pancreas Flashcards
average size of pancreas
12-18 cm
uncinate process
anterior to IVC
posterior to SMV
right lateral to SMA
hook like extension
main pancreatic duct normal diameter
<2mm
main pancreatic duct enters into what part of the duodenum
the 2nd part
accessory duct drains what
drains the head
celiac artery branches
left gastric , splenic, and common hepatic artery
the GDA is a branch of
the common hepatic artery
insulin is released by the
islets of langerhans
which cells release insulin
beta cells
which cells release glucagon
alpha cells
glycogenesis
formation of glycogen from glucose, controlled by insulin
glycogenolysis
conversion of glycogen back into glucose
blood sugar levels should not exceed
100mg/100dl
acini glands secrete…
trypsin, amylase, and lipase
what does amylase do
digest carbohydrates
what stimulates pancreatic just production
cholecystokinin
delta cells produce….
somatostatin
symptoms that indicate a scan for the pancreas
epigastric pain
nausea/vomiting
alcoholism
hypoglycemia
hyperinsulinism
hyperglycermia
what is hyperinsulism
increased insulin production
less common than diabetes
can be caused by insulinoma
insulin shock
what is hyperglycemia
increased blood sugar
diabetes mellitus
diminished rate of insulin secretion
can be hereditary or acquired
diagnosed by blood test urine. test and glucose tolerance
lipase does…?
digest fats
increase with acute pancreatitis & ductal obstruction
trypsin increases w/?
increase with acute pancreatitis & ductal obstruction
WBC increase with
infection
blood glucose increases with
decreased pancreas function
land marks for the pancreas
- Aorta - posterior to body
- Celiac axis - superior to the head
- Splenic artery - travels posterior and superior to the body and tail
4.gastroduodenal artery - seen entering the anterior head - IVC - posterior to the head/neck
6.Left renal vein - inferior to the body and tail - Splenic vein - inferior and posterior to the body and tail
8.Superior mesenteric vein - joins the splenic vein posterior to the head/neck, uncinate process posterior to the confluence
pancreas divisum
most common congenital pancreatic anomaly
2 embryonic pancreas buds do not fuse properly
separate ductal systems
annular pancreas
head surrounds 2nd portion of duodenum
complete or partial obstruction of duodenum
how cystic fibrosis effects the pancreas
causes pancreas to secrete a thick mucous
inhibits exocrine function, decreased lipase levels
organ shrinks, duct obstruction may occur
pancreas ductal stones
can be associated with biliary obstruction
stone in pancreatic duct
acute pancreatitis lab values
increased lipase, amylase, WBC
decreased hematocrit if bleeding
REVERSIBLE CONDITION
lipase more specific for pancreatitis
most common cause of pancreatitis
biliary tract disease
acute pancreatitis symptoms
sudden abdomen pain or back pain
nausea vomiting weight loss
fever
pancreas pseudocyst
accumulation of pancreatic juices that is walled off and appears to be a cyst
pancreas phlegmon
solid inflammatory mass that infiltrates surrounding structures
acute pancreatitis complication
pseudocyst MOST COMMON
phlegmon
abscess
hemorrhage
ascites
dilated biliary system
sono appearance for chronic pancreatitis
dilated pancreatic duct
calcifications in the gland
hyperechoic
heterogenous
irregular
chronic pancreatitis lab values
not helpful
chronic pancreatitis may develop
jaundice
diabetes
permanent damage to cells
chronic pancreatitis #1 cause
alcohol abuse
pancreatic abscess symptoms
fever
pain
increased WBC
pancreatic abscess sono appearance
complex cystic mass
ring down artifacts from air produced in bacteria
what is a pseudocyst
attempt of the body to to wall off pancreatic juices
no epithelial lining
where is a pseudocyst most commonly found
lesser sac
or anterior pararenal space
a pseudocyst can be caused by
trauma
carcinoma
chronic or acute pancreatitis #1
9 times more common
most common benign tumor of the pancreas
islet cell tumor
where is a islet cell tumor usually found
body and tail
lab values for islet cell tumors
increased amylase
and associated hormones with tumor tyoe
2 types of islet cell tumors
insulinoma
gastrinoma
most common islet cell tumor
isulinoma
what is insulinoma associated w/
von hippel landau syndrome
insulinoma produces …
hyperinsulinism which causes hypoglycemia
gastrinomas secrete the hormone…
gastrin which causes over production of the gastric acid
size of a islet cell tumor
<3cm diameter
what type of cells is the pancreatic adenoma composed of
beta cells
lab values for pancreatic adenoma
increased amylase, lipase
sono appearance of pancreatic adenoma
solid
posterior enhancement
Serous Cystadenoma is usually found in which part of the pancreas
body and tail
Serous Cystadenoma microcystic
<2cm
tiny cyst
Serous Cystadenoma macrocystic
over 2 cm
strong risk for malignancy
lab values for Serous Cystadenoma
increased amylase
sono findings for Serous Cystadenoma
cluster grape like cyst
external lobulation
thick walls
pap projections
Mucinous Cystadenoma
usually larger
have greater risk for malignant transformation
cystic mass w/ debris and calcifications
Adenocarcinoma usually occurs in which part of the pancreas
the head
Adenocarcinoma risk factors
high fat diet
smoking
chronic pancreatitis
cholangitis
diabetes
common clinical findings for Adenocarcinoma
palpable GB and obstructive jaundice
enzyme levels for Adenocarcinoma
normal
90% of Adenocarcinoma originate in the
ductal system
sono appearance Adenocarcinoma
mass usually in the head
double duct sign
courvoisier GB
ascites
Mucinous Cystadenocarcinoma
slow growing
rare
Mucinous Cystadenocarcinoma symptoms
jaundice
weight loss
couvoisier sign
abdnominal mss
Mucinous Cystadenocarcinoma lab values
increased amylase
billirubin and ALP
carcinoembryonic antigen
where is Mucinous Cystadenocarcinoma most commonly found
body and tail
whipple procedure
removal of the head, and sometimes the body of the pancreas, the duodenum and gallbladder, part of the jejunum, stomach, bile duct and lymph nodes near the pancreas
most common panc variant
tadpole
normal size of the head of pancreas
2-3 cm
pancreaticduodenal artery is a branch of the
gda
von hippel lindau syndrome
development of benign and malignant tumors
