Chapter 5: Pancreas Flashcards by Dayneilis Mora

What is the uncinate process

The posteriomedial extension of the pancreatic head that some people have

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What are the enzymes secreted by the exocrine portion of the pancreas

Amylase, lipase, sodium bicarbonate, trypsin, chymotripsin, and carboxypolypeptidase

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What is the function of amylase

Digest carbohydrates and converts starch to sugar

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What is the function of lipase

Digest fats and convert them to fatty acids and glycerol

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What is the function of sodium bicarbonate

Neutralizes stomach acid

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What is the function of trypsin, chymotripsin and carboxypolypeptidase

Breaks down proteins

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_____ cells carry the exocrine function of the pancreas

Acinar

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The enzymes travel through the main pancreatic duct which is also called ____

Duct of Wirsung

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What is the duct of Santorini

Accessory duct that branches off of the main duct, it also has its own little sphincter

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What is the name of the area where the sphincter of Oddi rests

Major duodenal papilla

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What hormone causes relaxation and opening of the sphincter of Oddi

Cholecystokinin

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What hormones are released by the endocrine portion of the pancreas

Alpha cells- Glucagon
Beta cells- Insulin
Delta cells- Somatostatin

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What is the function of the alpha cells (glucagon)

Promotes the release of glucose by the liver (increasing blood sugar)

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What is the function of beta cells (insulin)

Stimulates the body’s use of glucagon

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What is the function of delta cells (somastotatin)

Restrains insulin and glucose level

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The endocrine function is performed by the islets of _____

Langerhans

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What vessel supplies blood to the head of the pancreas

Gastroduodenal artery

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What vessels supply blood to the body and tail of the pancreas

Splenic artery and SMA

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What four vessels drain the pancreas

Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
portal vein

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Normal echogenicity of the pancreas is greater than the liver and _____ to the spleen

Equal

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The diameter of the main pancreatic duct should not exceed __ mm

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The pancreas head and body should measure between ___ and ___ cm

2-3

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The pancreas tail should measure ___ cm

1-2

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What is pancreatic divisum

The most common congenital anomaly.
Shortened main pancreatic duct that drains only the head.

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What happens to the duct of Santorini in a pancreatic divisum

It is forced to drain the rest of the pancreas

What complications does pancreatic divisum brings

Obstruction, improper pancreas drainage, high risk of developing inflammation ( prone to pancreatitis)

What is an annular pancreas

Cuando la parte de alante del páncreas se enrosca en el duodenum. May cause obstruction

What is acute pancreatitis

Inflammation of the pancreas secondary to leakage of pancreatic enzymes

What are the most common causes for acute pancreatitis

Alcohol abuse and biliary tract disease

What is phlegmon

Peripancreatic fluid collection

What is the most helpful lab value to diagnose pancreatitis

Lipase

Acute pancreatitis will cause a rise in amylase first, then a rise in _____

Lipase

Acute pancreatitis is divided into interstitial edematous pancreatitis or necrotizing pancreatitis. What is the difference

Interstitial edematous pancreatitis is better managed. Necrotizing pancreatitis is fatal

What are the lab values elevated with acute pancreatitis

Amylase (within 24 hrs), Lipase (within 72 hrs), leukocytes, ALT

What are the symptoms of acute pancreatitis

Abdominal pain (especially en supine) Back pain, fever, nausea, vomiting. May lead to hemorrhage

What does acute pancreatitis look like on ultrasound

Pancreas may appear normal or hypoechoic (when diffuse), focal hypoechoic area (when focal) Fluid collection around Pseudocyst Abscess formation Biliary obstruction Splenic vein thrombosis and pseudoaneurysm of splenic artery (sometimes)

What are the symptoms of chronic pancreatitis

Asymptomatic Epigastric pain, jaundice, back pain, anorexia, vomiting, weight loss, constipation

What lab values are elevated with chronic pancreatitis

Por roble elevation in ALP and amylase/lipase

What does chronic pancreatitis look like on ultrasound

Heterogenous hyperechoic atrophic pancreas with poor margins and calcifications

What other things can me present with chronic pancreatitis

Pancreatic pseudocyst Dilated pancreatic duct (may have stones in it) Portosplenic vein thrombosis

