Branch of splenic artery that supplies the tail of the pancreas
caudal pancreatic artery
Tapered end of the pancreas that lies in the left hypochondrium near the hilus of the spleen and upper pole of the left kidney
tail of the pancreas
Junction of the splenic and main portal vein; posterior border of the body of the pancreas
portal-splenic confluence
Help supply blood to the pancreas along with the splenic artery
pancreaticoduodenal arteries
Lies in the midepigastrium anterior to the superior mesenteric artery and vein, aorta, and inferior vena cava
body of the pancreas
Forms the lateral border of the head of the pancreas
C-loop of duodenum
Small area of the pancreas between the head and the body; anterior to the superior mesenteric vein
neck of the pancreas
Lies posterior to the neck or body of the pancreas and anterior to the uncinate process of the gland
superior mesenteric vein
Forms the right superior border of the body and head of the pancreas and gives rise to the gastroduodenal artery
common hepatic artery
Largest duct of the pancreas that trains the tail, body, and head of the gland; it joins the common bile duct to enter the duodenum through the ampulla of Vater
duct of Wirsung
Lies in the C-loop of the duodenum; the gastroduodenal artery is the anterolateral border, and the common bile duct is the posterolateral border
head of the pancreas
Serves as the posterior border to the body of the pancreas
superior mesenteric artery
Small accessory duct of the pancreas found in the head of the gland
duct of Santorini
Branch of the splenic artery that supplies the body of the pancreas
dorsal pancreatic artery
Small, curved tip of the pancreatic head that lies posterior to the superior mesenteric vein
uncinate process
The kind of pancreatic function that involves the production of the hormone insulin
endocrine
Portion of the pancreas that has an endocrine function and produces insulin, glucagon, and somatostatin
islets of Langerhans
Stimulates the liver to convert the glycogen to glucose; produced by alpha cells
glucagons
The kind of pancreatic function that involves the production and digestion of pancreatic juice
exocrine
Pancreatic enzyme that is elevated during pancreatitis
serum amylase
Cells that perform exocrine function
acini cells
Hormone that causes glycogen formation from glucose in the liver and that allows circulating glucose to enter tissue cells
insulin
Pancreatic enzyme that breaks down fats; enzyme is elevated in pancreatitis and remains increased longer than amylase
lipase
Enzyme secreted by the pancreas to aid in the digestion of carbohydrates
amylase
Congenital condition in which elevated fat levels cause pancreatitis
hyperlipidemia
Excessive bilirubin in the bloodstream caused by an obstruction of bile from the liver; characterized by a yellow discoloration of the sclera of the eye, skin, and mucous membranes
obstructive jaundice
Malignant neoplasm that arises from the lymphoid tissues
lymphoma
Dilated loops of bowel without peristalsis; associated with various abdominal problems, including pancreatitis, sickle cell crisis, and bowel obstruction
ileus
Space or cavity that contains fluid but has no true endothelial lining membrane
pseudocyst
Inflammation of the pancreas; may be acute or chronic
pancreatitis
“Sterile abscess” collection of pancreatic enzymes that accumulate in the available space in the abdomen, usually in or near the pancreas
pancreatic pseudocyst
Abnormal increase in white blood cells caused by infection
leukocytosis
Enlargement of the gallbladder caused by a slow, progressive obstruction of the distal common bile duct from an external mass, such as adenocarcinoma of the pancreatic head
Courvoisier’s gallbladder
Elevated levels of calcium in the blood
hypercalcemia
Fluid accumulation caused by a rupture of a pancreatic pseudocyst into the abdomen; free-floating pancreatic enzymes are very dangerous to surrounding structures
pancreatic ascites
Hereditary disease that causes excessive production of thick mucus by the endocrine glands
cystic fibrosis
The pancreas is located in the _______________ cavity posterior to the stomach, duodenum, and proximal jejunum of the small bowel.
retroperitoneal
The pancreatic gland appears sonographically _______________ to slightly more _______________ than the hepatic parenchyma.
isoechoic, hyperechoic
The major posterior vascular landmarks of the pancreas are the _______________ and _______________.
aorta, IVC
The head of the pancreas lies _______________ to the inferior vena cava.
anterior
The _______________ crosses anterior to the uncinate process of the head of the gland and posterior to the neck and body.
SMV
The tortuous _______________ is the superior border of the pancreas.
splenic artery
The tail of the pancreas is more difficult to image because it lies anterior to the left kidney and posterior to the left _______________ and _______________.
colic flexure, transverse colon
The _______________ receives tributaries from lobules at right angles and enters the medial second part of the duodenum with the common bile duct at the ampulla of Vater.
duct of Wirsung
The blood supply for the pancreas is from the _______________ artery and the _______________ arteries
splenic, pancreaticoduodenal
The _______________ duct crosses the anterior aspect of the portal vein to the right of the proper hepatic artery.
common bile
The portal vein is _______________ to the inferior vena cava.
anterior
The pancreas is both a digestive (_______________) and a hormonal (_______________) gland.
