Unit 8 Pancreas Physiology and Ultrasound (Zoey)

What type of gland is the pancreas?

Exocrine and Endocrine

What is the Exocrine Function?

-produce pancreatic juices

(2 L pancreatic juice per day)

-acini cells

The acini cells drains though…..

ducts to aid in digestion

What are the pancreatic enzymes?

-lipase

-amylase

-carboxypeptidase

-trypsin

-chymotrypsin

-nucleases

What does Lipase do?

digests fats

What does Amylase do?

digest carbohydrates

What does Carboxypeptidase, Trypsin, and Chymotrypsin do?

digest proteins

What do Nucleases do?

digest nucleic acids

Sodium Bicarbonate

to neutralize gastric acids

What is Chyme?

it’s in the duodenum and stimulates release of hormones that stimulate pancreatic juice formation.

What hormones does chyme stimulate?

-gastrin

-CCK

-Acetylcholine

-secretin

How does pancreatic juices enter the duodenum?

through the Wirsung’s Duct which joins the CBD

Together bile and pancreatic juices enter duodenum from

relaxation of Sphincter of Oddi surrounding Ampulla of Vater

Endocrine Function

-hormonal

-insulin

Islets of Langerhans:

• Alpha - Glucagon:

  • glycogen to glucose ( ^blood sugar)

• Beta - Insulin:

  • glucose to glycogen (v blood sugar)

• Delta - Somatostatin

  • inhibits both insulin and glucagon

Hormones are released into the.

bloodstream

Amylase is increased with

2 X Acute Pancreatitis

^ Chronic Pancreatitis

Amylase is elevated in

-mumps

-ischemic bowel disease

-Pelvic inflammatory disease

Lipase is elevated in

-Acute Pancreatitis

-Pancreatic Carcinoma

Glucose is elevated in:

-severe diabetes

-chronic liver disease

-overactivity of endocrine glands

Glucose decreases in:

tumors in Islets of Langerhans

What is the US patient prep for the Pancreas?

-fasting 6-8 hours

-3-5 MHz transducer

-curved linear array

What is the patient position when scanning the pancreas?

-usually spine

-may need to use decub, obilque, or upright

-push abdomen out

-may need H2O

What should we identify in Long and Trans Planes?

-head

-neck (may combine with body)

-body

-tail

What could you possibly identify while scanning the pancreas?

-pancreatic duct

-GDA

-CBD

Sonography Indications of the Pancreas:

-abdominal pain

-clinically acute or chronic pancreatitis

-abnormal lab values

-cholecystitis

-obstructive jaundice

What should you determine while scanning the pancreas?

-presence of cystic and solid masses

-biliary and ductal dilation

-presence of extrapancreatic masses and fluid collections

Pancreas Normal Echogenicity

-slightly hyperechoic to liver

-hypoechoic to surrounding tissue (retroperitoneal fat)

What are the reasons the pancreas increases echogenicity?

-older and/or diabetic patients

-fatty infiltrate

-fibrous changes

What are the reasons the pancreas is decrease in echogenicity?

-younger patients

-acute pancreatitis

What is the pancreas texture?

-finer than surrounding retroperitoneum

-coarser than liver

-homogenous

What do the borders look like?

-smooth to slightly lobular

-un encapsulated

Pancreatic Duct Measurement:

<2mm

Pancreatic Duct Pitful:

-wall of stomach

-vessel

What organs do we use as windows to visualize the pancreas?

-left lobe liver

-stomach

-colon

Water Technique:

-have patient drink 32 oz water thru a straw while erect or RLD position

-scan in upright position, using stomach as window

-if unable to sit up, scan in decubitus position

Is this the pre or post use of oral contrast agents?

pre

Is this the pre or post use of oral contrast agents?

post

Pre or Post?

Pre

Pre or Post?

post

What is this organ and what plane is it in?

The pancreas in trans

What organ is this and what plane is it in?

The pancreas in long

In the longitudinal scan of pancreas the SMV is _______ to uncinate process and __________ to body of pancreas

anterior; posterior

Where do you not want to measure the pancreas head? And what should you do instead

Don’t want SMV, move laterally or to patients right slighty

What is the pancreatic duct measurement in trans?

<2mm

What should you make sure is there on each side of the pancreatic duct?

pancreatic tissue