Module 5 : Pancreas Flashcards
pancreas embryology
- formed from ventral and dorsal diverticula of primitive foregut
- dorsal bud = neck, body, tail
- ventral bud = head and uncinate
location of panc
- retroperitoneal
- epigastrium and left hypochondrium
- anterior pararenal space
- sits in C loop of duodenum
- ## duodenal loop to splenic hilum
structures anterior to panc
- left lobe of liver
- stomach (pylorus)
- LESSER SAC
thin patient - panc position
- less retroperitoneal fat
- head and til more posterior to body and neck
fat patient - panc postion
- increased retroperitoneal fat
- head and tail more anterior
- all parts at same depth
panc size
- shrinks with age
- 12-15 cm long
- outline of panc should be smooth regardless of size and echogenicity
- no focal enlargement
panc shape
- comma , sausage, dumbbell, tadpole, boomerang
panc head structural relationships
- medial to duodenum
- anterior to ivc
- anterior OR superior to left renal vein
- lateral to portal/splenic confluence
- INFERIOR TO PORTAL VEIN
- posterior to pyloric stomach
- INFERIOR TO HEPATIC ARTERY
- GDA anterolateral
- CBD posterolateral
- uncinate
+posterior to SMV and SMA
panc neck structural relationships
- anterior to SMV and PORTAL CONFLUENCE
- inferior to common hepatic artery
celiac axis relationship to panc
- ANYTHING OFF CELIAC AXIS WILL BE SUPERIOR TO PANC
panc body structural relationships
- posterior to stomach
- anterior to aorta, left renal vein, splenic vein, SMA
- inferior to celiac axis and splenic artery
panc tail structural relationships
- anteriot to left adrenal gland
- left of aorta
- splenic artery POSTERIOR SUPERIOR BORDER
- splenic vein POSTERIOR INFERIOR BORDER
pancreatic ducts
- main duct = Duct of Wirsung
- accessory duct = Duct of Santorini
Duct of Wirsung
- extends along length of gland
- wins with CBD and enters ampulla of vater
- should not exceed diameter of 2mm
Duct of Santorini
- enters duosenum 2cm prox to main duct
- enters at minor duodenal papilla
function of pancreas
- exocrine (digestive)
- endocrine (hormones)
exocrine function of panc
- 80% of panc tissue - ductal and acini cells
- produce pan juices which are liberates into panc duct
- juices composed of digestive enzymes, water, bicarbonate, salt
pan enzymes
- amylase = acts on carbohydrates (starches)
- lipase = acts on fats
- sodium bicarbonate = neutralize hydrochloric acid
- trypsin, chymotrypsin, carboxypeptidase = protein
- protease - nucleic acid
what triggers release of pan juices
- food in duodenum triggers release of hormones which trigger release of panc juices
hormone trigger digestion
- secretin, pancreozymin/cholecystokinin
secretin
- stimulates production of sodium bicarbonate in pancreatic duct
pancreozymin/cholecystokinin
- stimulates acing cells to produce digestive enzymes
* also GB to contract
endocrine function of panc
- hormones produced in islets of langerhans
- more numerous in panc tail
- released into bloodstream
3 types of cells
alpha cells
- produce glucagon
beta cells
- produce insulin
* diabetes effects this cell
delta cells
- produce somatostatin
+ inhibits production of insulin and glucagon
lab tests
- syrum amylase
- lipase
- glucose
- urine amylase
serum amylase
- obstruction of duct or necrosis of tissue can cause enzyme to leak into tissue spaces and blood stream
- levels increase within 3-6 hours of incident can persist for 24 hours
- not specific for pancreatitis (amylase produced in salivary glands too)
lipase
- excreted by panc only
- increased inflammatory conditions and some neoplasms
- levels can stay elevated up to 14 days after amylase has dropped
glucose
- increase occurs in diabetes, chronic liver and panc diseases and over activity of endocrine glands
- decrease in tumors of islets of langerhans and hypoglycaemia
blood glucose
- fasting blood sugar level
glucose tolerance
- measures body ability to process sugar
urine amylase
- parallels level found in blood
- urine levels return to normal more slowly than blood
- levels remain elevated up to 7-10 days in chronic and acute pancreatitis
blood supply to panc
- from pancreaticoduodenal arteries (branches of right gastric which is branch of hepatic artery) and branches of splenic artery
- anterior and inferior pancreticoduodenal arteries supply head and part of duodenum
- splenic artery supplies body and tail
scanning technique for panc
- one of first organs to image to avoid affect of gas
- use left lobe of liver as window
- caudal angulation / slightly counterclockwise rotation
sonographic appearance of panc
- homogenous slightly coarser than liver
- generally isoechoic or slightly more echogenic in adults
- panc duct visualized in transverse plane
+double parallel line surrounded by panc tissue
+ collapsed wall of pylorus might mimic duct
* MAKE SURE TO SEE PANC TISSUE ON BOTH SIDES OF LINE
reasons panc is not well seen
- no capsule
- gas shadowing from pylorus of stomach
- location in general
- lig teres shadows head
