A & P Flashcards
_________ & _________ Are primary imaging modality.
CT and MRI
Location of the pancreas?
Retroperitoneum
Anterior pararenal space
Posterior to the lesser sac
What is a technical challenge of scanning the pancreas?
If there is dilated loops of bowel without peristalsis/a blockage in the bowl…this is called Ileus
The pancreas is a _________ gland bounded anteriorly by the _________ and _________ and posteriorly by the _________ and _________.
Retroperitoneal
Stomach and duodenum
AO and IVC
It is located deep in the _________ and _________ behind the lesser omental sac.
Epigastric
Left hypochondrium
The pancreas is generally found in a _________ line, extending from the concavity of the duodenum to the hilum of the spleen.
Horizontal - oblique
Approximate size of the pancreas?
12 cm long x 2 cm thick
This gland is divided into 3 major areas:
Head
Neck/body
Tail
The head of the pancreas is anterior to the _________ and _________, inferior to the _________ lobe of the liver and the _________, and lateral to the second portion of the _________.
IVC and left renal vein
Caudate and PV
Duodenum
It lies in the “_________” of the duodenum.
Lap
The _________ crosses anterior to the uncinate process of the head of the gland and posterior to the neck and body of the pancreas.
Superior mesenteric vein
The _________ is the small, curved tip at the end of the head of the pancreas.
Uncinate process
The uncinate process lies _________ to the IVC and _________ to the SMV.
Anterior
Posterior
The _________ passes through a groove posterior to the pancreatic head, and the _________ artery serves as the anterolateral border.
CBD
GDA
The neck is found directly anterior to the _________ or _________.
Portal-splenic confluence or SMV
The portal vein is formed posterior to the neck by the junction of the _________ and _________.
SMV and splenic vein
The body is the _________ part of the gland and lies posterior to the _________ and anterior to the origin of the _________.
Largest
Stomach
PV
It rests _________ to the AO, the origin of the SMA, the left renal vessels, the left adrenal glands, and the left kidney.
Anteriorly
The tortuous _________ is usually the superior border of the pancreatic body.
Splenic artery
The _________ courses to the posteromedial surface of the pancreas to join the main PV.
Splenic vein
The tail of the pancreas lies anterior to the _________, close to the _________ and left colic flexure.
Left kidney
Spleen
The splenic vein forms the _________ border, the stomach forms the _________ border.
Posterior
Superoanterior
_________ Is the primary duct extending the entire length of the gland.
Wirsung’s Duct
Wirsung’s duct receives tributaries from lobules at right angle and enters the medial second part of the _________ with the CBD at the _________. This is all guarded by the _________.
Duodenum
Ampulla of Vater
Sphincter of Oddi
_________ Is a secondary duct that drains the upper anterior head. It enters the duodenum at the minor papilla approximately _________ proximal to the Vater’s ampulla.
Santorini’s duct
2 cm
Which duct is smaller: Wirsung’s or Santorini’s?
Santorini’s
The normal length range is _________ cm. The head is the _________, measuring _________ cm. The neck is _________ cm. The body is _________ cm. The tail is _________ cm.
12-18 cm
Thickest, 2-3 cm
1.5-2.5 cm
2-2.5 cm
1-2 cm
Pancreas is _________ echogenic than the liver and _________ in echogenicity of the spleen depending on its texture.
More
Varies
The pancreas echotexture is _________.
Homogeneous
The surface of the pancreas is _________ to _________ (islets of langerhans).
Smooth to slightly lobular
Blood supply is from which 2 arteries?
Splenic
Pancreaticoduodenal
Venous drainage is through the tributaries of the _________ and the _________.
Splenic vein
SMV
The _________ originates from the anterior ABD AO and serves as the superior border of the pancreas.
Celiac axis
The Celia axis hives rise to what 3 branches?
Left gastric artery
Common hepatic artery
Splenic artery
The _________ arises from the celiac artery and runs along the superior margin of the gland, slightly anterior and posterior, to follow its vein.
Splenic artery
The _________ is seen in 30% of patients as it travels a short distance along the anterior aspect of the head just to the right of the neck before it divides into the superior pancreaticoduodenal branches.
GDA
The _________ arises from the AO inferior to the celiac axis and posterior to the lower portion of the body of the pancreas.
SMA
_________ Tissue is the most common anomaly.
Ectopic pancreatic
Variant
Ectopic pancreatic tissue is found in the form of _________ in various places in the _________ tract.
Intramural nodules
GI
What may develop within the ectopic pancreatic tissue?
Acute pancreatitis
An _________ pancreas is another CONGENITAL abnormality.