exocrine, endocrine
Failure of the pancreas to furnish sufficient insulin leads to _______________.
diabetes mellitus
Exocrine function is performed by _______________ of the pancreas
acini cells
The _______________ is a muscle surrounding the ampulla of Vater that relaxes to allow pancreatic juice and bile to empty into the duodenum.
sphincter of Oddi
The endocrine function is located in the _______________ in the pancreas.
islets of Lagerhans
The beta cells are most prevalent and produce _______________, a hormone that causes glycogen formation from glucose in the liver.
insulin
Alpha cells produce _______________, a hormone that causes the cells to release glucose to meet the energy needs of the body.
glucagons
Delta cells are the smallest composition of endocrine tissue and produce _______________.
somatostatin
There are specific enzymes of the pancreas that may become altered in pancreatic disease, namely _______________ and _______________.
amylase, lipase
Both amylase and lipase rise at the same rate, but the elevation in _______________ concentration persists for a longer period in pancreatitis.
lipase
_______________ controls the blood sugar level in the body.
glucose
Explain how fat influences the echogenicity of the pancreas on ultrasound.
The parenchymal texture of the pancreas depends on the amount of fat between the lobules and to a lesser extent on the interlobular fibrous tissue. The internal echoes of the pancreas consist of closely spaced elements of the same intensity with uniform distribution throughout the gland. Fat is strongly echogenic.
Name the structures that should be identified as landmarks to locate the pancreas.
SMA and SMV; portal and splenic veins; aorta and IVC; common bile duct; gastroduodenal artery; left renal vein; duodenal bulb; posterior wall of the stomach; pancreatic duct
Describe the water technique used to image the pancreas with ultrasound.
The patient should drink 32-300 mL of fluid through a straw in the erect or the eight lateral decubitus position. The fluid fills the duodenal cap to outline the lateral margin of the head of the pancreas. The upright position allows air to move from the gastric antrum to the fundus of the stomach and causes the upper viscera to move downward for a better sonic window.
When the pancreas is enlarged, the anterior border of the _______________ may depict a slight indentation.
IVC
When the pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts, _______________ occurs.
pancreatitis
An acute attack of pancreatitis is commonly related to _______________ and _______________.
alcoholism, biliary tract disease
The patient with pancreatitis typically presents with moderate to severe tenderness in the _______________ radiating to the _______________.
epigastrium, back
When swelling does occur, the gland is hypoechoic to anechoic and is less echogenic than the liver because of the increased prominence of _______________ and _______________.
lobulations, congested vessels
The pancreatic duct may be obstructed in acute pancreatitis as a result of _______________, _______________, _______________, _______________, and _______________.
inflammation, spasm, edema, papilla swelling, and pseudocyst
Fluid collections around the pancreatic _______________, along the _______________ spaces, withing the _______________ pouch, and around the _______________ may be present in a patient with acute pancreatitis.
bed, pararental, Morison’s, duodenum
Patients with acute pancreatitis may develop complications, such as _______________, _______________, _______________, _______________, and _______________.
pseudocyst, phlegmon, abscess, hemorrhage, duodenal obstruction
Necrosis of the blood vesseels results in the development of hemorrhagic areas referred to as _______________ sign.
Grey Turner’s
An inflammatory process that spreads along fascial pathways, causing localized areas of diffuse inflammatory edema of soft tissue, is known as _______________.
phlegmon
The _______________ become obstructed with a buildup of protein plugs with resultant calcifications along the duct in ______________ pancreatitis.
pancreatic ducts, chronic
Describe how a pseudocyst develops.
The pancreatic enzymes that escape the ductal system cause enzymatic digestion of surrounding tissue and pseudocyst development. The walls of the pseudocyst form in various peritoneal spaces in which escaped pancreatic enzymes are found. The pseudocyst usually presents few symptoms until it becomes large enough to cause pressure on surrounding organs.
The most common location of a pseudocyst is in the _______________, anterior to the pancreas and posterior to the stomach.
lesser sac
A pseudocyst develops when pancreatic _______________ escape from the gland and break down tissue to form a sterile abscess somewhere in the abdomen.
enzymes
The most common primary neoplasm of the pancreas is _______________.
adenocarcinoma
List the clinical findings in a patient with carcinoma of the pancreas.
weight loss, painless jaundice, nausea, vomiting, and changes in stools
The most frequent parapancreatic neoplasm is _______________.
lymphoma
A 45-year-old male presents with midepigastric pain, elevated amylase and lipase levels, and tenderness. Identify the sonographic findings.
Sonographic findings consist of an enlarged, edamatous pancreas–pancreatitis
A patient with known acute pancreatitis presents with continued pain. Describe the sonographic findings.
Findings consist of pancreatitis with hemorrhage. The gland is enlarged and echogenic secondary to freshly clotted blood.
A 56-year-old male with a 1-week history of jaundice and pain has reported a 3-month history of nausea, vomiting, weight loss, and diarrhea. Given this information, what are the sonographic findings?
Findings consist of adenocarcinoma of the pancreas with a dilated common bile duct. The gallbladder is dilated.
