T/F? The pancreas is retroperitoneal.
T/F? The pancreas is encapsulated.
Name the five areas of the pancreas.
uncinate process head neck body tail
The pancreas is normally ___ cm in length.
The pancreas head is normally ___ cm or less.
The pancreas neck is situated directly anterior to...
the porto-splenic confluence.
The pancreas neck is normally about ___ mm.
The pancreas body is normally about ___ cm.
The pancreas tail is normally around ___ cm.
Name the two functions of the pancreas.
As part of the exocrine system, the pancreas secretes these through the ductal system.
trypsin, lipase, amylase
How much of the pancreatic tissue is dedicated to exocrine functions?
As part of the endocrine system, the pancreas secretes this via the islets of langerhans.
How much of the pancreatic tissue is dedicated to endocrine functions?
This is a digestive enzyme for carbs, produced by the pancreas, the salivary glands, and the kidneys.
Amylase elevation suggests...
pancreatitis, salivary gland dysfunction, and/or renal disease.
T/F? Lipase levels parallel the amylase levels.
T/F? Lipase levels rise first, and amylase levels rise later but persist longer.
false. AMYLASE levels rise FIRST, and lipase levels rise later and persist longer.
The normal pancreas is ___geneous and ___echoic or ___echoic (when compared to the liver).
homo, iso, hypo
With aging and obesity, the pancreas becomes ___ and may blend into the surrounding fat.
more echogenic; this is REVERSIBLE.
Describe an iffy trick to visualize the pancreas tail.
Have the patient drink water to fill their stomach and create an acoustic window, while supine or RLD.
The anterior border of the pancreas body and tail is overlied by the...
The duodenal loop, except for the ___, encircles the pancreas head.
The pancreas head is ___ to the IVC.
The pancreas head is ___ to the duodenum.
The CBD is ___ to the pancreas head.
The GDA is ___ to the pancreas head.
The SMA and SMV are ___ to the pancreas neck.
The SMA and SMV are ___ to the uncinate process and 3rd part of the duodenum.
The abd aorta runs ___ to the pancreas body.
The celiac axis arises from the aorta ___ to the pancreas.
The CHA proceeds ___ to the right, ___ to the pancreas head.
The splenic artery follows a ___ course along the ___ border of the pancreas body and tail.
The SMA arises from the aorta just ___ to the pancreas body, descending ___ to the uncinate process and the 3rd part of the duodenum.
The splenic vein runs from the splenic hilam along the ___ aspect of the pancreas to join the ___.
The SMV and the splenic vein join ___ to the pancreas neck to form the ___.
posterior; portosplenic confluence
The MPV ascends toward the porta hepatis ___ to the pancreas head.
The CBD travels ___ to the 1st part of the duodenum and the pancreas head to lie to the ___ of the main pancreatic duct and opens into the duodenum at the ___.
posterior, right, ampulla of Vater
The duodenum is divided into ___ portions.
The 1st and 3rd portions of the duodenum are ___.
The 2nd and 4th portions of the duodenum are ___.
The main pancreatic duct is also known as the...
duct of Wirsung.
The pancreatic duct is considered abnormal if it is greater than ___ mm.
Pancreatic duct dilation is typically due to stones within the ___ from chonic pancreatitis or a stone at the ___.
pancreatic duct, ampulla of Vater
The accessory pancreatic duct is also known as the...
duct of Santorini.
The duct of Santorini drains the...
'Agenesis' of the pancreas is used to mean...
a lack of pancreatic body and tail. The remaining head shows compensatory hypertrophy.
T/F? Multiple congenital cysts are associated with adult type polycystic liver disease.
false; *kidney disease
This condition is characterized by viscous secretions and dysfunction of multiple glands, including the pancreas, leading to pancreatic insufficiency.
Sonographically, this presents as a shrunken, fibrous, fatty, cystic pancreas with increased echogenicity.
The condition is from a failure of the dorsal and ventral pancreatic ducts to fuse during embryonic development.
This is the most common variant of pancreatic anatomy.
This results is smaller santorini's ducts draining the body and tail and is associated with pancreatitis.