Annular
Variant
What is annular pancreas?
The head of the pancreas encircles the duodenum
May cause obstruction
More common in males
What is pancreatic divisum?
Failure of fusion of the ducts
Unable to accurately diagnosis with US
Variant
The pancreas is an _________ and _________ gland.
Exocrine and endocrine
Small glands within the EXOCRINE gland are called?
Acini
What enzymes are found within the EXOCRINE functioning of the pancreas?
Lipase
Amylase
Trypsin, chymotrypainogen, carbonxypeptidase
Nucleases
Digestive action for lipase?
Deals with fats
May persist for a longer time than other exocrine enzymes
Digestive action for amylase?
Deals with carbohydrates
Digestive actions for Trypsin, chymotrypainogen, carbonxypeptidase?
Deals with proteins
Digestive action for nucleases?
Deals with nucleic acids
The ENDOCRINE function is represented by?
The islets of langerhans
Regulation of pancreatic secretions are _________.
Complex
_________ Is the most important agent which is produced in the duodenum.
Secretin
The main hormones produced by the ENDOCRINE portion includes _________ and _________.
Insulin and glucagon
What are the 3 pancreatic ENDOCRINE hormones?
Insulin
Glucagon
Somatostatin
For insulin, what is the cell type and action?
Beta
Glucose to glycogen
For glucagon, what is the cell type and action?
Alpha
Glycogen to glucose
For somatostatin, what is the cell type and action?
Delta
Alpha and beta inhibitor
_________ Controls the blood sugar levels in the body.
Glucose
Tumors of the islets of langerhans may have an increase or decrease of blood sugar levels?
Decrease
An increase in blood sugar levels may be found what 3 diseases?
Severe diabetes
Chronic liver disease
Overactivity of endocrine glands
Lab values for pancreatitis:
Elevated serum amylase
Elevated urine amylase
Elevated serum lipase - for a longer time
_________ Is the most difficult ABD organ to image.
Pancreas
Patient should fast _________ hrs before getting pancreas scanned so stomach is empty and GB and ducts can be seen too.
6-8
Fasting causes less _________
Bowel gas
Clinical symptoms for scanning the pancreas?
Severe epigastric pain ABD distention Abn lab values Unexplained weight loss Nausea & vomiting
What parts of the pancreas should be identified and in what planes?
Head, neck, body, and tail in long & trans
What are we evaluating when scanning the pancreas?
Shape
Contour
Lie
Texture (compare with characteristics in liver)
What technique can be used to fill the stomach for better visualization of the pancreatic area?
Water or fluid technique
32-300 ml of water through a straw in an upright position
The texture depends on the amount of …
Fat between the lobules
Internal echoes of the pancreas consist of _________ and _________ spaced elements of _________ intensity.
Regularly and closely
Uniform
The pancreas is either as dense or more dense than the _________.
Liver
_________ Increases with age.
Echogenicity
The head is located to the right of the _________.
SMV
The _________ is posterior to the head.
IVC
The _________ is the anterior lateral border of the head.
GDA
The _________ is lateral to the GDA by the head.
CBD
The _________ is cranial to the head.
PV
The _________ is directly posterior to the SMV by the head.
Uncinate process
The head measurement is _________.
Less than or equal to 3 cm
The neck is directly anterior to the _________.
SMV
The _________ is formed behind the neck.
PV
The neck measurement is _________.
Less than or equal to 2.5 cm
The body is the _________ section of the pancreas.
Largest
The body is anterior to the _________.
SMA
The anterior border of the body is the posterior wall of the antrum of the _________.
Stomach
The right lateral border of the body is the _________.
Neck
The _________ courses along the posterior surface of the body.
SV
The _________ begins to the left lateral margin.
Tail
The body measurement is _________.
Less than or equal to 2.5 cm
The _________ is the most difficult section of the pancreas to image.
Tail
The tail begins to the left of the left lateral vertebral body and extends to the _________.
Splenic hilum
The _________ courses along the posterior surface of the body and the tail.
SV
The tail is anterior to the _________, posterior to the _________, and medial to the _________. List organs.
Left kidney
Stomach
Spleen
The tail measurement is _________.
Less than or equal to 2 cm
Common shapes the pancreas is called?
Sausage Dumbbell Tadpole Comma Worm
The _________ duct is seen more in the body than the tail.
Pancreatic
The pancreatic duct appears as…
An echogenic line or lucency bordered by 2 echogenic lines
The pancreatic duct measures _________.
2 mm
The pancreatic duct decreases toward the _________.
Tail
Do not confuse the pancreatic duct with _________.
Vascular structures
