Pancreas

Anatomy

-retroperitoneal structure located in the anterior pararenal space

-lies horizontally oblique from C-loop of duodenum to spleen hilum

Anatomy Landmarks

-posterior: AO, IVC, SMA, Splenic Vein, Portal Confluence

-celiac axis arises from AO just superior to pancreas body

-stomach, duodenum, trans colon lie anterior and lateral (bowel gas)

Vascular Landmarks

Celiac Axis: superior border (seagull)

Splenic Artery: sup/ant of body and tail

CHA: sup of neck/head

GDA: ant/lat of head; arises from CHA

SMA: post to body

Splenic Vein: post of tail/body from splenic hilum to portal confluence

SMV: post to neck, ant to ucinate

Portal Vein: splenic/SMV join post to neck

Ductal Landmark

CBD: ant to portal vein and lat of hepatic artery; runs through inf/post of portion of head

Congenital Anomalies

Annular Pancreas: pancreas encircles the duodenum; causes duodenal stenosis

Ectopic Pancreatic Tissue: pancreatic tissue found within the wall of the bowel; can develop inflammation/tumors like normal

Pancreas Divisum: Wirsung and Santorini Ducts do not fuse, draining separately into duodenum

Physiology

Exocrine: involves secretion of digestive enzymes into duodenum for digestion and absorption of food

Endocrine: Islets of Langerhans secrete hormone; 3 types of Islet cells

Endocrine Cells

Beta Cells: secrete insulin; stimulates liver to form glycogen

Alpha Cells: secrete glucagon; which releases glucose

Delta Cells: secret somatostatin; inhibits production of insulin and glucagon

Exocrine Enzymes

Pancreatic Juice: thick and alkaline that neutralizes gastric acid from the stomach

Secretin: stimulates liver to make more bile and pancreas to secrete soidum bicarb.

Lipase

Amylase

Trypsin/Chymotrypsin/Carboxypeptidase

Nucleases

Lab Values

Amylase - elevated with pancreatitis, mumps, ischemic bowel disease, and PID (quick to rise and fall)

Lipase - elevated with pancreatitis and pancreatic cancer (longer to fall)

Glucose - elevated with diabetes, liver disease

WBCs - elevated with infection; pancreatitis

ALP - biliary obstruction

Insulin, Glucagon - elevated when Islet cell tumor is functional

Patient Prep

must be NPO

-option:have patient drink water to displace gas in stomach and provide acoustic window

Sonography

Long & Trans: must image head, neck, body, tail, and uncinate process in both

Normal Appearance: isoechoic/slightly hyperechoic to liver; homogeneous

Long Landmarks

Head- IVC

Neck/UP- SMV

Body- AO, Celiac Axis, SMA

Tail- posterior dive of splenic artery and vei