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Term 1 > Normal Anatomy (Pancreas & Liver) > Flashcards

Normal Anatomy (Pancreas & Liver) Flashcards

1
Q

What region is the pancreas located in?

A

-the epigastric region, close to the midline

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2
Q

What happens to the pancreas with age?

A
  • decreases in size

- increases echogenicity

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3
Q

What tissue is the pancreas composed of?

A

-exocrine and endocrine (mostly exocrine)

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4
Q

What are the functions of the pancreas?

A

Exocrine

  • digestion
  • secretes pancreatic juice
  • breaks down fat, carbohydrates and proteins

Endocrine

  • hormones (glucagon and insulin)
  • maintain sugar and salt balance
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5
Q

Acini Cells

A
  • exocrine
  • 80% performs exocrine functions
  • small grape like structures with endocrine tissue in between
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6
Q

What is pancreatic juice composed of?

A
  • amylase (carbohydrates)
  • lipase (fats)
  • trypsin (protein)
  • chymotrypsin (protein)
  • carboxypepidase (protein)
  • nucleases (nucleic acids)
  • sodium bicarbonate (neutralize hypochlorite acid)
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7
Q

What do digestive hormones do?

A
  • release is stimulated by partially digested food

- cause the production of pancreatic juices

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8
Q

What are the Pancreatic Digestive Hormones?

A
  • cholecystokinin, gastrin and acetylcholine (stimulate acini cells to produce digestive enzymes)
  • secretin (stimulates production of sodium bicarbonate)
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9
Q

What is the main pancreatic duct?

A

Duct of Wirsung

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10
Q

What is the accessory duct?

A

Duct of Santorini

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11
Q

How does digestion occur?

A
  • pancreatic juice collects in the Duct of Wirsung, then moves into the duodenum through the Ampulla of Vater
  • the Sphincter of Oddi relaxes to allow the passage of juices
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12
Q

Endocrine Function

A

-secretes hormones directly into blood stream

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13
Q

What does the Islets of Langerhans consist of?

A
  • alpha cells
  • beta cells
  • delta cells
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14
Q

What are the 3 pancreatic hormones?

A
  • insulin
  • glucagon
  • somatostanin
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15
Q

Insulin

A

-glucose to glycogen

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16
Q

Glucagon

A

-glycogen to glucose

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17
Q

Somatostanin

A

-alpha and beta inhibitor (inhibit insulin and glucagon production)

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18
Q

What does the pancreaticoduodenal artery supply?

A

-supplies pancreas head and part of the duodenum

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19
Q

What do the branches of the splenic artery supply and where are they located?

A
  • body and tail of pancreas
  • courses on the superior edge (before it enters spleen)
  • tortuous
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20
Q

Venous (pancreas)

A

-tributaries of SMV and SV

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21
Q

Is the pancreas retroperitoneal of intraperitoneal?

A

retroperitoneal

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22
Q

What are the 3 key regions of the pancreas?

A
  • head
  • body
  • tail
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23
Q

What is the 4th region of the pancreas?

A

-the neck

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24
Q

Where is the pancreas head located?

A

-more inferior to the body and tail

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25
Q

Where is the pancreas neck and body located?

A

-more superficial than head and tail

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26
Q

Where is the pancreas tail located?

A
  • more superior

- towards the spleen

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27
Q

What is the echogenicity of the pancreas?

A
  • usually isoechoic or hyperechoic to the liver
  • increases in echogenicity with age
  • uncinate process can appear hypoechoic to the rest of the pancreas
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28
Q

What is the echotexture of the pancreas?

A

-homogenous (can have a mottled appearance)

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29
Q

Size of Pancreas

A
  • size is comparable between males and females
  • head is usually largest in dimension
  • neck is usually the smallest
  • body and tail are slightly smaller than head
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30
Q

Pancreas Shape

A

-varies

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31
Q

Pancreas Contour

A
  • usually smooth (occasionally lobulated)
  • if increased in echogenicity with age it can blend into retroperitoneal fat, making it hard to tell true size and contour
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32
Q

Landmarks for the Pancreas Head

A
  • gastroduodenal artery (GDA): anterior lateral aspect of pancreas head and the second part of the duodenum lies lateral to the GDA
  • common bile duct (CBD): posterior lateral aspect of head
  • inferior vena cava (IVC): posterior
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33
Q

Pancreas Neck Landmarks

A

-anterior to the SMV and portosplenic confluence

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34
Q

Pancreas Body Landmarks

A
  • superior mesenteric artery (SMA): easiest to find
  • splenic vein (SV)
  • superior mesenteric vein (SMV)
  • body is medial to the portosplenic confluence
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35
Q

Pancreas Tail Landmarks

A
  • splenic vein lies posterior to the tail

- splenic artery is tortuous and travels adjacent to the splenic vein (seen in cross section)

36
Q

Duct of Wirsung

A
  • dumps secretions into the duodenum via major papilla (ampulla of Vater)
  • usually merges with common bile duct before entering the duodenum at the major papilla or ampulla of Vater
37
Q

What is the size of the duct of Wirsung?

A

3mm or less

38
Q

How does the duct of Wirsung appear?

A
  • linear structure in the pancreas body (echogenic walls if beam is 90 degrees)
  • anechoic (fluid filled)
39
Q

What are some windows used when scanning the pancreas?

