CH 8 Pediatric Pancreas Flashcards
Pancreas
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.
Pancreas location
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.
Duct of Wirsung
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.
Duct of santorini
accessory pancreatic duct, empties into the duodenum, proximal to the ampulla of Vater.
*Pancreas divisum
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.
Pancreatic cysts
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.
Annular pancreas
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
Annular pancreas associated with congenital disorders:
Down’s syndrome, TEF (tracheoesophageal fistula), intestinal atresia and pancreas divisum.
Ectopic pancreas
lies in the submucosal position and occurs around the antrum of the stomach.
associated with: VATER syndrome, gut malrotation, and duodenal atresia.
Nesidioblastosis
persistence of the fetal state of the pancreas.
Nesidioblast secrete insulin.
babies present with HYPOglycemia
Effect of cystic fibrosis on pancreas
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
Schwachman syndrome:
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.
Acute pancreatitis
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.
Pancreatitis symptoms:
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.
Chronic pancreatitis
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.
Causes of chronic pancreatitis in children:
autoimmune pancreatitis hereditary pancreatitis cystic fibrosis pancreas divisum abdominal trauma
Vasculature complications from pancreatitis
pancreatic enzymes can erode the vessels or cause thrombosis, hemorrhage, rupture or a pseudoaneurysm.
Bowel complications in pancreatitis
bowel perforation may result due to the erosion by the pancreatic enzymes.
Pancreatic cysts occur in the following:
pancreatitis cyst adenoma/adenocarcinoma ADPKD cystic fibrosis congenital cystic lymphangioma hydatid disease pancreaticoblastoma
Pancreatic neoplasms:
extremely rare in children. may be solid or cystic.
Pancreatic serous cytadenomas
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.
Pancreatic mucinous cystadenomas
premalignant/malignant, largely occur in the body and tail of the pancreas.
Ovarian - type stroma and are more common in females.
Pancreatic pseudocysts
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.
Solid pancreatic neoplasm:
predominately endocrine.
Insulinomas- benign
Gastronomas- malignant
Adneomcarcinoma’s are the most common malignant neoplasm and similar findings as those in adults.
Pancreaticoblastoma
rare solid pancreatic tumor
*associated with Beckwith Wiedemann syndrome.
