Pancreas Flashcards
(42 cards)
1
Q
Pancreas location
A
- horizontally oblique (across midline of body (in epigastrium
- tail is cephalad & to the left
- head is caudal & to the right
2
Q
Is the pancreas peritoneal?
A
- majority is retroperitoneal
- small portion of the head is within peritoneal space
3
Q
Pancreas size
A
- size decreases with age
- 15 cm long, 1.5 - 3.5 cm thick (thickest at head)
4
Q
Pancreas anatomy
A
head, neck, body, tail, uncinate (underneath)
5
Q
Head of pancreas
A
- cradled in the C-loop of duodenum
- ant. to IVC (sits on it)
- forms hook with uncinate process & panc. neck
- surround splenic portal confluence
6
Q
Where do most pancreatic masses occur?
A
pancreatic head
7
Q
Size of pancreatic head
A
disproportionate size, like a hammer not a candy cane
8
Q
Body of pancreas
A
anterior to aorta/SMA/left renal vein/splenic vein
9
Q
Tail of pancreas
A
- posterior to stomach
- medial to spleen
- anterior to left kidney
10
Q
Uncinate process of pancreas
A
- small, curved tip at pancreas head
- lies anterior to IVC & posterior to SMV
11
Q
Portal confluence
A
SMV and splenic vein
12
Q
Pancreatic ducts
A
- duct of Wirsung
- duct of Santorini
13
Q
Duct of Wirsung
A
- main pancreatic duct
- extending the entire length of the pancreas
- joins the CBD at the ampulla of vater
14
Q
Duct of Santorini
A
- accessory pancreatic duct in pancreatic head
- anterior/superior head
15
Q
Where does the tail of the pancreas point?
A
superiorly
16
Q
Exocrine function
A
- digestion!
- acini cells produce pancreatic juice w/ enzymes
- drain through the duct of wirsung & duct of santorini
17
Q
Enzymes in acini cells
A
- amylase: digests carbs
- lipase: digests fats
- sodium bicarbonate: neutralizes stomach acids
- trypsin, chymotrypsin, carboxypolypeptidase: digests proteins
18
Q
What does the pancreatic juice do?
A
- mix with bile from liver and release into duodenum through the sphincter of Oddi
- chyme in duodenum instigates breakdown of various food parts
19
Q
Endocrine function
A
- hormonal!
- performed by Isles of Langerhans (insulin production)
- released directly into bloodstream
- produces special cells
20
Q
Special cells of endocrine function
A
- alpha: glucagon
- beta: insulin
- delta: somatostatin
21
Q
Glucagon
A
promotes release of glucose by liver directly into bloodstream, which increases bloodsugar
22
Q
Insulin
A
released directly into bloodstream and stimulates body to use up glucagon to produce energy
23
Q
Somatostatin
A
restains insulin & glucose levels
24
Q
Vasculature: arterial supply
A
- gastroduodenal artery & SMA supply head & neck
- splenic artery & SMA supply blood & tail
25
Vasculature: venous drainage
- head & neck drains into portal vein & SMV
- body & tail drains into splenic vein & IMV
26
Vasculature: splenic artery branches
- dorsal pancreatic artery, transverse pancreatic artery, greater pancreatic artery
- gastric arteries
- left gastroepiploic artery
27
Left gastroepiploic artery (LGA)
- part of splenic branches
- runs in greater omentum along the greater curvature of the stomach to anast w/ R gastroepiploic artery
28
Landmarks/branches
- IVC/Aorta
- Celiac axis (splenic artery, GDA)
- SMA
- SMV
- Splenic vein
- Portal veins
- CBD
29
Congenital variants
- agenesis
- pancreas divisum
- ectopic pancreatic tissue
- annular pancreas
- cystic fibrosis
30
Agenesis
- congenital defect
- body & tail do not form
- hypertrophy (enlargement) of pancreatic head
31
Pancreas divisum
- rare
- failure of normal fusion of ducts of Wirsung & Santorini (no communication)
- fusion of dorsal & ventral pancreas buds does not occur
- no communication btwn. ducts
- duct of wirsung is small
- duct of santorini drains majority of panc
32
Why is pancreas divisum difficult for us to diagnose?
dorsal panc duct may be visable but communication with ventral duct may not be visable
33
Ectopic pancreatic tissue
- M/C pancreatic anomaly
- intramural nodules, polyploid w/ central dimple, small (0.5 -2 cm)
- found in stomach, duodenum, small & large bowel
- acinar and ductal elements
- better seen on CT or MRI
34
Annular pancreas
- rare
- head of pancreas surrounds 2nd part of duodenum
- assoc. w/ complete/partial duodenal atresia
- M>F
- can overlap post duodenal wall & form complete ring
- susceptible to any panc diseases
35
What can help prove a duodenum vs. a mass?
peristalsis (muscle contractions)
36
Cystic fibrosis
- autosomal recessive exocrine gland disorder
- organs clogged w/ mucus secreted by exocrine gland
- hyperechoic
- small cysts may be present
- GI tract has thick, irregular folds (donut sign)
37
What are true pancreatic cysts?
- congenital anomalies development of pancreatic duct
- seen w/ Hippel-Lindau disease & ADPKD
- more common in panc head
38
What do true pancreatic cysts look like on a scan?
- well defined, anechoic mass w. post enhancement & smooth borders
- fluid in duct = enzymes
39
Pseudocysts
pathology, not a variant
40
Pancreas sonographic appearance
- echogenicity >/= liver parenchyma
- echotexture - minimally heterogeneous
41
Pancreas plane differentiation
- transverse plane = long axis
- sagittal plane = short axis
- Rt = head/IVD
- Mid = body/aorta
- Lt = tail & Lt. kidney (obscured by stomach)
42
Relationship btwn. biliary system & pancreas
- biliary duct adjacent to the pancreatic head
- mass in pancreas can obstruct biliary tract
- stone in duct (distal) can cause inflammation of pancreas
