Pancreas Flashcards
(102 cards)
1
Q
What structures is the neck of the pancreas anterior to?
A
SMV and PC
2
Q
What structure is the neck of the pancreas inferior to?
A
CHA
3
Q
What structure in the body of the pancreas posterior to?
A
Stomach
4
Q
What structures is the body of the pancreas anterior to? (4)
A
- Aorta
- LRV
- SV
- SMA
5
Q
What structures is the body of the pancreas interior to? (2)
A
- Celiac axis
2. SA
6
Q
What structure is the tail of the pancreas anterior to?
A
Left adrenal gland
7
Q
Is the tail of the pancreas located to the right or left of the aorta?
A
Left
8
Q
Is the splenic artery located on the posterior superior or posterior inferior border of the pancreas tail?
A
Posterior superior border
9
Q
Is the splenic vein located on the posterior superior or posterior inferior border of the pancreas tail?
A
Posterior inferior border
10
Q
Where does the tail of the pancreas extend to?
A
Splenic hilum
11
Q
What is the most difficult area of the pancreas to visualize?
A
Tail
12
Q
Why is the tail of the pancreas the hardest to see?
A
Usually obscured by bowel gas
13
Q
What is the pancreas formed from?
A
Ventral and dorsal diverticula of the primitive foregut
14
Q
What buds originate from the dorsal aspect of the duodenum?
A
Dorsal buds
15
Q
What buds originate from a common diverticula with the primitive CBD?
A
Ventral bud
16
Q
What cavity does the pancreas lye in?
A
Retroperitoneal
17
Q
Does the pancreas have a capsule?
A
No
18
Q
What quadrants does the pancreas lie in?
A
Epigastrium and left hypochondrium
19
Q
What structures are position anterior to the pancreas?
A
Lesser sac, stomach and left lobe of the liver
20
Q
What space does the pancreas lie in?
A
Anterior pararenal space
21
Q
What portion of the duodenum does the pancreas sit in and attach to?
A
Descending “c” shape aspect of the duo
22
Q
A shorter duodenum would cause the pancreas head to be located more anterior or posterior?
A
Anterior
23
Q
A longer duodenum would cause the pancreas head to be located more anterior or posterior?
A
Posterior
24
Q
What position does the pancreas lie?
A
Horizontal oblique but varies with body habitus
25
A thin pt (less retroperitoneal fat) would have the head and tail more what, to the body and neck?
Posterior
26
How does an increased amount of retroperitoneal fat cause the head and tail of the pancreas to move?
More anterior so all parts of the pancreas are at the same length
27
What happens to the pancreas as you age?
Shrinks
28
What is the length of the pancreas?
12-15cm in length
29
How does the pancreas appear in children?
Enlarged
30
How does the pancreas appear in the elderly?
Atrophied to a thin strip of tissue (heavily fibrosed)
31
How should the outline of the pancreas always appear?
Smooth regardless of echogenicity
32
What would be indicative of an abnormality in the pancreas?
If there is focal enlargement
33
List the dimensions of each segment of the pancreas
Head: 2-3cm
Neck: 1.5-2.5cm
Body: 2-3cm
Tail: 1-2cm
34
What are the common shapes that describe the pancreas?
Comma, sausage dumbbell and tadpole shaped
35
How is the head of the pancreas located compared to the duodenum?
Medial to the "C" loop
36
Is the pancreas head located anterior or posterior to the IVC?
Anterior
37
What is the location of the pancreas head in comparison to the LRV?
Anterior or superior
38
What is the located of the pancreas head in comparison to the portal confluence?
Lateral
39
What is the located of the pancreas head in comparison to the PV?
Inferior
40
What is the location of the pancreas head in comparison to the stomach Antrum?
Posterior
41
What is the location of the pancreas head in comparison to the CHA?
Inferior
42
What part of the pancreas head holds the GBD?
Anterolateral
43
What portion of the pancreas head holds the CBD?
Posterolateral
44
What is the uncinate process?
Posteromedial projection of the pancreas head
45
Where is the uncinate located?
Posterior SMV
| If large enough posterior to SMA
46
What is another name for the main pancreatic duct?
Duct of wirsung
47
How long do the duct of wirsung?
Extends the whole length of the pancreas
48
After the main pancreatic duct joins the CBD what does it enter?
Ampulla of vater
49
What should the main pancreatic duct diameter not exceed?
2mm
50
What is the accessory duct called?
Duct of santorini
51
Where does the duct of santorini enter the duodenum?
2cm prox to the main duct at the minor duodenal papilla
52
What % of the pancreatic tissue (ductal and acini) is part of the exocrine system?
80%
53
What small glands join together to form a "grape-like" cluster?
Acinus glands
54
How much pancreatic juice is produced per day?
2L/day
55
What is pancreatic juice composed of?
