C5: Pancreas

Question 1

What is the panc formed by in fetal development

Answer 1

The ventral and dorsal diverticula of the primitive foregut

Question 2

The dorsal bud forms which part of the panc

Answer 2

Neck, body and tail

Question 3

The ventral bud forms which part of the panc

Answer 3

Head and uncinate of the panc

Question 4

What’s the relationship of the panc to the lesser sac, stomach and L lobe of liver

Answer 4

Posterior

Question 5

In which retroperitoneal space does the panc lie

Answer 5

Anterior pararenal space

Question 6

How does the panc appear in thin vs larger patients

Answer 6

Thinner: the head and tail will be more posterior

Larger: those parts more anterior and there located at almost the same depth

Question 7

What’s the norm measurement of the panc?

Does it shrink w/ age

Answer 7

12-15 cm

Yes

Question 8

How should the outline of the panc appear

Answer 8

ALWAYS smooth

Question 9

What’s the relationship of the panc head to the LRV?

Answer 9

Anterior OR superior

Question 10

What’s the relationship of the panc head to the portal confluence?

Answer 10

Lateral

Question 11

When does the portal confluence become the MPV

Answer 11

Above the level of the panc…. so MPV is superior to the panc head

Question 12

What’s the relationship of the panc head to the CHA?

Answer 12

Inferior

Question 13

What is the uncinate process and whats its relationship to the SMV and SMA

Answer 13

• posteromedial projection of the panc

- posterior to SMV and posterior to SMA if large enough

Question 14

What’s the relationship of the panc body to the stomach?

Answer 14

Posterior

Question 15

What’s the relationship of the panc body to the splenic artery and celiac axis?

Answer 15

Inferior

Question 16

What’s the relationship of the panc tail to the L adrenal gland?

Answer 16

Anterior (think of where the panc and adrenals are located in the retroperitoneal space)

Question 17

What area of the panc is the most difficult to image

Answer 17

Panc tail

Question 18

Where are the splenic A and splenic V located in the panc

Answer 18

SA: posterior superior border
SV: posterior inferior border

Question 19

Where does the panc tail end?

Answer 19

Splenic hilum

Question 20

Another term for the main panc duct

Where is it located and what duct does it join w/

Answer 20

Duct of Wirsung

Along the length of the panc…. joins the CBD to enter into the duodenum through the Ampulla of Vater

Question 21

What’s the norm diameter of the panc duct

Answer 21

<2 mm

Question 22

What’s the name of the accessory panc duct and where does it enter into the duodenum

Answer 22

• duct of santorini

- enters ~2cm proximal to the main panc duct at the minor duodenal papilla

Question 23

Describe the exocrine functions of the panc

What glands for this part of the panc

Answer 23

• makes up 80% of pan tissue and includes both ductal and acini cells
• several small glands called acinus join together for form acini

Question 24

What is panc juice composed of?

Answer 24

Digestive enzymes
Water
Bicarbonate
Salts

Question 25

What enzymes does the panc release

Answer 25

• amylase
• lipase
• sodium bicarbonate: neutralizes hydrochloric acid

Question 26

What triggers the release of panc juices and hormones

Answer 26

-food in the duodenum

Question 27

What hormones are released by the duodenum and what are their functions

Answer 27

1. Secretin: stimulates production of sodium bicarbonate

2. Cholecystokinin/pancreozymin (CCK): stimulates a inner cells in panc to produce digestive enzymes

Question 28

Where are the hormones from the panc produced and where are they the most concentrated

Answer 28

Islets of langerhans

The panc tail

Question 29

What are the 3 types of cells in the panc that release hormones

Describe each

Answer 29

1. Alpha:
   - 15-20% of cells
   - produce glucagon which increases blood sugar levels
2. Beta
   - 60-70%
   - produces insulin which lowers blood sugar levels
3. Delta
   - produces somatosatin which inhibits the production os insulin and glucagon

Question 30

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

Answer 30

• 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

Question 31

What is a lipase lab test?

What is the norm value and what can cause them to be elevated

Answer 31

• increased in inflammatory conditions and some neoplasms

- < 1.5 u/dl

Question 32

What is a glucose lab test

When would it be increased or decreased

Answer 32

• looks for glucose levels
• increased in diabetes, chronic liver and panc disease, over activity of endocrine glands
• decreased in tumors islets langerhans and hypoglycemia

Question 33

What does a blood glucose level check for

Answer 33

Fasting blood sugar

Question 34

What does glucose tolerance check for

Answer 34

-looks at bodies ability to process sugar

Question 35

What is urine amylase

Answer 35

• 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

Question 36

Where does the panc get its blood supply

Answer 36

-pancreaticoduodenal arteries (branch off the R gastric which is from the AO) and branches of the splenic artery

Question 37

The anterior and inferior pancreaticoduodenal A supply which areas of the panc

Answer 37

Head and part of duodenum

Question 38

Which artery supply the panc tail and body

Answer 38

Splenic artery

Question 39

What is the US appearance of the panc

Answer 39

Homogenous and slightly courser than the liver

-usually isoechoic to the liver or slightly more echogenic in adults… but variable in echogenicity

Question 40

What should you see to confirm you’re seeing the panc duct and not the pylorus of the stomach

Answer 40

-see a double parallel line w/ panc tissue on both sides

Question 41

Where is lipase exclusively produced

Answer 41

Panc