Ch 12 Pancreas Flashcards
body of the pancreas
Lies in the midepigastrium anterior to the superior mesenteric artery and vein, aorta, and inferior vena cava
caudal pancreatic artery
Branch of splenic artery that supplies the tail of the pancreas
C-loop of the duodenum
Forms the lateral border of the head of the pancreas
Common hepatic artery
Forms the right superior border of the body and head of the pancreas and gives rise to the gastroduodenal artery
dorsal pancreatic artery
Branch of the splenic artery that supplies the body of the pancreas
duct of Santorini
Small accessory duct of the pancreas found in the head of the gland
duct of Wirsung
Largest duct of the pancreas that drains the tail, body, and head of the Gland; it joins the common bile duct to enter the duodenum through the ampulla of Vater
head of the pancreas
Lies in the C- Loop of the duodenum; the gastroduodenal artery is the anterolateral border, and the common bile duct is the posterolateral border
neck of the pancreas
Small area of the pancreas between the head and the body; anterior to the superior mesenteric vein
pancreaticoduodenal artery
Help supply blood to the pancreas along with the splenic artery
portal-splenic confluence
Junction of the splenic and main portal vein; posterior border of the pancreas
superior mesenteric artery
Serves as the posterior border to the body of the pancreas
superior mesenteric vein
Lies posterior to the neck or body of the pancreas and anterior to the uncinate process of the gland
Tail of the pancreas
Tapered end of the pancreas that lies in the left hypochondrium near the hilus of the spleen and upper pole of the left kidney
uncinate
Small, curved tip of the pancreatic head that lies posterior to the superior mesenteric vein
acini cell
Cells that perform exocrine function
amlylase
Enzyme secreted by the pancreas to aid in the digestion of carbohydrates
endocrine
The kind of pancreatic function that involves the production of the hormone insulin
exocrine
The kind of pancreatic function that involves the production and digestion of pancreatic juice
glucagons
Stimulates the liver to convert the glycogen to glucose; produced by alpha cells
insulin
Hormone that cause glycogen formation from glucose in the liver and that allows circulating glucose to enter tissue cells
islets of Langerhans
Portion of the pancreas that has an endocrine function and produces insulin, glucagon, and somatostatin
lipase
Pancreatic enzyme that break down fats; enzyme is elevated in pancreatitis and remains increased longer than amylase
serum amylase
Pancreatic enzyme that is elevated during pancreatitis
Courvoisier’s gallbladder
Enlargement of the gallbladder caused by a slow, progressive obstruction of the distal common bile duct from an external mass such as adenocarcinoma of the pancreatic head
cystic fibrosis
Hereditary disease that causes excessive production of thick mucus by the endocrine glands
hypercalcemia
Elevated levels of calcium in the blood
hyperlipidemia
Congenital condition in which elevated fat levels cause pancreatitis
ileus
Dilated loops of bowel without peristalsis; associated with various abdominal problems, including pancreatitis, sickle cell crisis, and bowel obstruction
leukocytosis
Abnormal increase in white blood cells caused by infections
lymphoma
Malignant neoplasm that arises from the lymphoid tissues
obstructive jaundice
Excessive bilirubin in the bloodstream caused by an obstruction of bile from the liver; characterized by a yellow discoloration of the sclera of the eye, skin, and mucous membranes
pancreatic ascites
Fluid accumulation caused by a rupture of a pancreatic enzymes are very dangerous to surrounding structures
pancreatic pseudocyst
“Sterile abscess” collection of pancreatic enzymes that accumulate in the available space in the abdomen, usually in or near the pancreas
pancreatitis
Inflammation of the pancreas; may be acute or chronic
pseudocyst
Space or cavity that contains fluid but has no true endothelial lining membrane
The pancreas is located in the ____ cavity posterior to the stomach, duodenum and proximal jejunum.
retroperitoneal
The pancreatic gland appears sonographically _____ to slightly more _____ than the hepatic parenchyma
isoechoic, heyerechoic
The major posterior vascular landmarks of the pancreas are the ____ and ____.
aorta, inferior vena cava
The head of the pancreas lies
____ to the inferior vena cava
anterior
The _____ crosses anterior to the uncinate process of the head of the gland and posterior to the neck and body
Superior mesenteric vein
The tortuous ____ is the superior border of the pancreas
splenic artery
The tail of the pancreas is more difficult to image because it lies anterior to the left kidney and posterior to the left _____ and ____.