This is an uncommon congenital anomaly wherein a ring of normal pancreatic tissue encircles the duodenum secondary to the abnormal migration of the ventral pancreas.
This pancreatic condition is frequently diagnosed in infancy because of associated duodenal obstruction.
This is a temporary inflammatory disease of the pancreas, usually caused by biliary tract disease or chronic ETOH abuse.
Sonographically, this can appear as an enlarged hypoechoic gland in the pancreas, ductal dilation, mass effect from phlegmon or hemorrhage, peripancreatic fluid collections, thickening of adjacent fascial planes, and ascites.
Complications of this pancreatic condition include pseudocyst formation, abcsess, panreatic necrosis, hemorrhage, splenic vein thrombosis, and pseudoaneurysm formation.
Focal pancreatitis is most often seen in the ___ and is difficult to differentiate from a ___.
pancreas head, neoplasm
With normal amylase, a pancreatic mass is likelyto represent a ___.
In a pediatric patient, this pancreatic condition is most likely associated with choledochal cysts, cystic fibrosis or hereditary autosomal dominant pancreatitis.
In this condition, the pancreas becomes increasingly hypoenchogenic relative to normal liver and increases size.
This is the most common cystic lesion of the pancreas.
This is an accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum that contains high amounts of amylase, lipase, and trypsin.
These are generally spherical and take 4-6 weeks to enclose by forming a wall composed of collagen and vascular granulation tissue.
Pseudocysts occur in ___% of patients who have had acute pancreatitis.
These are most commonly associated with alcoholic or biliary etiology or after blunt abdominal trauma in children or secondary to pancreatic malignancy.
Sonographically, these appear as a well-defined smooth-walled anechoic pancreatic structure with acoustic enhancements. Debris may occur within it due to hemorrhage or infection.
If a pancreatic pseudocyst ruptures...
acute peritonitis can ensue in the peritoneal cavity.
These clinical findings suggest a pancreatic pseudocyst, but it must be confirmed by u/s.
persistant pain and elevated amylase
If a pancreatic pseudocyst becomes enlarged, it may cause ___ of the stomach, small bowel, colon, or bile ducts, progressing to ___.
obstruction, jaundice and obstructive cholangitis
Pancreatic pseudocysts that persist beyond ___ or grow larger than ___ in diameter may require non-surgical intervention.
6 weeks, 5 cm
This is irreversible destruction to the pancreas due to repeated bouts of pancreatic inflammation.
In this pancreatic condition, the fibrous connective tissue proliferates around the ducts and between the lobules, causing interstitial scarring, leading to an irregular, nodular appearance of the pancreas surface.
Chronic pancreatitis is caused by...
alcoholism* hereditary pancreatitis cystic fibrosis* congenital abnormalities blunt abdominal trauma idiopathic chronic pancreatitis
Sonographically, this appears as a small echogenic pancreas with calcifications, pseudocyst formation, dilated pancreatic and bile ducts, and portal vein thrombosis.
This is a non-encapsulated inflammatory process that spreads along peripancreatic tissue, causing localized areas of diffuse inflammatory edema of soft tissue that may proceed to necrosis and suppuration. "inflamed fluid"
Sonographically, this appears as a hypoechoic pancreas with good through transmission.
___% of patients with pancreatic carcinoma present with lympatic and metastatic spread of the tumor.
Adenocarcinoma presents in the head of the pancreas ___% of the time.
The 5 year survival rate for pancreatic cancer patients is less than ___%.
Sonographically, this appears as a solid hypoechoic mass, usually in the pancreas head, in patients with abd pain and jaundice.
Associated findings with pancreatic cancer include...
bile duct dilation courvoisier's GB painless jaundice dilatd pancreatic duct pancreatitis liver mets ascites lymphadenopathy around the aorta pseudocyst formation
Clinically, patients with this condition present with elevated alk phos and bilirubin. (Amylase may or may not be elevated.)
How is pancreatic cancer treated?
surgery chemotherapy radiation therapy pallative care
If the pancreatic tumor is resectable, what are the two surgical options?
