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Abdominal II > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Pancreas location

A
  • horizontally oblique (across midline of body (in epigastrium
  • tail is cephalad & to the left
  • head is caudal & to the right
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2
Q

Is the pancreas peritoneal?

A
  • majority is retroperitoneal
  • small portion of the head is within peritoneal space
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3
Q

Pancreas size

A
  • size decreases with age
  • 15 cm long, 1.5 - 3.5 cm thick (thickest at head)
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4
Q

Pancreas anatomy

A

head, neck, body, tail, uncinate (underneath)

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5
Q

Head of pancreas

A
  • cradled in the C-loop of duodenum
  • ant. to IVC (sits on it)
  • forms hook with uncinate process & panc. neck
  • surround splenic portal confluence
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6
Q

Where do most pancreatic masses occur?

A

pancreatic head

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7
Q

Size of pancreatic head

A

disproportionate size, like a hammer not a candy cane

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8
Q

Body of pancreas

A

anterior to aorta/SMA/left renal vein/splenic vein

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9
Q

Tail of pancreas

A
  • posterior to stomach
  • medial to spleen
  • anterior to left kidney
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10
Q

Uncinate process of pancreas

A
  • small, curved tip at pancreas head
  • lies anterior to IVC & posterior to SMV
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11
Q

Portal confluence

A

SMV and splenic vein

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12
Q

Pancreatic ducts

A
  • duct of Wirsung
  • duct of Santorini
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13
Q

Duct of Wirsung

A
  • main pancreatic duct
  • extending the entire length of the pancreas
  • joins the CBD at the ampulla of vater
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14
Q

Duct of Santorini

A
  • accessory pancreatic duct in pancreatic head
  • anterior/superior head
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15
Q

Where does the tail of the pancreas point?

A

superiorly

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16
Q

Exocrine function

A
  • digestion!
  • acini cells produce pancreatic juice w/ enzymes
  • drain through the duct of wirsung & duct of santorini
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17
Q

Enzymes in acini cells

A
  • amylase: digests carbs
  • lipase: digests fats
  • sodium bicarbonate: neutralizes stomach acids
  • trypsin, chymotrypsin, carboxypolypeptidase: digests proteins
18
Q

What does the pancreatic juice do?

A
  • mix with bile from liver and release into duodenum through the sphincter of Oddi
  • chyme in duodenum instigates breakdown of various food parts
19
Q

Endocrine function

A
  • hormonal!
  • performed by Isles of Langerhans (insulin production)
  • released directly into bloodstream
  • produces special cells
20
Q

Special cells of endocrine function

A
  • alpha: glucagon
  • beta: insulin
  • delta: somatostatin
21
Q

Glucagon

A

promotes release of glucose by liver directly into bloodstream, which increases bloodsugar

22
Q

Insulin

A

released directly into bloodstream and stimulates body to use up glucagon to produce energy

23
Q

Somatostatin

A

restains insulin & glucose levels

24
Q

Vasculature: arterial supply

A
  • gastroduodenal artery & SMA supply head & neck
  • splenic artery & SMA supply blood & tail
25
Q

Vasculature: venous drainage

A
  • head & neck drains into portal vein & SMV
  • body & tail drains into splenic vein & IMV
26
Q

Vasculature: splenic artery branches

A
  • dorsal pancreatic artery, transverse pancreatic artery, greater pancreatic artery
  • gastric arteries
  • left gastroepiploic artery
27
Q

Left gastroepiploic artery (LGA)

A
  • part of splenic branches
  • runs in greater omentum along the greater curvature of the stomach to anast w/ R gastroepiploic artery
28
Q

Landmarks/branches

A
  • IVC/Aorta
  • Celiac axis (splenic artery, GDA)
  • SMA
  • SMV
  • Splenic vein
  • Portal veins
  • CBD
29
Q

Congenital variants

A
  • agenesis
  • pancreas divisum
  • ectopic pancreatic tissue
  • annular pancreas
  • cystic fibrosis
30
Q

Agenesis

A
  • congenital defect
  • body & tail do not form
  • hypertrophy (enlargement) of pancreatic head
31
Q

Pancreas divisum

A
  • rare
  • failure of normal fusion of ducts of Wirsung & Santorini (no communication)
  • fusion of dorsal & ventral pancreas buds does not occur
  • no communication btwn. ducts
  • duct of wirsung is small
  • duct of santorini drains majority of panc
32
Q

Why is pancreas divisum difficult for us to diagnose?

A

dorsal panc duct may be visable but communication with ventral duct may not be visable

33
Q

Ectopic pancreatic tissue

A
  • M/C pancreatic anomaly
  • intramural nodules, polyploid w/ central dimple, small (0.5 -2 cm)
  • found in stomach, duodenum, small & large bowel
  • acinar and ductal elements
  • better seen on CT or MRI
34
Q

Annular pancreas

A
  • rare
  • head of pancreas surrounds 2nd part of duodenum
  • assoc. w/ complete/partial duodenal atresia
  • M>F
  • can overlap post duodenal wall & form complete ring
  • susceptible to any panc diseases
35
Q

What can help prove a duodenum vs. a mass?

A

peristalsis (muscle contractions)

36
Q

Cystic fibrosis

A
  • autosomal recessive exocrine gland disorder
  • organs clogged w/ mucus secreted by exocrine gland
  • hyperechoic
  • small cysts may be present
  • GI tract has thick, irregular folds (donut sign)
37
Q

What are true pancreatic cysts?

A
  • congenital anomalies development of pancreatic duct
  • seen w/ Hippel-Lindau disease & ADPKD
  • more common in panc head
38
Q

What do true pancreatic cysts look like on a scan?

A
  • well defined, anechoic mass w. post enhancement & smooth borders
  • fluid in duct = enzymes
39
Q

Pseudocysts

A

pathology, not a variant

40
Q

Pancreas sonographic appearance

A
  • echogenicity >/= liver parenchyma
  • echotexture - minimally heterogeneous
41
Q

Pancreas plane differentiation

A
  • transverse plane = long axis
  • sagittal plane = short axis
  • Rt = head/IVD
  • Mid = body/aorta
  • Lt = tail & Lt. kidney (obscured by stomach)
42
Q

Relationship btwn. biliary system & pancreas

A
  • biliary duct adjacent to the pancreatic head
  • mass in pancreas can obstruct biliary tract
  • stone in duct (distal) can cause inflammation of pancreas

Abdominal II (4 decks)

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