What is the main cause of chronic pancreatitis

Alcohol abuse

Pancreatic adenocarcinoma is also called pancreatic ____ adenocarcinoma

Ductal

Pancreatic adenocarcinoma is most common in men or women

Men

Pancreatic adenocarcinoma is most common in what part of the pancreas

Head

Cancer of the pancreas had can eventually cause _____ obstruction and _______ gallbladder

CBD, Courvoisier

What is the Whipple procedure

Pancreaticoduodenectomy

During a pancreaticoduodenectomy, what is removed

Pancreas head, GB, prox duodenum, and bile ducts

What are the symptoms of pancreatic adenocarcinoma

Loss of appetite, weight loss, jaundice, epigastric pain

Pts with what type of history have a higher risk of developing pancreatic adenocarcinoma

Hx of smoking, diabetes, and chronic pancreatitis

What lab values may be elevated with pancreatic adenocarcinoma

Amylase and/or lipase, ALP

What does pancreatic adenocarcinoma look like on ultrasound

Hypoechoic mass on the head, double duct sign, Courvoiser gallbladder

What does a Courvoiser gallbladder refer to

Large, palpable gallbladder

A cystadenoma within the pancreas can be called a (microcystic) ______ cystadenoma, or a (macrocystic) ______ cystadenoma

Serous, mucinous

Serous (microcystic) cystadenomas are small and ______

Benign

Macrocystic (mucinous) cystadenomas are big and usually _______

Malignant

When a mucinous tumor is malignant, it’s called

Mucinous cystadenocarcinomas

Mucinous cystadenocarcinomas are often found in what part of the pancreas

Within the body and tail

What are the symptoms of cystadenomas and cystadenocarcinomas

May be asymptomatic at first Epigastric pain, weight loss palpable mass and jaundice

What does a benign serous cystadenoma look like on ultrasound

Cystic small mass May appear solid and echogenic due to how small it is

What does a mucinous cystadenoma and cystadenocarcinoma look like

Multilocular cystic mass that may contain mural nodules and calcifications

With mucinous cystadenomas and cystadenocarcinomas, there may be an associated dilation of the _____ duct

Pancreatic

What is the gold standard imaging for the pancreas

Endoscopic retrograde cholangiopancreatography (ERCP)

Islet cell tumors are also called pancreatic ______ tumors

Neuroendocrine

What are islet cell tumors

Tumors found within islets of Langerhans

There are two types of islet cell tumors: insulinoma and ______

Gastrinoma

Insulinomas are more common and usually _____

Solitary

Gastrinomas are usually how many

Múltiples

Functional gastrinomas can cause _______ _______ syndrome

Zollinger Ellison

What is Zollinger Ellison syndrome

Excessive secretion of acid by the stomach that leads to peptic ulcers

Functional insulinomas can cause _____

Hypoglycemia

What is the Whipple triad

A group of clinical indicators of a functional insulinoma

What clinical indicators are included in the Whipple Triad

Hypoglycemia, low fasting glucose, and relieve with IV glucose administration

What are some other symptoms of insulinomas

Palpitations, sweating, tremors, headaches, diabetic coma

What does an islet cell tumor look like on ultrasound

Small hypoechoic mass that may contain calcifications Hypervascularity may be present in the functioning tumors

Cyst within the pancreas is associated with what three diseases

Von hippel-lindau disease (especially este) Cystic fibrosis Autosomal dominant polycystic kidney disease (ADPKD)

When they do a pancreas transplant, ___% of the time they transplant the kidney too

Describe exocrine bladder drainage pancreas transplant

Vasculature of donor is attached to pts iliacs Donors duodenum is attached to bladder (used to expel pancreatic juices)

Describe exocrine enteric drainage (more common)

Donors duodenum is attached to pt jejunum (where it expels pancreas juices) Vasculature is connected to donors iliacs (Y graft)

What does chronic transplant rejection look like

Hyperechoic, atrophy, calcifications

What does acute transplant rejection looks like

Hypoechoic or heterogenous pancreas, elevated resistive indices

What are some fluid collections that may occur with a transplant

Abscess Ascites Hematoma Urinoma Pseudocyst

What index usually represents splenic vein thrombosis

>1.0, with absent splenic inflow

What are some pancreatic transplant vascular complications

Arterial stenosis, arterial thrombosis, graft thrombosis, pseudoaneurysm, splenic vein thrombosis, strictures