C5: Pancreas Flashcards
What is the panc formed by in fetal development
The ventral and dorsal diverticula of the primitive foregut
The dorsal bud forms which part of the panc
Neck, body and tail
The ventral bud forms which part of the panc
Head and uncinate of the panc
What’s the relationship of the panc to the lesser sac, stomach and L lobe of liver
Posterior
In which retroperitoneal space does the panc lie
Anterior pararenal space
How does the panc appear in thin vs larger patients
Thinner: the head and tail will be more posterior
Larger: those parts more anterior and there located at almost the same depth
What’s the norm measurement of the panc?
Does it shrink w/ age
12-15 cm
Yes
How should the outline of the panc appear
ALWAYS smooth
What’s the relationship of the panc head to the LRV?
Anterior OR superior
What’s the relationship of the panc head to the portal confluence?
Lateral
When does the portal confluence become the MPV
Above the level of the panc…. so MPV is superior to the panc head
What’s the relationship of the panc head to the CHA?
Inferior
What is the uncinate process and whats its relationship to the SMV and SMA
- posteromedial projection of the panc
- posterior to SMV and posterior to SMA if large enough
What’s the relationship of the panc body to the stomach?
Posterior
What’s the relationship of the panc body to the splenic artery and celiac axis?
Inferior
What’s the relationship of the panc tail to the L adrenal gland?
Anterior (think of where the panc and adrenals are located in the retroperitoneal space)
What area of the panc is the most difficult to image
Panc tail
Where are the splenic A and splenic V located in the panc
SA: posterior superior border
SV: posterior inferior border
Where does the panc tail end?
Splenic hilum
Another term for the main panc duct
Where is it located and what duct does it join w/
Duct of Wirsung
Along the length of the panc…. joins the CBD to enter into the duodenum through the Ampulla of Vater
What’s the norm diameter of the panc duct
<2 mm
What’s the name of the accessory panc duct and where does it enter into the duodenum
- duct of santorini
- enters ~2cm proximal to the main panc duct at the minor duodenal papilla
Describe the exocrine functions of the panc
What glands for this part of the panc
- makes up 80% of pan tissue and includes both ductal and acini cells
- several small glands called acinus join together for form acini
What is panc juice composed of?
Digestive enzymes
Water
Bicarbonate
Salts
What enzymes does the panc release
- amylase
- lipase
- sodium bicarbonate: neutralizes hydrochloric acid
What triggers the release of panc juices and hormones
-food in the duodenum
What hormones are released by the duodenum and what are their functions
- Secretin: stimulates production of sodium bicarbonate
2. Cholecystokinin/pancreozymin (CCK): stimulates a inner cells in panc to produce digestive enzymes
Where are the hormones from the panc produced and where are they the most concentrated
Islets of langerhans
The panc tail
What are the 3 types of cells in the panc that release hormones
Describe each
- Alpha:
- 15-20% of cells
- produce glucagon which increases blood sugar levels - Beta
- 60-70%
- produces insulin which lowers blood sugar levels - Delta
- produces somatosatin which inhibits the production os insulin and glucagon
What does a serum amylase lab test look for?
What is the norm value and what can cause them to be elevated
Is it specific for pancreatitis
- levels of amylase in blood stream
- can be elevated if there’s obstruction of a duct or necrosis of tissue
- should be <70 u/dl
- not specific for pancreatitis
What is a lipase lab test?
What is the norm value and what can cause them to be elevated
- increased in inflammatory conditions and some neoplasms
- < 1.5 u/dl
What is a glucose lab test
When would it be increased or decreased
- looks for glucose levels
- increased in diabetes, chronic liver and panc disease, over activity of endocrine glands
- decreased in tumors islets langerhans and hypoglycemia
What does a blood glucose level check for
Fasting blood sugar
What does glucose tolerance check for
-looks at bodies ability to process sugar
What is urine amylase
- will usually be the same as the levels found in the blood
- returns to norm more slowly than blood levels
- elevated for 7-10 days
Where does the panc get its blood supply
-pancreaticoduodenal arteries (branch off the R gastric which is from the AO) and branches of the splenic artery
The anterior and inferior pancreaticoduodenal A supply which areas of the panc
Head and part of duodenum
Which artery supply the panc tail and body
Splenic artery
What is the US appearance of the panc
Homogenous and slightly courser than the liver
-usually isoechoic to the liver or slightly more echogenic in adults… but variable in echogenicity
What should you see to confirm you’re seeing the panc duct and not the pylorus of the stomach
-see a double parallel line w/ panc tissue on both sides
Where is lipase exclusively produced
Panc