colic flexure, transverse colon
The _____ receives tributaries from lobules at right angles and enters the medial second part of the duodenum with the common bile duct at the ampulla of Vater
Duct of Wirsung
The blood supply for the pancreas is from the ____ artery and the ____ arteries
Splenic, pancreaticoduodenal
The _____ artery is seen along the anterolateral border of the pancreas as it travels a short arteries
gastroduodenal
The ____ duct crosses the anterior aspect of the portal vein to the right of the proper hepatic artery
common bile
The portal vein is ____ to the inferior vena cava
anterior
The pancreas is both a digestive ____ and a hormonal ____ gland
exocrine, endocrine
Failure of the pancreas to furnish sufficient insulin leads to ____
diabetes mellitus
Exocrine function is performed by _____ of the pancreas
acini cell
The ____ is a muscle surrounding the ampulla of Vater that relaxes to allow pancreatic juice and bile to empty into the duodenum
sphincter of Oddi
The endocrine function is located in the ____ in the
pancreas.
islets of Langerhans
The beta cells are most prevalent and produce ____, a hormone that cause glycogen formation from glucose in the liver
insulin
Alpha cells produce ____, a hormone that causes the cells to release glucose to meet the energy needs of the body.
glucagons
Delta cells are the smallest composition of the endocrine tissue and produce ____
somatostatin
There are specific enzymes of the pancreas that may become altered in pancreatic disease namely, ____ and ___.
amylase, lipase
Both amylase and lipase rise at the same rate, but the elevation in _____ concentration persists for a longer period in pancreatitis
lipase
____ controls the blood sugar level in the body
Glucose
Explain how fat influences the echogenicity of the pancreas on ultrasound
Fat is strongly echogenic, the internal echoes of the pancreas consist of closely spaced elements of the same intensity with uniform distribution throughout the gland. Parenchymal texture of the pancreas depends on the amount of fat between the lobules and to a less extent on the interlobular fibrous tissue
Name the structures that could be identified as landmarks to locate the pancreas
superior mesenteric artery and vein, portal and splenic vein, aorta and inferior vena cava, common bile duct, gastroduodenal artery, left renal vein
Describe the water technique used to image the pancreas with ultrasound
Patient should drink 32 to 3000 ml through a straw in a erect position. Fluid fills the duodenal cap to outline the lateral margin of the head of the pancreas. Upright position allow air to move from the gastric antrum to the fundus of the stomach and cause the upper viscera to move downward for a better sonic window.
When the pancreas is enlarged, the anterior border of the ____ may depict a slight indentation
inferior vena cava
When the pancreas becomes damaged and malfunctions as a result of secretion and blockage of ducts ____ occurs
Pancreatitis
An acute attack of pancreatitis is commonly related to ____ and ____
alcoholism, biliary tract disease
The patient with pancreatitis typically presents with moderate to severe tenderness in the ____ radiating to the ____.
epigastrium, back
When swelling does occur the gland is hypoechoic and is less echogenic than the liver because of the increased prominence of ____ and ____
lobulations, congested vessels
The pancreatic duct may be obstructed in acute pancreatitis as a result ___, ____, ____, ____, and ___.
inflammation, spasm, edema, swelling of the papilla and pseudocyst
Fluid collections around the pancreatic ____, along the ___ spaces, with in the ____ pouch, and around the ____ may be present in a patient with acute pancreatits
Bed, pararenal, Morison’s, duodenum
Patients with acute pancreatitis may develop complications, such as
pseudocyst, phlegmon, abscess, hemorrhage, and duodenal obstruction
Necrosis of the blood vessels results in the development of hemorrhagic areas referred to as ___ signs
Grey’s Turner’s
An inflammatory process that spreads along fascial pathway, causing localized areas of diffuse inflammatory edema of soft tissue, is known as ___
phlegmon
The ____ becomes obstructed with build up of protein plugs with resultant calcification along the duct in ____ pancreatitis
pancreatic ducts, chronic
Describe how a pseudocyst develops
Pancreatic enzymes that escape the ductal system cause enzymatic digestion of surrounding tissue and pseudocyst development. The walls of the pseudocyst form in various potential spaces in which escaped the pancreatic enzymes are found. The pseudocyst usually presents few symptoms until it becomes large enough to cause pressure on surrounding organs
The most common location of a pseudocyst is in the ____, anterior to the pancreas and posterior to the stomach
lesser sac
A pseudocyst develops when pancreatic _____ escape from the gland and break down tissue to form a sterile abscess somewhere in the abdomen
enzymes
The most common primary neoplasm of the pancreas is ____
adenocarcinoma
List clinical findings in a patient with carcinoma of the pancreas
weight loss, painless jaundice, nausea, vomiting, and change is stool
The most frequent parapancreatic neoplasm is ____>
lymphoma
