

pancreas is located in the __________, between the ___________ of the _____________ and ____________________

epigastrium

C-loop

duodenum

splenic hilum

portal splenic confluence is __________ to the pancreas

posterior

what forms the portal splenic confluence

joining of splenic vein of SMV

forms the posteromedial border of pancreas

splenic vein

aorta and IVC are ________ to pancreas

posterior

pancreas 4 parts

head, neck, body, tail

most inferior portion of pancreas

head

panc head lies _______ to the IVC

anterior

panc head lies ________to the MPV and caudate lobe

inferior

the SMV crosses anterior to the uncinate process of the head, and ________ to the neck and body

posterior

the ________ forms the anterolateral border of the pancreas head

GDA

use ________ to differentiate between the GDA and CBD

color

IVC, CBD, Ampulla of Vater, GDA, C-Loop are all in contact with the pancreas

head

located between the head and body

neck

lies anterior to the portal splenic confluence/SMV

neck

the SMV is located to the right of the

SMA

if you see the celiac, which way would you move the probe to see the pancreas

inferiorly

splenic vein runs posterior to

body and tail

the posterior wall of the _________ forms the anterior border of the pancreas ______________

stomach

body and tail

lies anterior to the aorta and celiac axis, left renal vein, left adrenal gland, left kidney

body

superior border of the pancreas body and tail

splenic artery

tail lies _______ to left kidney

anterior

lies _____ to left colic flexure and transverse colon

posterior

what are the pancreatic ducts

Wirsung, Santorini, Common Bile

primary pancreatic duct

Duct of Wirsung

duct of Wirsung should measure less than

2mm

duct of Wirsung enters

2nd part of the duodenum at the ampulla of Vater witht the CBD

duct of Santorini is an___________ duct

accessory

duct of Santorini enters duodenum __________ to the ampulla of Vater

2cm proximal

CBD travels ___________ to the 1st portion of the duodenum and head of pancreas to the _____ of the _______________

posterior

right

main pancreatic duct

normal length of pancreas

15cm (rages 12-18cm)

normal AP pancreas measures

less than or equal to 3

pancreas is normally _______ in kids

larger

supplies body and tail of pancreas

splenic artery

supplies the head and part of the duodenum

pancreaticoduodenal arteries

supplies head of the pancreas

GDA

venous drainage is through

branches of splenic vein and SMV

absence of body and tail, with hypertrophy of the head

pancreatic agenesis

failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development

pancreas divisum

results in a shortened duct of Wirsung that drains only the head, not the entire pancreas

pancreas divisum

most common anomaly

ectopic pancreatic tissue

pancreatic tissue can be found in GI tract

ectopic pancreas tissue

ventral part of the head of the pancreas encircles the 2nd portion of the duodenum

annular pancreas

pancreas is both an __________ and _____________ gland

exocrine and endocrine

to secrete pancreatic juices through the ductal system

exocrine function

digests fats

lipase

digests carbs

amylase

digests proteins

carboxypeptidase, trypsin, chymotrypsinogen

digests nucleic acids

nucleases

exocrine function is performed by the

acini cells

pancreas can produce ______ of pancreas juices a day

2L

hormone that stimulates contraction of the GB and secretion of the pancreatic enzymes

CCK

exocrine =

digestive

endocrine =

hormonal

to secrete glucagon's and insulin into the blood via the islets of Langerhans

endocrine function

produce glucagon

alpha cells

produce insulin

beta cells

produce somatostatin

delta cells

Lab tests important for pancreatic disease

amylase, lipase, glucose

a serum amylase level of twice normal can =

acute pancreatitis

amylase is also secreted by the ______ so increased levels are seen with ______ disease

kidneys, renal

lab value more specific for pancreatitis

lipase

both amylase and lipase rise at the same rate, but ________will stay elevated for longer

lipase

increases in acute pancreatitis and carcinoma of the pancreas

lipase

controls the blood sugar level in the body

glucose

increase levels found in diabetes, chronic liver disease, overactivity of endocrine glands

glucose

decreased levels seen with tumors of the islets of Langerhans

glucose

performed to assess damage of the pancreas

lipase

abdominal pain

abnormal lab values

cholecystitis

obstructive jaundice

clinically manifested pancreatitis

indications for pancreas exam

pancreas appears isoechoic or more ________ than liver and spleen

hyperechoic

inflammation of the pancreas, occurs when the pancreas becomes damaged due to increased secretion and blockage of ducts

pancreatitis

inflammation of the pancreas caused by inflamed acini cells leaking enzymes into surrounding pancreatic tissue

acute pancreatitis

Clinical Symptoms:

usually only last for several days

acute, onset severe epigastric pain

elevated blood glucose

amylase rises 6-12 hrs after onset

lipase rises 4-8 hours after onset

leukocytosis

acute pancreatitis

Complications:

necrosis

hemorrhagic pancreatitis

pseudocyst formation

pancreatic phlegmon

splenic vein thrombosis

abscess formation

pancreatic ascites

pancreatitis

cyst surrounded by fibrous tissue that consists of pancreatic enzymes that have leaked from the pancreas

pseudocyst

most common reason for pseudocyst formation in children

abdominal trauma (abuse)

most common complication of a pseudocyst

spontaneous rupture

most common cause of acute pancreatitis

biliary tract disease, gallstones

Causes:

biliary tract disease, gallstones

alcohol abuse

ERCP, trauma

acute pancreatitis

with spontaneous rupture, patient will go into ______ which leads to ______ that has a _______________

shock

peritonitis

50% mortality rate

AKA focal pancreatitis

pancreatic phlegmon

inflammatory mass formed by edema and leakage of pancreatic enzymes

phlegmon

Sonographic findings:

early stages may appear normal

diffusely enlarged, swollen pancreas

hypoechoic

compression of IVC

acute pancreatitis

irreversible, results from recurrent attacks of acute pancreatitis, causing destruction of tissue and structural damage

chronic pancreatitis

Causes:

alcohol abuse

biliary abuse

hyperparathyroidism

chronic pancreatitis

most common cause of chronic pancreatitis

alcohol abuse

Sonographic findings:

small, atrophic, heterogenous pancreas

diffusely hyperechoic

irregular borders

dilated pancreatic duct/CBD

splenic vein thrombosis

chronic pancreatitis

true cysts of the pancreas are

rare

Associated with:

ADPKD

Von-Hippel-Lindahl disease

Cystic Fibrosis

multiple pancreatic cysts

multiple small cysts in the kidney and liver, size of cyst varies

ADPKD

inherited disorder, cysts in many parts of the body

von hippel lindau syndrome

inherited disease, fatty replacement of the pancreas with calcifications

cystic fibrosis

most common cause of hyperechoic pancreas in a child

cystic fibrosis

rare, benign, well-circumscribed tumor with multiple tiny cysts

associated with von hippel lindau

serous cystic tumors

Sonographic findings:

depends on number of cysts

cluster of grape like cysts

if they are small they may appear echogenic

serous cystic tumors

uncommon, has malignant potential, occur in body/tail, elevated CEA

malignant cystic neoplasm/mucinous cystadenoma/mucinous cystadenocarcinoma

______% of mucinous cystic neoplasms occur in body/tail of pancreas

80

either functioning or non functioning

islet cell tumors

functional tumors

insulinoma and gastrinoma