Chapter 12 Flashcards
Where does the pancreas lie?
Deep in the epigastrium and left hypochondrium, behind the lesser sac
How is the pancreas divided?
Head- Most inferior portion, anterior to IVC, to right of portal-splenic confluence, inferior to MPV and caudate lobe, medial to duodenum
Uncinate process- Small curved tip at the end of the head of the panc.
Neck- Anterior to the confluence or SMV
Body- Largest section, anterior to the SMA, the splenic a. is the superior border of the gland, splenic v. is posteriomedial border
Tail- Anterior to the left kidney, posterior to the left colic flexure and transverse colon (making it difficult to image), splenic v. is posterior border
What is the primary duct?
Duct of Wirsung is the primary duct extending the length of the pancreas, enters duodenum with the CBD at the ampulla of Vater (they join)
Duct of Wirsung- easier to visualize, should measure less than 2 mm
What is the secondary duct?
Duct of Santorini- secondary duct, drains the upper anterior head, enters the duodenum at the minor papilla 2 cm proximal to the ampulla of Vater
Where does the CBD open into?
Opens into the duodenum after forming a common trunk with the pancreatic duct
What is the ms for pancreas? Head, neck, body and tail ms?
Length- 15 cm, range 12-18 cm Head- thickest part 2-3 cm AP Neck- 1.5-2.5 cm Body- 2-2.5 cm Tail- 1-2 cm
What should sonographers evaluate?
Sonographers should evaluate the size, contour, and texture
True or false: The gland appears larger in children than in adults.
True
True or False: The gland stays the same even with age.
False.
The gland decreases in size with age
What is the vascular supply to the pancreas?
Splenic artery Pancreaticoduodenal arteries (many branches)
What is the vascular drainage from the pancreas?
Venous drainage is through tributaries of the splenic and superior mesenteric veins
What are the branches of the celiac axis?
Celiac axis- superior to pancreas
Left gastric artery
Common hepatic artery
Splenic artery
What is the superior border of the pancreas body and tail?
splenic artery
What does the CHA divide into?
Common Hepatic Artery- divides into the proper hepatic artery and gastroduodenal artery (GDA)
What is the anterolateral border of the pancreas?
GDA
From where does the SMA rise from?
SMA- rises from the aorta inferior to the celiac axis, posterior to the lower portion of the pancreatic body
Where is the MPV formed?
MPV is formed posterior to the neck by the junction of the SMV and splenic vein.
Where does the CBD join the pancreatic duct?
Ampulla of Vater
Define agenesis of the pancreas
Agenesis- agenesis of the body and tail, hypertrophy of the pancreatic head. Congenital defect
Define pancreatic divisum
Pancreas divisum- Rare, lack of fusion of the dorsal and ventral pancreatic buds, difficult to diagnosis with sonography
Define ectopic pancreatic tissue
Ectopic pancreatic tissue- most common pancreatic anomaly, in the form of intramural nodules, frequent sites—stomach, duodenum, small bowel, and large bowel
define annular pancreas
Annular pancreas- rare, head of the pancreas surrounds the 2nd portion of the duodenum, more common in males than females
What is the function of the pancreas?
Pancreas is a digestive (exocrine) and hormonal (endocrine) gland
What is the function of the exocrine gland?
Primary exocrine function- produce pancreatic juice, which enters duodenum together with bile—these are essential for normal digestion and absorption of food
What is the function of the endocrine gland?
Endocrine function (located in islets of Langerhans)- controls secretion of glucagon and insulin, failure of the pancreas to produce sufficient insulin leads to diabetes mellitus
What are the three lab values associated with pancreas?
Amylase
Lipase
Glucose
Why is the pancreas difficult to visualize?
Pancreas is the most difficult abdominal organ to evaluate because it lies posterior to the stomach and sometimes transverse colon
What does the pancreatic tissue texture depend on?
Pancreatic tissue texture depends on the amount of fat between the lobules
What are the patient positions for examining the pancreas?
Patient is examined in supine, oblique and sometimes upright positions
What is the transducer selection for pancreas?
Curved and 3-5MHz
What can provide an acoustic window?
Giving the patient 32 oz. of water through a straw can help with visualization along with having the patient in an upright position
Define pancreatitis
Inflammation of the pancreas
Why does pancreatitis occur?
Occurs when the pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts
Pancreatic tissue may be digested by its own enzymes
What is associated with acute pancreatitis that makes it difficult to visualize the pancreas?
In acute pancreatitis it may be difficult to visualize the pancreas because ileus is often associated with this condition
What are the categories of pancreatitis?
Acute
Hemorrhagic
Phlegmonous
Chronic
What is acute pancreatitis caused by?
Caused by inflamed acini releasing pancreatic enzymes into pancreatic tissue
The enzymes usually do not become active until they reach the duodenum to breakdown food
What is the most common cause of acute pancreatitis?
Gallstones
What is the second most common cause of acute pancreatitis?
Alcohol abuse
What are the symptoms of acute pancreatitis?
Severe pain, usually after a large meal or alcohol binge
With damage to the tissue and ductal system the pancreatic juices can leak into what?
With damage to the tissue and ductal system the pancreatic juices can leak into the pancreatic tissue as well as peripancreatic tissue