CH 8 Pediatric Pancreas

Question 1

Pancreas

Answer 1

retroperitoneal structure. functions as an endocrine and exocrine gland.

Endocrine function: secrete insulin via the islets of langerhans.

Exocrine function: secrete trypsin, lipase and amylase.

Question 2

Pancreas location

Answer 2

Pancreas lies between the splenic hilum and the duodenal loop. the GDA is anterolateral to the pancreatic head and the CBD is posterolateral to the pancreatic head. The SMA/SMV are posterior to the neck of the pancreas and anterior to the uncinate process. the splenic artery courses along the superior border of the pancreas and the splenic vein is posterior.

Question 3

Duct of Wirsung

Answer 3

main pancreatic duct.
courses through the pancreas and joins the CBD to form the ampulla of Vater which empties into the 2nd portion of the duodenum.

Question 4

Duct of santorini

Answer 4

accessory pancreatic duct, empties into the duodenum, proximal to the ampulla of Vater.

Question 5

*Pancreas divisum

Answer 5

occurs when the ventral and dorsal pancreatic buds do not fuse and each maintains a separate duct. This results in a smaller duct of santorini which may cause pancreatitis due to inadequate pancreatic enzyme drainage.

Question 6

Pancreatic cysts

Answer 6

true pancreatic cysts are rare. They are associated with ADPKD, von hippel - lindau and cystic fibrosis.

congenital cysts of the pancreas are caused by anomalous development of the pancreatic ducts.

Question 7

Annular pancreas

Answer 7

ventral segment of the developing pancrease encircles the duodenum and forms a ring of pancreatic tissue causing and obstruction of the gastric outlet. (2nd most common panc anomaly)

more common in males

Question 8

Annular pancreas associated with congenital disorders:

Answer 8

Down’s syndrome, TEF (tracheoesophageal fistula), intestinal atresia and pancreas divisum.

Question 9

Ectopic pancreas

Answer 9

lies in the submucosal position and occurs around the antrum of the stomach.

associated with: VATER syndrome, gut malrotation, and duodenal atresia.

Question 10

Nesidioblastosis

Answer 10

persistence of the fetal state of the pancreas.
Nesidioblast secrete insulin.
babies present with HYPOglycemia

Question 11

Effect of cystic fibrosis on pancreas

Answer 11

85% of children with cystic fibrosis have pancreatic insufficiency, which leads to steatorrhea (fat in feces) and malabsorption. Ducts become dilated and cause small cysts and fibrosis of pancreas.

*thickened mucus lines pancratic, bronchial, and biliary ducts.

obstruction and distention lead to: degeneration, atrophy, insufficiency, fibrosis, and fatty replacement.

Sono: increase in echogenicity and decrease in size

Question 12

Schwachman syndrome:

Answer 12

causes: pancreatic insufficiency (2nd most common), and fatty infiltrate of pancreas.
sono: normal hyperechoic pancreas

Syndrome includes: metaphyseal chondroplasia (shortening of extremities), metaphyseal widening “cupping” of the ribs and bone marrow hypoplasia, enlarged spleen.

Question 13

Acute pancreatitis

Answer 13

usually due to blunt abdominal trauma or non-accidental injury (child abuse)
can be caused by: mumps, drug toxicity and biliary and pancreatic anomalies.

sono: pancreas appears hypoechoic and edematous
* trauma due to child abuse is the most common cause in children.

Question 14

Pancreatitis symptoms:

Answer 14

constant, severe epigastric or periumbilical pain which radiates to the back and shoulders nd the patient has raised amylase levels.

rest, and oral feedings must be stopped.

Question 15

Chronic pancreatitis

Answer 15

repeated attacks of pancreatitis and is NOT reversible.

sono: pancreas usually small due to fibrosis and appears heterogeneous. calcifications may be present and dilatation of the pancreatic duct and CBD is common.

Question 16

Causes of chronic pancreatitis in children:

Answer 16

autoimmune pancreatitis
hereditary pancreatitis
cystic fibrosis
pancreas divisum
abdominal trauma

Question 17

Vasculature complications from pancreatitis

Answer 17

pancreatic enzymes can erode the vessels or cause thrombosis, hemorrhage, rupture or a pseudoaneurysm.

Question 18

Bowel complications in pancreatitis

Answer 18

bowel perforation may result due to the erosion by the pancreatic enzymes.

Question 19

Pancreatic cysts occur in the following:

Answer 19

pancreatitis
cyst adenoma/adenocarcinoma
ADPKD
cystic fibrosis
congenital
cystic lymphangioma
hydatid disease
pancreaticoblastoma

Question 20

Pancreatic neoplasms:

Answer 20

extremely rare in children. may be solid or cystic.

Question 21

Pancreatic serous cytadenomas

Answer 21

benign neoplasms that arise from the acinar cells of the pancreas. ususally in head or neck of pancreas. if large may cause CBD obstruction.

numerous small cysts with proteinaceous fluid and septa are seen.

Question 22

Pancreatic mucinous cystadenomas

Answer 22

premalignant/malignant, largely occur in the body and tail of the pancreas.
Ovarian - type stroma and are more common in females.

Question 23

Pancreatic pseudocysts

Answer 23

collection of pancreatic fluid and inflammatory exudates encapsulated by fibrous tissue.

*they develop post trauma or are due to inflammatory injury to the pancreas.

most located in body and tail. may be complicated due to hemorrhage or infection.

sono: septations, internal echoes and fluid-debris levels are seen.

Question 24

Solid pancreatic neoplasm:

Answer 24

predominately endocrine.

Insulinomas- benign
Gastronomas- malignant

Adneomcarcinoma’s are the most common malignant neoplasm and similar findings as those in adults.

Question 25

Pancreaticoblastoma

Answer 25

rare solid pancreatic tumor

*associated with Beckwith Wiedemann syndrome.