Flashcards in Pancreas Deck (74):
the pancreas is a _______, _________ structure.
the pancreas lies.....
between the duodenal loop and the splenic hilum
the five components of the pancreas include
the head, Uncinate process, neck, body, and tail
what are the two functions of the pancreas?
the exocrine and endocrine
what is the exocrine function?
secretion of trypsin, lipase, and amylase through the ductal system
what is the endocrine function?
this is the non ductal function. it secretes insulin via the islets of Langerhans.
what would be a normal measurement of the pancreas?
AP less than or equal to 3 cm
what supplies the blood to the pancreas?
CA, SMA, and splenic artery
what supplies blood to the head, body and tail of the pancreas?
the splenic artery
the posterior wall of the stomach overlies what?
the anterior border of the pancreatic body and tail
name the two techniques to better image the pancreas
1. place transducer anterior to left lobe in midline and angle inferiorly to avoid air filled stomach and first portion of duodenum that lies anterior to the pancreas.
2. patient in LLD drinks water to fill stomach, then turns RLD which fills the duodenum with water pushing out air and creating an acoustic window for better visualization, especially for the tail.
the head of the pancreas is anterior to what?
the head of the pancreas is medial to what?
CBD is located where in the pancreas?
posterior/ lateral to the pancreatic head
the GDA is located where in the pancreas?
anterior and lateral to the pancreatic head
Where is the SMA and SMV located in relation to the pancreas?
posterior to the neck of the pancreas, but anterior to the Uncinate process
where is the pancreatic tail located?
anterior and medial to the splenic hilum
what is posterior to the bod of the pancreas?
what vessels arise at the superior and inferior borders of the pancreas?
the Celiac axis arises in the superior border, and the SMA arises at the inferior border
what is the first branch, and other branches of the celiac axis?
the first branch is the left gastric, then divides into CHA and splenic artery
what artery could you see at the superior border of the pancreatic body and tail?
the splenic artery
the common hepatic artery becomes what?
the proper hepatic artery and the gastroduodenal arteries
what travels superiorly toward the liver, anterior to the portal vein and left bile duct?
the proper hepatic artery- branch = right gastric artery.
what travels posterior to the first portion of the duodenum and anterior to the head of the pancreas?
where is the SMA located?
inferior to the pancreas, anterior to Uncinate, and anterior to the third portion of the duodenum.
what creates the MPV?
splenic vein, and SMV
where is the SMV located?
to the right of the SMA, anterior to the third portion of the duodenum and Uncinate.
Where does the IMV drain into?
what travels posterior to the first portion of the duodenum and head of the pancreas?
what forms the ampulla of vater
CBD and duct of wirsung. @ the major papilla which is the second portion of the duodenum.
what is located at the minor papilla?
duct of Santorini.
how many sections of the duodenum?
4- 1 and 3 are trans and 2 and 4 are longitudinal.
what is an inflammatory disease producing temporary pancreatic changes?
what are the most common causes of acute pancreatitis?
alcohol abuse- 35%
what are the sonographic findings with acute pancreatitis?
enlarged and hypoechoic.
what are further complications that might happen with acute pancreatitis?
resolution, chronic pancreatitis, or pseudo cyst formation.
what are some complications of pancreatitis?
abscess, pseudo cyst, necrosis, hemorrhage, thrombosis, formation of a pseudoanuerysm.
what is another name for focal pancreatitis? what is this?
phlegmon, an inflammatory mass formed by edema or leakage of pancreatic enzymes.
what is the most common cause of chronic pancreatitis?
alcoholic chronic pancreatitis?
if you see elevation of serum amylase and lipase, what are you thinking?
acute attack of pancreatitis
describe chronic pancreatitis sonographically
small, echogenic, calcifications, duct dilation, possible pseudocyst, PV thrombosis.
what is associated with multiple pancreatic cysts?
von hippel lindau syndrome and PCKD
if you se a hyperechoic pancreas in a child what are you thinking?
cystic fibrosis, this can also cause the gland to atrophy, appear fibrotic, fatty, and have cysts.
what is cystic fibrosis?
a disorder of the exocrine gland. this causes viscous secretions that cause pancreatic dysfunction.
what is associated with cystic fibrosis?
what is the accumulation of pancreatic fluid and necrotic debris?
why do pancreatic pseudocysts form?
to wall of pancreatic secretions to prevent further tissue damage.
what contains high amounts of amylase, lipase, and trypsin?
what is the primary and secondary location of a pseudocyst?
1= pararenal space, 2= lesser sac
what part of the Retroperitoneum is the pancreas located?
anterior pararenal space.
what commonly occurs at the pancreatic tail?
what might you see in relation to the pancreas is a child with a recent abdominal trauma?
what is it called when the duct of Santorini works in place of wirsung?
pancreatic divisum- there is nor duct of wirsung. this can cause inadequate enzyme drainage which may result in pancreatitis.
what is annular pancreas
a congenital anomaly that cause the ventral pancreas to encircle the 2nd portion of the duodenum. "double bubble" sign.
when you have a patient with jaundice and pain what does this point to?
when you see painless jaundice what are you thinking?
what is the holy trio?
conjugated bilirubin, alkaline phosphatase, and GGT.
what lab values are associated with the pancreas?
amylase and lipase.
what does a pancreatic adenocarcinoma look like?
solid hypoechoic mass
what can be elevated with pancreatic adenocarcinoma?
holy trio, amylase, and lipase.
sonographically what do you see with serous cystadenoma?
cluster of grapes appearance, lobulation. when the cysts are really small, it may appear as echogenic. these are benign
what is associated with von hippel lindau?
what pancreatic cystic neoplasm has malignant potential?
mucinous cystic neoplasms.
what does mucinous cystic neoplasms look like?
large multicystic mass with septations and debris
if you had a patient with increase CEA levels and a multicystic panc mass, what would you be thinking?
carcinoembryonic antigen, you would be thinking mucinous cystic neoplasm
what is the first and second most common islet cell tumor?
1= insulinoma ( benign), 2= gastrinoma ( frequently malignant- aka zollinger Ellison syndrome.
insulinomas are associated with what?
weight loss, fainting, hypoglycemic
where are many pancreatic islet cell tumors located?
in the body and tail
what does MEN stand for?
multiple endocrine neoplasia?
what are the two types of MEN?
type 1= wermer syndrome, type 2= sipples syndrome
where might you see MEN?
think endocrine, parathyroid, pancreatic islet cells, pituitary glands, adrenal glands, and thyroid
increased levels of amylase can pertain to what?
pancreatic and kidney dysfunction.
what lab value rises later and persists longer?