Pancreas Flashcards
Where is the pancreas located?
-Anterior portion retroperitoneum
-Not an encapsulated organ
What are the portions of the pancreas?
-Head/uncinate process
-Neck
-Body
-Tail
What does endocrine produce?
Hormone production
-into blood or soft tissue
What does exocrine produce?
Produces digestive enzymes
-into a duct
Head measurement?
2-3.5cm AP
Location of head?
-Anterior to IVC
-Right and inferior to body/tail
-Right of SMV/SV confluence
-Inferior to MPV and caudate
-Medial to duodenum
Where is the uncinate process?
-Curved tip at the head
-Posterior/behind and medial to head
-Anterior to IVC
-Posterior to SMV
Location of neck?
-Between head and body
-Anterior to SMV/SV confluence
Location of body?
-Anterior to AO, SMA, LRV
-Posterior to antrum of stomach
Body measurement?
2-3cm AP
Tail measurement?
1-2cm AP
Location of tail?
-Bordered posteriorly by SV
-Anterior to stomach
-Lateral to LK
-Extends into splenic hilum
(Obstructed by gas b/c close to stomach)
What does the pancreatic duct do?
Transports digestive enzymes from pancreatic tissue to duodenum via the ampulla of vater
Pancreatic duct measurements?
-Head is 3mm
-Body is 2.1mm
-Tail is 1.6mm
What is the duct of santorini?
Smaller accessory duct off main pancreatic duct that makes a hole (perforates) into duodenum separately
What arteries supply the head?
-GDA (gastroduodenal artery)
-SPDA (superior pancreaticoduodenal artery)
What arteries supply the body/tail?
IPDA (inferior pancreaticoduodenal artery)
What veins supplies the venous drainage?
-SMV
-SV
What hormones does endocrine/islets of Langerhans produce?
-Insulin (beta cells - metabolism of carbs into energy)
-Glucagon (alpha cells - conversion into glucose)
-Somatostatin (delta cells - regulates insulin and glucagon)
Diabetes is an imbalance in?
Insulin
What hormones do exocrine/acini cells produce?
-Amylase (carb digestion)
-Lipase (fat digestion)
-Trypsinogen (protein digestion)
-Chymotrypsinogen (protein digestion)
-Bicarbonate (neutralizes acidic gastric enzymes and triggers pancreatic enzymes into duodenum)
When will amylase be increased/decreased?
-Increased when there is a disease
-Decreased when there is permanent damage
When will lipase be increased?
-With inflammatory diseases
What is steatorrhea?
Increased fat in stool
Will the echogenicity of the liver be the same in adults vs pediatrics?
No, it will look hypoechoic in pediatrics because they have less fat
What do acini cells do?
Perform exocrine functions (digestive enzymes)
What do alpha cells do?
Perform endocrine functions (secretes glucagon)
What do beta cells do?
Perform endocrine functions (secretes insulin)
What do delta cells do?
Performs endocrine functions (secretes somatostatin)
What does endocrine do?
Secretes into blood or tissue
What does exocrine do?
Secretes into a duct
What artery does NOT supply the pancreas with blood?
SMA
Where does the pancreatic head lie in relation to the surrounding veins?
Lies anterior to the SMV/SV confluence
What is the m/c anomaly?
Panc divisum
(when dorsal + ventral don’t fuse together into 1 duct, now 2 ducts)
What is annular process?
-M/c males
-Associated with congenital anomalies
-Occurs when head panc surrounds 2nd part duodenum
What is hypoechoic ventral head?
When the head is diminished by fat
Where are the m/c sites for ectopic panc tissue to grow to?
-Stomach
-Duodenum
-Lg/sm intestines
What is panc agenesis?
When dorsal (M/C) or ventral section is missing during development
SF of dorsal agenesis?
Round head with absence of neck/body/tail, as bowel moves into this area
M/c cause of pancreatolithiasis?
Chronic pancreatitis
(appears as many small hyperechoic dots in panc)
What are the m/c causes of acute pancreatitis?
-Biliary tract disease (cholelithiasis)
-Excessive alcohol intake
What is the m/c complication of acute pancreatitis?
Fluid collections
Lightbulbs for acute pancreatitis?
-Pain radiating to back (relieved by sitting/bending at waist)
-Less than 5 days
-Possibly enlarged, or can look normal
-Associated with gallstones
-Leukocytosis
What is the m/c location for panc pseudocyst?
Tail!
(make up 75% of cystic lesions in panc)
M/c complications with chronic pancreatitis?
-Pseudocysts
-Venous thrombosis
-Increased risk panc cancer
Lightbulbs for chronic pancreatitis?
-Greater than 5 days
-Atrophied + fibrotic
-Repreated attacks acute
-Calcifications
-Increased amylase + bilirubin
(image looks like very small hyperechoic dots in panc representing calcifications)
What is polycystic disease?
-Multiple cysts in kidney, liver, and in last stage will show up in panc
(if no cysts present in kidney/liver - think inflammation + not polycystic)
M/c cause of polycystic disease?
Family history
What is von Hippel Lindau disease?
Affects CNS by developing cysts in several parts of body
(peripheral calcifications)
Lightbulbs for cystic fibrosis?
-Steatorrhea
-Correlates to pancreatitis
-M/c in children
-Due to excess production of thick mucous by endocrine glands
Who is m/c to get neoplastic disease?
African American men
Is it common to have panc cancer?
Yes!
Often caught late stages tho
Are most panc tumours solid or cystic?
Solid (m/c involved panc head)
Are malignant cystic neoplasms common?
No, 1% malignant, 75% benign pseudocysts!
Is exocrine or endocrine the largest group of panc tumours?
Exocrine
What is the m/c panc malignancy?
Adenocarcinoma (in head)
SF of adenocarcinoma?
Often hypoechoic, solid, in head
Lightbulb for serous cystadenoma?
-Women
-Head
-Cystic
-Calcifications
-Less than 2cm
Lightbulb for mucinous adenoma?
-Women
-Cystic
-Body/tail
-Big (1-36cm)
Lightbulb for IPMN (intraductal papillary mucinous neoplasms)?
-Elderly men
-Malignant potential (“mucinous” in title)
-Head
-Ductal dilatation
Lightbulb for solid pseudopapillary?
-Young women
-Head/tail
-Mass has cystic + solid components*
-Low malignant potential
Another name for endocrine neoplasms?
-Neuroendocrine tumours
-Islet cell tumours
Types of endocrine neoplasms?
-Insulinomas
-Gastroinomas
-Glucagonomas (uncommon)
Lightbulb for insulinoma?
-B cell tumour
-Benign
-Hyperinsulinism (b/c too much insulin) + hypoglycemia (b/c not enough glucose)
-Body/tail
-Hyperechoic, 1-2cm
Lightbulb for gastrinoma?
-G cell tumour
-Malignant (most)
-Tail
-Hypoechoic
-Excess gastrin
-Multile sm tumours
Are metastases to the panc common?
Nope
Primaries: melanoma, breast, GIT, lung