A
  • supine (most common)
  • right anterior oblique and left later decubitus
  • left coronal
40
Q

What organs may create problems when viewing the pancreas?

A
  • stomach

- bowel

41
Q

What organs may help us see the pancreas?

A

-liver

42
Q

Where does the GDA originate?

A

-common hepatic artery

43
Q

Where does the splenic vein originate?

A

-spleen

44
Q

Where does the SMV originate?

A

-small intestine

45
Q

What are some maneuvers/techniques used to view the pancreas better?

A
  • standing up
  • taking a breath in
  • pushing belly out
46
Q

What are the 2 main functions of the pancreas?

A

1) exocrine- creates pancreatic juice (aids in digestion)

2) endocrine- produces insulin

47
Q

Echogenicity of Pancreas

A

-hyperechoic

48
Q

Echotexture of Pancreas

A

-homogeneous or heterogenous (depending on fat)

49
Q

Size of Pancreas

A

13-17cm long and 3-5cm wide

50
Q

Where does the pancreas lie in the body?

A
  • epigastric region
  • retroperitoneal
  • abdominal cavity
51
Q

Landmarks for Pancreas

A
  • head: CBD, GDA
  • neck: portal confluence
  • body: aorta, SMA
  • tail: splenic vein
52
Q

How does the pancreas start?

A

-2 buds that join together (dorsal and ventral) that fuse at 6 to 8 weeks

53
Q

Dorsal (cranial) forms…

A

-body and tail

54
Q

Ventral (caudal) forms…

A

-head and uncinate process

55
Q

Annular Pancreas

A
  • ring of pancreatic tissue that encircles the duodenum

- can cause problems

56
Q

Cysts

A
  • epithelium lined true cysts, anomalous development of the pancreatic duct
  • multiple cysts are associated with cystic disease, von hippie lindau
57
Q

Agenesis

A
  • congenital absence of the body and tail

- the head is typically larger

58
Q

Pancreatic Divisum

A
  • most common
  • lack of fusion of the dorsal and ventral pancreatic buds
  • the duct of Wirsung and Santorini don’t fuse (most of pancreas is drained through duct of Santorini and minor papilla)
59
Q

Is ultrasound the best way to image the pancreas?

A

no

60
Q

What are some other imaging modalities that could be used to image the pancreas?

A
  • CT

- MRI

61
Q

Pseudomasses (false masses)

A
  • not real, but can fool you when scanning
  • appear as bugles
  • extend to the right of GDA
  • anterior body where left lobe liver touches the pancreas
  • same echogenicity and texture as normal pancreas
62
Q

What is the liver covered by?

A

-Glisson’s Capsule (thin connective layer)

63
Q

Where is Glisson’s Capsule thickest?

A

-around the IVC

64
Q

Is the liver intraperitoneal or retroperitoneal?

A

-intraperionteal, except for the bare area

65
Q

What region is the liver located in?

A
  • RUQ
  • extends into epigastric and Lt hypochondrium
  • majority lies beneath right costal margin
66
Q

What are the borders of the liver?

A
  • superior: diaphragm
  • posterior: lumbar region of posterior abdominal wall
  • anterior: abdominal wall, ribs
  • inferior: organs (pancreas, Rt kidney, duodenum, colon, GB, lesser curvature of stomach)
67
Q

What are the 2 main surfaces of the liver?

A
  • anterior (aka parietal)

- posterior/inferior (aka visceral)

68
Q

What are the 3 fissures in the liver?

A
  • main lobar fissure (median)
  • left intersegmental fissure
  • right intersegmental fissure
69
Q

Hepatoduodenal Ligament

A

-covers the porta hepatis entrance to the liver

70
Q

Gastrohepatic Ligament

A

-connects lesser stomach to liver

71
Q

Coronary Ligament

A

-connects posterior liver to diaphragm

72
Q

Right and Left Triangular Ligament

A

-connects liver to body wall

73
Q

What is the bare area?

A
  • located on posterior superior aspect of the liver
  • direct contact with diaphragm
  • only part of the liver not covered by peritoneum
74
Q

What are the similarities between hepatic and portal veins?

A
  • both located within the liver
  • walls compare
  • relatively the same size
75
Q

Intersegmental

A

-definite division between borders (hepatic veins)

76
Q

Intrasegmental

A

-unclear division between borders (portal veins)

77
Q

What is the normal size of the liver? (measuring posterior/superior to anterior/inferior tip)

A
  • 13 to 17cm (Rt lobe)

- variable (Lt lobe)

78
Q

What is the echogenicity of the liver?

A

echogenic

79
Q

What is the echo texture of the liver?

A

homogenous

80
Q

How does the echogenicity of the liver compare to the kidney?

A

-liver is hyperechoic or isoechoic to the kidney

81
Q

How does the echogenicity of the liver compare to the spleen?

A

-the liver is hyopechoic to the spleen

82
Q

What is the contour of the liver?

A

-smooth

83
Q

What is the shape of the liver?

A
  • Lt lobe: triangular shape

- Rt lobe: varies

84
Q

What are the scanning approaches for the liver?

A
  • subcostal (under ribs)

- intercostal (between ribs)

85
Q

What are the patient positions for scanning the liver?

A
  • supine

- Lt lateral decubitus

Term 1 (17 decks)

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