CSA - Pancreas Exam Review

The pancreas is located near the level of the ___ and ___ lumbar bodies

1st and 2nd

A normal pancreas lies _____, and ______

horizontally, obliquely

Has a ___ and ___ architecture.

tan, lobular

Is the pancreas capsulated or non-encapsulated?

non-encapsulated

The pancreas is a _______ organ.

retroperitoneal

The pancreas develops from the ________.

foregut

How much does the pancreas on average weigh?

60-100 g

How much does the panc weigh in females?

85 g

How much does the panc weigh in males?

100 g

The pancreas lies ___ to the stomach, duodenum, and proximal duodenum

posterior

What is the shape of the pancreas?

Upside down U

What is the criteria for the shape of the pancreas? same size ___ and ___, same ___, head is ___, tail is __

head and tail, thickness, larger, larger

In children, the head and tail of the pancreas are the ___ size and are separated by a ______ body.

same, thin

Varies in size due to its ___ and patient ____.

shape, age

Pancreas is ___ in children and increased with ____.

smaller, age

The pancreas is ____ in older patients/old age

decreased

How long does the pancreas measure in length?

12-18 cm

AP Diameter of the Head = ___ - ___ cm

2.5-3.0 cm

AP Diameter of the Neck = ___ cm

2.0

AP Diameter of the Body = ___ - ____ cm

2.0-2.5 cm

AP Diameter of the Tail = ___ - ___ cm

2.0-2.5 cm

The texture of the panc depends on what?

fat between the lobules

How is the pancreas compared to the liver?

Pancreas is either isoechoic or hyperechoic

The echogenicity of the pancreas ____ with age because of?

increases, due to fat deposition or fibrosis

Put these in order of least to most echogenicity: Adults, Older Patients, and Children

Children < Adults < Older Patients

What are the segments of the Pancreas?

Head, Neck, Body, Tail

What portion of the pancreas is not always considered its own portion?

Neck

Head of Panc is the ____ portion in AP Diameter

bulkiest

___ is the most caudal portion of the panc

Head

What is the smallest portion of the panc?

Neck

The neck is directly _____ to the SMV and PSC

anterior

Where is the neck measured?

directly over the SMV

What is the largest section of the pancreas?

Body

The body of the pancreas is _____ to the SMA, Aorta, LRV, and LRA

anterior

Body of panc lies ____ to the ____ of the stomach

posterior, antrum

Splenic artery is ___ and ___ to the body of panc

anterior, superior

Splenic vein courses along the ____ surface of the body

posterior

Right lateral border of body is the ____. Left lateral border is ____.

neck, indefinite

What is the most difficult portion of the panc to scan?

Tail

___ and ___ blend together

Body and tail

Where does the tail begin?

To the left of the lateral border of the aorta

The tail extends to ?

hilum of the spleen

Compared to the body, the tail could be at a ___ level, the ___ level, or an ___ level

higher, same, inferior

The tail is ___ to the stomach

posterior

The tail is __ to the spleen

medial

SV runs long the ___ surface of the tail

posterior

SA runs ____ and ____ to the border of the tail

anterior, superior

What is the main pancreatic duct?

Duct of Wirsung

The Duct of Wirsung extends the ____ length of the pancreas

entire

Where is the Duct of Wirsung mostly seen?

in the body

Where does the Duct of Wirsung enter? Enters the ____ aspect of the ___ portion of the ___ with the ___ at the Ampulla of Vater

medial, 2nd, duodenum, CBD

What is the AP Measurement of the Duct of Wirsung>

2 mm

The Duct of Wirsung is seen as an ______ line bordered by two ____ echogenic lines

anechoic, echogenic

The Duct of Wirsung is seen in approx. _____% of patients

84%

What is the secondary pancreatic duct?

Duct of Santorini

The Duct of Santorini is ___ than the Duct of Wirsung

smaller

The Duct of Santorini drains what?

Upper anterior head

Where does the Duct of Santorini enter? The duodenum at the ___ papilla about ___ cm ___ to the Ampulla of Vater

minor, 2cm, proximal

Blood is supplied to the pancreas from?

branches of the SA, GDA, and SMA

Blood is drained from the pancreas through?

tributaries of the SV and SMV

Pancreas is divided into ___ and ____ components

exocrine, endocrine

Exocrine components constitute ____% of pancreatic tissue

80%

Endocrine components constitute ___% of pancreatic tissue

2%

Exocrine portion is made up of ___ and ___ cells

ductal, acinar

Endocrine portion is made up of ?

Islets of Langerhans

Remaining 12% consists of fibrous stroma that contains ___ ____, ____, and ____.

blood vessels, nerves, and lymphatics

Exocrine pancreas secretes ___ that are carried by ____.

juices (enzymes), ducts

Pancreatic jucies are enzymes that help digest what?

fats, proteins, carbs, and nucleic acids

Pancreatic enzymes aid in digestion of food using what enzymes?

Lipase, Amylase, and Trypsin

Pancreatic juices move through which ducts?

Duct of Wirsung and Duct of Santorini

Endocrine Pancreas is secreted by ?

Islets of Langerhans.

What cells make up the endocrine pancreas?

Alpha, Beta, Delta, Gamma, Epsilon

Alpha cells make up __-__% of pancreatic tissue

15-20%

Beta cells make up __-__% of pancreatic tissue

50-70%

Delta cells make up ___% of pancreatic tissue

5%

Gamma cells make up ___% of pancreatic tissue

<5%

Epsilon cells make up ___% of pancreatic tissue

<1%

Endocrine pancreas is more numerous in the _____ of the pancreas

tail

Endocrine secretions are released directly into the ____.

blood

Endocrine secretions regulate what?

sugar metabolism

Failure to produce adequate amounts of endocrine secretions results in ____.

diabetes

Patient should fast for ___-___ hrs.

6-8 hrs

Pancreas is scanned in what positions?

supine, RAO, LAO, or upright

Pancreatic contour should be _____

smooth

Use a ___-___ MHZ transducer for adults and a ___-___ MHz transducer for pediatrics

3-5, 5-7

Is Chronic Pancreatitis more common in males or females?

Males

Patients may present with that when they have Chronic Pancreatitis?

Chronic abdominal pain, Ileus, vomiting, diabetes, weight loss, nausea, steatorrhea

Lab values/analysis for patients with chronic pancreatitis include: elevated ___ or ____, ___ in feces, and glucose tolerance test is _____

serum amylase or lipase, fat, abnormal

_______, ______ and _____ vein thrombosis can develop of a result of chronic pancreatitis

pseudocysts, portal and splenic

On ultrasound a pancreas with chronic pancreatitis appears:

inhomogeneous and hyperechoic b/c of fatty changes and fibrosis

The site of a pancreas with chronic pancreatitis ____ with stage of disease

varies

contour or outline of pancreas is ____ w/ chronic pancreatitis

irregular

The pancreatic duct is dilated ___-___% b/c of ductal obstruction or stricture

60-90%

Calculi in a pancreas with chronic pancreatitis can be seen in ?

the duct or parenchyma

In a pancreas with chronic pancreatitis the hypoechoic focal masss can be seen due to what?

proliferation of fibrous tissue from inflammatory cells

Pancreatic duct joins the CBD at the ?

Ampulla of Vater

Function of lipase?

breakdown fats to monoglycerides and sometimes glycerides to fatty acids

Amylase function = 

converts carbs to glucose

Trypsin function =

breaks down proteins into amino acids

Function of Beta cells =

produce insulin and turns glucose into glycogen