Digestive enzymes, water, bicarbonate and salts
56
What are some enzymes produced by the pancreas? (3)
1. Amylase
2. Lipase
3. Sodium bicarbonate
57
What is the function of amylase?
Acts on carbohydrates (starches)
58
What is the function of lipase?
Acts on fats
59
What is the function of sodium bicarbonate?
Neutralizes hydrochloric acid
60
What triggers the release of pancreatic juices?
Trigger found in the duo released by hormones (released into blood stream and carried to liver
61
What are 2 hormones released by the duodenum?
1. Secretin
| 2. Pancreozymin/cholecystokinin
62
What is the function of secretin?
Stimulate production of sodium bicarbonate in pancreatic tissue
63
What is the function of pancreozymin/cholecystokinin?
Stimulates Alina's cells to produce digestive enzymes
64
What are the 3 types of endocrine hormones related by the pancreas?
1. Alpha
2. Beta
3. Delta
65
Where are the hormones produced in the pancreas?
Islets of langerhans - more numerous in pancreatic tail
66
Describe the alpha hormone
15-20% of cells
| Increase blood sugar levels by stimulating the liver to convert glycogen to glucose
67
What does alpha hormone produce?
Glucagon
68
Describe the beta hormone
60-70% of cells
Influences body to take up sugar from the bloodstream
Lowers blood sugar levels
69
What does the beta hormone produce?
Insulin
70
What is the function of the delta hormone?
Inhibits production of insulin and glucagon
71
What does the delta hormone produce?
Somatostatin
72
Side notes...under endocrine section....
It is thought that an inhibiting factor is secreted by the same cells that secrete exocrine enzymes
Prevents trypsin and chymotrypsin from auto digesting the protein in cell walls of the pancreas
With injury or dx the inhibiting factors are unable to prevent the activation of proteolytic enzymes
73
What is the function of the enzyme is serum amylase?
Aids in carbohydrate digestion
74
What can cause serum amylase to leak into the tissue spaces and abdomen?
Obstruction of the duct or necrosis of tissue
75
When do levels of serum amylase increase following incident? How long can they persist?
3-6 post incident
| Persist for 24hrs
76
Is serum amylase specific for pancreatitis?
No
77
What are the normal levels of serum amylase?
Less then 70 u/dl
78
When are levels of lipase increased?
In inflammatory conditions and some neoplasms
79
How long can levels of lipase stay elevated for?
Up to 14 days after amylase has dropped
80
What is the normal valve of lipase?
Less then 1.5 u/dl
81
What is the function of the glucose enzyme?
Increases glucose metabolism
82
What enzyme is only secreted from the pancreas?
Lipase
83
What causes an increase of glucose?
Diabetes, chronic liver and pancreatic dx and overactivity of several endocrine glands
84
What causes glucose levels decrease?
Tumours of islets of langerhans and hypoglycemia
85
What are the 2 glucose tests that can be preformed? Describe them
1. Blood glucose- fasting blood sugar (high or low)
| 2. Glucose tolerance- measure body ability to process sugar
86
What 2 ways can the glucose oral test be taken?
1. Oral glucose test- normal is the return to the fasting state within 2 hours
2. Intravenous- normal is a return to the fasting in 1 hour
87
How much urine amylase is in the body?
Parallel levels found in blood
88
Do levels of urine amylase return to normal quicker or slower than serum levels?
Slower
89
When do levels of urine amylase remain elevated? For how long?
Elevated for 7-10days in chronic and acute pancreatitis
90
Can serum amylase be tested and come back normal but urine amylase come back positive?
Yes - since it take the urine amylase longer to diminish
91
Where does the pancreas get it blood supply from?
Pancreaticoduodenal arteries and branches of the splenic artery
92
What part of the pancreas does the anterior and inferior pancreaticoduodenal arteries supply?
Head of the pancreas
| Part of the duodenum
93
What parts of the pancreas does the splenic artery supply?
Body and tail
94
What is patient prep for imaging the pancreas?
NPO 6-12 hours including no gum chewing or smoking
95
What time of day should the exam be scheduled for? Why?
Morning because air is ingested through talking and swallowing
96
Why should the pancreas be one of the first organs scanned?
To avoid gas moving into the epigastric area
97
What structure should you use as a window to visualize the pancreas?
Liver
98
What may help visualize the pancreas head when scanning?
Fluid filled duodenum- ingestion of water through a straw
99
What should be the sonographic appearance of the pancreas?
Homogeneous appearance- can look slightly coarser then the liver
Variable echogenicity depending on age and body habitus
Generally isoechoic to the liver or slightly less echogenic
100
How does the pancreas compare to the liver echogenicity in a child?
Less echogenic
101
What is the sonographic appearance of the pancreatic duct?
Seen as a double parallel line surrounded by pancreatic tissue
102
What structure might mimic the appearance of the main pancreatic duct?
Collapsed pylorus wall may lay across pancreas
