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Abdomen Section 1 > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Pancreas Anatomy

A

retroperitoneal organ

lies posterior to the stomach, duodenum, proximal jejunum of the small bowel, also the transverse colon run horizontallyh acraoss the ab

contained in the anterior pararenal space

drapes across the mid aspect of the ab, just under the xyphoid process

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2
Q

pancreas segments

A

4 primary

head

neck

body

tail

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3
Q

pancreas head

A

cradled in the C-loop of the duodenum,

IVC posterior

GDA anterolateral border

CBD posterior and lateral

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4
Q

Pancreas Uncinate process

A

located anterior to the IVC and posterior to the SMV

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5
Q

Pancreas vascular landmarks

A

aorta

IVC

SMA

SMV

splenic vein

portal vein

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6
Q

Main pancreatic duct

A

duct of Wirsung

courses entire lenght of pancreas

enters duodenum via the ampulla of vater

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7
Q

pancrease accessory duct

A

Duct of Santori

drains the anterior segment of the head

>2mm internal measurment is abnormal

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8
Q

Vascular structure pancreatic head

A

right lateral to SMV

anterior to IVC

inferior to portal vein

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9
Q

Vascular structure Uncinate process

A

posterior to SMV

may completely surround SMV

anterior to aorta

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10
Q

vascular structure neck

A

anterior to portal confluence

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11
Q

vascular structure body

A

anterior to SMV

splenic vein

SMA

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12
Q

vascular structure tail

A

splenic vein marks posterior border

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13
Q

Duct of Wirsung

Main pancreatic duct

A

primary duct extending entire length of pancreas

seen as 2 echogenic lines especially in neck/body

receives tributaries from the lobules

enters the duodenum with the common bile duct at the ampulla of vater

sphincter of Oddi-small muscle that guards the ampulla of vater

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14
Q

duct of santorini

secondary duct

A

drains the upper anterior head

endters the duodenum at the minor papilla

2cm proximal to the ampulla of vater

just draions the head

not normally seen on ultrasound

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15
Q

Common bile duct

CBD

A

runs inferior in the free edge of the lesser omentum to level of the duodenum

travels posterior to the first portion of duodenum where it forms a common trunk with the pancreatic duct and opens into the duodenum

ducts have smooth muscle surrounding them to make it easier to transport the pancreatic fluid

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16
Q

Pancrease body

A

longest segment

antrum of the stomach lies anterior

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17
Q

pancreas tail

A

most difficult to visualize

course left lateral aspect of the body, extending to the hillum of the spleen

splenic vein serves as the posterior border

left kidney is posterior to the tail

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18
Q

Pancrease vascular supply

A

supplied by the splenic artery and the pancreaticoduodenal arteries

veinous drainage is through tributaries of the splenic and SMV

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19
Q

Panreatic congential anomilies

A

Agenisis

pancreas divisum

ectopic

annular

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20
Q

Agenesis

A

missing body and tail with a large (hypertropic) head

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21
Q

pancreas divisum

A

lack of fusion of the dorsal and ventral pancreatic buds

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22
Q

ectopic

A

most common anomalie

pancreatic nodules are found throughout the GI tract

.5-2.0cm in size

acute pancreatitis and tumor may be found in these nodules

23
Q

annular

A

head of the pancreas surrounds the second portion of the duodenum

male prevalence

24
Q

pancreas functions

A

Exocrine

Endochrine

25
Q

Exocrine

A

digestive function

26
Q

Acini cells

A

produces up to 2 liters of pancreatic juice per day

arranged in sac-like structures

juice converges into the two ducts which drain the juice into the duodenum for digestion

pancreatic juice enzymes capable of completing almost all of the digestion of our food

27
Q

Excocrine function

A

produces pancreatic juice to aid in digestion

enzymes

lipase

trypsin

amylase

nucleases

sodium bicarbonate

28
Q

lipase

A

breaks down fats

29
Q

trypsin

A

digest proteins

30
Q

amylase

A

digest carbohydrates

31
Q

nucleases

A

digest nucleic acids

32
Q

sodium bicarbonate

A

neutralizes gastric acids

ph of juice needs to be almost neutral for best action

33
Q

Exocrine enzyme triggers

A

chyme (partially digested food) in the duodenum triggers release of hormones that start pancreatic juice formation

gastrin

cholecystokinin

aceytlcholine

secretin (sodium bicarbonate)

these now enter duodenum after allowing the sphincter of Oddi to relax

34
Q

Endocrine function

A

produces glucagons and insulin

35
Q

insulin production

A

alpha, beta and delta cells within the islets of Langerhans

36
Q

Insulin

A

regulates the metabolism of sugars

insufficient leads to diabetis mellitus

hormone that causes glycogen formation from teh glucose stored within the liver

37
Q

glucagon

A

changes the forms of sugar

hormone that causes our cells to release glucose to meet the bodies energy needs

stimulates the liver to convert glycogen to glucose and increase sugar levels

38
Q

gastrin

A

autoregulator

inhibits the production of both insulin and glucagon

39
Q

Beta cells

A

most prevalent cells

produces insulin

enables cells within insulin receptors to take up clucose which lowers blood sugar

40
Q

alpha cells

A

produce glucagon

41
Q

delta cells

A

smallest number of cells

produce gastrin

42
Q

Amylase

A

digestive enzyme produced by the pancreas as well as the parotid glands, bowel and gynecological system

certain types of pancreatic disease escapes into the surrounding tissue causing death of tissue, resulting in severe pain and inflammation

43
Q

ANypase lab tests

A

blood test twice normal usually indicates acute pancretitis, or obstruction of panc duct, acute cholecystitis, perforated peptic ulcer, alcohol poisoning

differentials include mumps, ischemic bowel disease, pelvic inflammatory disease

44
Q

urine amylase

A

may be elevated in pancreatitis

diseases not affectin the pancreas may cause an elevation of blood serum amylase with elevation

45
Q

Lipase

A

enzyme excreted only by the pancreas

small amounts pass into the blood

used to assess damage to the pancreas

rises at teh same rate as amylase, but persists for a longer period of time

46
Q

lipase differentials

A

obstruction of panc duct

pancreatic CA

acute cholecystitis

47
Q

glucose

A

controls the blood sugar lever in the body

GTT performed to asses a disorder of glucose metablolism

48
Q

elevated Glucose differentials

A

diabetes

chronic liver disease

overactivity of several of the endocrine glands

49
Q

decreased glucose differential

A

tumor of the islets of langerhans

50
Q

normal pancreatic tissue sonographically

A

echogenicity is caompared to liver

echo intensity is slightly less than surrounding retroperitoneum and slightly greater than liver

texture depends on amount of fat dispersed between the lobules

fat is strongly echogenic so may be isoechoic with surround retroperitoneal fat

echotexture-homogeneous

surface smooth to slightly lobular

51
Q

Scanning pancreas

A

NPO 6-8 hrs

2.5-5Mhz adults

5-7Mhz peadiatrics

left lobe for window

deep inspiration to allow liver to displace inferior

supine, oblique and upright positions (distends vascular structures) also valsalva

52
Q

Pancread normal size

A

head <=3 cm

Neck <=2.5 cm

Body <=2.5 cm

tail <=2 cm

53
Q

pancrease normal echogenicity

A

>liver

<>spleen (depends on fibrous/fatty content)

Abdomen Section 1 (10 decks)

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