Module 5 : Pancreas

Question 1

pancreas embryology

Answer 1

• formed from ventral and dorsal diverticula of primitive foregut
• dorsal bud = neck, body, tail
• ventral bud = head and uncinate

Question 2

location of panc

Answer 2

• retroperitoneal
• epigastrium and left hypochondrium
• anterior pararenal space
• sits in C loop of duodenum
• ## duodenal loop to splenic hilum

Question 3

structures anterior to panc

Answer 3

• left lobe of liver
• stomach (pylorus)
• LESSER SAC

Question 4

thin patient - panc position

Answer 4

• less retroperitoneal fat

- head and til more posterior to body and neck

Question 5

fat patient - panc postion

Answer 5

• increased retroperitoneal fat
• head and tail more anterior
• all parts at same depth

Question 6

panc size

Answer 6

• shrinks with age
• 12-15 cm long
• outline of panc should be smooth regardless of size and echogenicity
• no focal enlargement

Question 7

panc shape

Answer 7

• comma , sausage, dumbbell, tadpole, boomerang

Question 8

panc head structural relationships

Answer 8

• 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

Question 9

panc neck structural relationships

Answer 9

• anterior to SMV and PORTAL CONFLUENCE

- inferior to common hepatic artery

Question 10

celiac axis relationship to panc

Answer 10

• ANYTHING OFF CELIAC AXIS WILL BE SUPERIOR TO PANC

Question 11

panc body structural relationships

Answer 11

• posterior to stomach
• anterior to aorta, left renal vein, splenic vein, SMA
• inferior to celiac axis and splenic artery

Question 12

panc tail structural relationships

Answer 12

• anteriot to left adrenal gland
• left of aorta
• splenic artery POSTERIOR SUPERIOR BORDER
• splenic vein POSTERIOR INFERIOR BORDER

Question 13

pancreatic ducts

Answer 13

• main duct = Duct of Wirsung

- accessory duct = Duct of Santorini

Question 14

Duct of Wirsung

Answer 14

• extends along length of gland
• wins with CBD and enters ampulla of vater
• should not exceed diameter of 2mm

Question 15

Duct of Santorini

Answer 15

• enters duosenum 2cm prox to main duct

- enters at minor duodenal papilla

Question 16

function of pancreas

Answer 16

• exocrine (digestive)

- endocrine (hormones)

Question 17

exocrine function of panc

Answer 17

• 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

Question 18

pan enzymes

Answer 18

• amylase = acts on carbohydrates (starches)
• lipase = acts on fats
• sodium bicarbonate = neutralize hydrochloric acid
• trypsin, chymotrypsin, carboxypeptidase = protein
• protease - nucleic acid

Question 19

what triggers release of pan juices

Answer 19

• food in duodenum triggers release of hormones which trigger release of panc juices

Question 20

hormone trigger digestion

Answer 20

• secretin, pancreozymin/cholecystokinin

Question 21

secretin

Answer 21

• stimulates production of sodium bicarbonate in pancreatic duct

Question 22

pancreozymin/cholecystokinin

Answer 22

• stimulates acing cells to produce digestive enzymes

* also GB to contract

Question 23

endocrine function of panc

Answer 23

• hormones produced in islets of langerhans
• more numerous in panc tail
• released into bloodstream
  3 types of cells

Question 24

alpha cells

Answer 24

• produce glucagon

Question 25

beta cells

Answer 25

• produce insulin

* diabetes effects this cell

Question 26

delta cells

Answer 26

• produce somatostatin

+ inhibits production of insulin and glucagon

Question 27

lab tests

Answer 27

• syrum amylase
• lipase
• glucose
• urine amylase

Question 28

serum amylase

Answer 28

• 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)

Question 29

lipase

Answer 29

• excreted by panc only
• increased inflammatory conditions and some neoplasms
• levels can stay elevated up to 14 days after amylase has dropped

Question 30

glucose

Answer 30

• increase occurs in diabetes, chronic liver and panc diseases and over activity of endocrine glands
• decrease in tumors of islets of langerhans and hypoglycaemia

Question 31

blood glucose

Answer 31

• fasting blood sugar level

Question 32

glucose tolerance

Answer 32

• measures body ability to process sugar

Question 33

urine amylase

Answer 33

• 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

Question 34

blood supply to panc

Answer 34

• 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

Question 35

scanning technique for panc

Answer 35

• one of first organs to image to avoid affect of gas
• use left lobe of liver as window
• caudal angulation / slightly counterclockwise rotation

Question 36

sonographic appearance of panc

Answer 36

• 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

Question 37

reasons panc is not well seen

Answer 37

• no capsule
• gas shadowing from pylorus of stomach
• location in general
• lig teres shadows head