Normal week 8 pancreas

Pancreas location

Anterior pararenal space

What kind of structure is the pancreas

Retroperitoneal structure

Small portion of the pancreatic head is in the peritoneal cavity

How does the pancreas lay

In a horizontal oblique plane, and extends from C loop of duodenum to hilum of spleen

Posterior landmarks of pancreas

Aorta, IVC, SMA, splenic vein, portal confluence

Where does the celiac axis arise from in relation to the pancreas

Arises superior to pancreas body

What organs lay anterior and lateral to pancreas

Stomach, duodenum, transverse colon

Normal size of pancreas

12-18 cm

Duct of wirsung

Primary secretory duct mainly seen in the body

Normal is <3 mm

Duct of Santorini

Secondary secretory duct

Sphincter of oddi

Surrounds CBD and pancreatic ducts as they go into duodenum

Pancreas lies posterior to:

Left liver, stomach, duodenum, transverse colon

Splenic artery in relation to pancreas

Runs superior/anterior border of body and tail

Common hepatic artery in relation to pancreas

Runs along superior border of neck/head

Branches into proper hepatic and gastroduodenal artery

Which vessel runs along the anterior/lateral portion of the pancreatic head

Gastroduodenal artery

Where does the SMA arise in relation to pancreas

Posterior to pancreatic body

Where does the splenic vein run in relation to pancreas

Along posterior porter of pancreatic tail and body from splenic hilum to portal confluence

Where does the SMV run in relation to pancreas

Posterior to the neck and anterior to uncinate process

Portal vein

Splenic vein and SMV join at portal confluence posterior to pancreas neck

Which vessel runs through groove on inferior/posterior portion of pancreatic head

Common bile duct

CBD joins the pancreatic ducts at:

Ampulla of Vater

Is the pancreas endocrine or exocrine

Has both endocrine and exocrine functions

Pancreas primary function

EXOCRINE

Secretion of digestive enzymes into duodenum via ampulla of vater

Pancreatic juice aka

Digestive enzymes released by pancreas

Pancreatic juice

Thick and alkaline

Neutralize gastric acid

What makes pancreatic juice alkaline

High levels of sodium bicarbonate

The more pancreatic juice that is secreted;

The more alkaline it becomes

Secretin

Secreted by duodenum

Stimulates liver to produce more bile, and pancreas’s to secrete sodium bicarbonate

Hormones secreted by duodenum

Secretin

Gastrin

Cholecystokinin

Acetylcholine

Lipase

Digest fats

When is lipase elevated

Acute pancreatitis and pancreatic carcinome

Amylase

Digests carbohydrates

When will amylase be elevated

Acute pancreatitis, mumps, ischemic bowel, or PID

What enzymes digest proteins

Trypsin, chymotrypsin, carboxypeptidase

Nucleases

Digest nucleic acids

Islets of langerhans

Secrete hormones involved in endocrine function of pancreas

Three types of islet cells

Beta cells, alpha cells, delta cells

Most numerous type of islet cell

Beta cells

Beta cells

Secrete insulin

What does insulin do

Stimulates liver to form glycogen from glucose

Also stimulates certain cells to take up more glucose from blood stream

Net effect of insulin

Decrease levels of glucose in blood

Alpha cells

Secrete glucagon

What does glucagon do

Stimulates cells to release glucose to meet energy of body

Stimulate liver to break down glycogen to glucose for use

Net effect of glucagon

Increase glucose levels in bloodstream

Delta cells

Secrete somatostatin

Inhibits production of both insulin and glucagon

Helps keep glucose levels in blood from making large swings

Which enzyme is quick to rise and quick to fall

Amylase

Which enzyme is quick to rise but slow to fall

Lipase

When is glucose elevated

With severe diabetes, chronic liver disease, overactive endocrine glands

When are white blood cells elevated

In presence of infection

When is alkaline phosphatase elevated

When mass in pancreas causes biliary obstruction

When is insulin/glucagon elevated

When islet cells tumor is functional (insulinoma, glucagonoma)

Annular pancreas

Pancreas encircles duodenum

Thought to occur during rotation of the ventral bud to meet the dorsal bud

May cause duodenal stenosis

Ectopic pancreas tissue

Pancreatic tissue found within the wall of the bowel

Functioning tissue which can develop inflammation or tumors just like the normal pancreas

Pancreas divisum

Occurs in about 10% of population

The duct of wirsung and the duct of Santorini do not fuse, and each drain separately into the duodenum

Patient prep

NPO for 8-12 hours

Transducer

Curvilinear 3.5-5 MHz for adults

Patient position

Supine

If unable to visualize, have patient sit up

Technique for visualization

If pancreas is extremely difficult to visualize, have patient drink at least 12-16 oz of water

Provides acoustic window

Normal echogenicity

Typically isoechoic or slightly hyperechoic compared to liver

Texture of pancreas

Finer than liver, generally homogeneous

What should be evaluated for pancreas

Size, shape, texture, contour, and lie of the organ

What view of the pancreas Is the transverse plane

Long view

What view of pancreas is the long plane

Transverse view

Trans pancreas superior

See mostly tail

Often see splenic artery arising from Celiac axis

Trans pancreas mid

See more body

Splenic vein posterior to pancreas

Trans pancreas inferior

See Neck and head surrounding portal confluence on 3 sides

Trans pancreas (entire organ)

rotate probe slightly counter clockwise

Long pancreas head landmark

IVC

Long pancreas neck landmark

Superior mesenteric vein

Long pancreas body landmark

Aorta, celiac axis, SMA

Long pancreas tail landmark

Just past posterior dive of splenic artery and vein