Whipple procedure distal pancreatectomy and splenectomy
The Whipple procedure is performed due to cancer in the pancreatic...
The Whipple procedure is also known as...
What happens in a Whipple procedure?
The head of the pancreas, a portion of the bile duct, the GB and duodenum are removed. The rest of the pancreas and bile duct are sutured back to the intestines to direct secretions back to the gut.
A distal pancreatectomy and splenectomy are performed due to cancer in pancreatic...
body or tail. Also chronic pancreatitis, pancreatic pseudocysts, and injury due to trauma.
What happens in a distal pancreatectomy and splenectomy?
The end of the pancreas is removed, while the head is left in place. If the disease affects the splenic artery or vein, then the spleen in removed, too.
What are the two most common kinds of pancreatic cystic neoplasms?
serous cystadenoma mucinous cystic neoplasm
This is a benign cystic neoplasm of the pancreas.
serous cystadenoma (aka microcystic cystadenoma)
Sonographically, this appears as a 'cluster of grapes' pattern in the pancreas. The masses may be echogenic and appear solid with through transmission.
This is a (potentially) malignant cystic neoplasm of the pancreas.
mucinous cystic neoplasm (aka macrocystic neoplasm)
Sonographically, this appears as a well-defined large multicystic mass in the pancreas in patients with increase CEA lab tests.
mucinous cystic neoplasm
Mucinous cystic neoplasms primarily form in the pancreatic ___ and, because of the potential for malignant transformation, should be ___.
This is an uncommon endocrine tumor usually found in the pancreatic body & tail.
islet cell tumor
This is a small tumor of the pancreas that produces excessive amounts of insulin, more common in women.
T/F? Insulinomas are usually malignant.
false, usually non-cancerous
Sonographically, these appear as a round/oval well-circumscribed hypoechoic mass.
This is the most common type of islet cell tumor.
This is the second most common type of islet cell tumor.
Gastrinoma is also known as...
This is a rare endocrine tumor and commonly present with severe recurrent peptic ulcer disease.
T/F? Gastrinomas are usually non-cancerous.
false, usually malignant
This is a tumor in the pancreas that secretes excess gastrin leading to ulceration in the duodenum, stomach, and small intestine.
Gastrinomas are usually found in the ___ and ___.
duodenum (50-70%) and pancreas (20-40%)
This is a group of heritable syndromes characterized by abherant growth of benign or malignant tumors in a subset of endocrine tissues.
M.E.N. - multiple endocrine neoplasia
A type I MEN tumor involves the...
parathyroid glands, endocrine pancras, and the pituitary.
A type II-A MEN tumor involves...
medullary cancinoma of the thyroid gland, pheochromocytoma and hyperparathyroidism.
A type II-B MEN tumor involves...
medullary carcinoma of the thyroid, multiple neuromas, and pheochromocytoma.
MEN tumors are associated with...
insulinoma gastrinoma medullary thyroid carcinoma pheochroocytoma parathyroid gland hyperplasia pituitary tumors
dilated main pancreatic duct
adult cystic fibrosis
Hypoechoic areas representing areas of fibrosis. Small anechoic areas within pancreas represent small cysts. Tiny echogenic foci with acoustic shadowing represent pancreatic calcification.
ENLARGED HYPOECHOIC GLAND BUT MAY BE NEGATIVE IN MILDER FORMS OF ACUTE PANCREATITIS.
peripancreatic fluid collections,
GENERALLY SPHERICAL AND TAKE 4-6 WEEKS TO ENCLOSE ITSELF BY FORMING A WALL COMPOSED OF COLLAGEN AND VASCULAR GRANULATION TISSUE.
A WELL DEFINED, SMOOTH-WALLED ANECHOIC STRUCTURE WITH ACOUSTIC ENHANCEMENT.
SMALL ECHOGENIC PANCREAS
The tumor itself usually presents as a hypoechoic mass
serous cystadenoma neoplasm
mucinous cystic neoplasm
Islet cell tumors are round or oval and well-circumscribed hypoechoic mass