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Abdominal Sonography > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Is the pancreas encapsulated?

A

NO

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2
Q

Where does the pancreas lie in the abdomen?

A

Retroperitoneal

Between the duodenal loop and the splenic hilum

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3
Q

What are the different parts of the pancreas?

A

Head, uncinate process, neck, body, and tail

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4
Q

What is the exocrine function of the pancreas?

A

Secrete trypsin, lipase and amylase

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5
Q

What is the endocrine function of the pancreas?

A

Secrete insulin via islets of Langerhans

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6
Q

What is the normal size of the pancreas in AP dimension?

A

<3 cm

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7
Q

What overlies the anterior border of the pancreatic body and tail?

A

Posterior wall of the stomach

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8
Q

Where is the head of the pancreas?

A

Anterior to the IVC and medial to the duodenum

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9
Q

Where is the CBD in relation to the pancreas?

A

Posterior and lateral to the pancreatic head

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10
Q

Where is the gastroduodenal artery in relation to the pancreas?

A

Anterior and lateral to the pancreatic head

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11
Q

Where is the SMA/V in relation to the pancreas?

A

Posterior to the neck of the pancreas and anterior to the uncinate process

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12
Q

Where is the pancreatic tail located?

A

Anterior and medial to splenic hilum

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13
Q

Where does the aorta lie in relation to the pancreas?

A

Posterior to the body of the pancreas

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14
Q

What does the celiac axis divide into?

A

Left gastric artery then divides into the common hepatic artery and splenic artery

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15
Q

What does the common hepatic artery divide into?

A

Proper hepatic and gastroduodenal arteries

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16
Q

Where does the proper hepatic artery travel towards?

A

Travels superiorly toward the liver, anterior to the portal vein, and left of the bile duct

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17
Q

Where does the right gastric artery come from?

A

Proper hepatic artery

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18
Q

Where does the gastroduodenal artery travel?

A

Posterior to the first portion of the duodenum then anterior to head of pancreas

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19
Q

What does the GDA divide into?

A

Right gastroepiploic artery

Superior pancreaticoduodenal artery

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20
Q

Where is the SMA located?

A

Inferior to pancreas
Anterior to uncinate process
Anterior to 3rd portion of the duodenum

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21
Q

Where is the splenic vein located?

A

Posterior aspect of the pancreas

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22
Q

What 2 veins make up the main portal vein?

A

Superior mesenteric vein and splenic vein

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23
Q

Where is the SMV located?

A

Right of the SMA
Anterior to the 3rd portion of the duodenum
Anterior to uncinate process

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24
Q

What does the IMV drain?

A

Left lower quadrant sigmoid and descending colon into the splenic vein

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25
Q

Where does the CBD travel?

A

Posterior to 1st portion of the duodenum and head of pancreas
Right of main pancreatic duct

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26
Q

Where does the ampulla of Vater open into?

A

2nd portion of duodenum at major papilla

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27
Q

Where does the accessory pancreatic duct (duct of Santorini) open into?

A

2nd portion of duodenum at minor papilla

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28
Q

How many portions does the duodenum divide into?

A

4
1st and 3rd - transverse
2nd and 4th - longitudinal

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29
Q

At what size is the pancreatic duct considered abnormal?

A

> 2.0 mm

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30
Q

What structures are in contact with the pancreatic head?

A 
IVC
CBD
Ampulla of Vater
Gastroduodenal artery
Duodenal C loop (2nd portion)
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31
Q

What are the most common causes of acute pancreatitis?

A

Gallstones

Alcohol abuse

32
Q

What are sonographic findings of acute pancreatitis?

A

Enlarged hypoechoic gland

33
Q

What are some complications of acute pancreatitis?

A 
Pseudocyst formation
Abscess
Pancreatic necrosis
Hemorrhage
Venous hemorrhage
Pseudoaneurysm formation
34
Q

What is a pancreatic phlegmon?

A

Focal pancreatitis

Inflammatory mass formed by edema and leakage of pancreatic enzymes

35
Q

What are causes of chronic pancreatitis?

A 
Alcoholic chronic pancreatitis
Autoimmune
Hereditary
CF
Congenital abnormalities
Abdominal trauma
Idiopathic
36
Q

What are sonographic findings of chronic pancreatitis?

A 
Small and echogenic gland
Calcifications
Pancreatic duct dilatation
Bile duct dilatation
Portal vein thrombosis
37
Q

What diseases are multiple pancreatic cysts associated with?

A

Adult PCKD

Von Hippel-Lindau syndrome

38
Q

What are US findings of CF of the pancreas?

A

Increase pancreatic echogenicity
Gland atrophy
Fibrosis and fatty replacement
Cysts due to ductal obstruction

39
Q

What condition is associated with CF?

A

Meconium ileus

40
Q

What are pancreatic pseudocysts?

A

Accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum

41
Q

What causes pancreatic pseudocysts?

A 
Acute pancreatitis
Chronic pancreatitis
Pancreatic trauma
Pancreatic ductal obstruction
Pancreatic neoplasms
42
Q

Where in the retroperitoneum is the pancreas located?

A

Anterior pararenal space

43
Q

What is the most common cause of a pancreatic pseudocyst in children?

44
Q

What is a pancreas divisum?

A

Failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development which results in the smaller Santorini’s duct draining the pancreas

45
Q

What is an annular pancreas?

A

Congenital anomaly where the ventral pancreas encircles the second portion of the duodenum

46
Q

What may present as a “double-bubble” sign?

A

Annular pancreas - dilated stomach and duodenal bulb

47
Q

How do pts with pancreatic CA present?

A

Lymphatic and metastatic spread of tumor
Mean pt age 55yo
80% arise from pancreatic head

48
Q

What are sonographic findings of pancreatic adenoCA?

A

Solid hypoechoic mass

49
Q

What are associated findings of pancreatic adenoCA?

A 
Courvoisier's GB
Bile duct dilatation
Dilated pancreatic duct
Liver mets
Ascites
Lymphadenopathy
Pseudocyst formation
50
Q

What is the Whipple procedure?

A

Pancreaticoduodenectomy

Head of pancreas, portion of bile duct, the GB and duodenum are removed

51
Q

Are pancreatic serous cysteadenomas malignant?

A

NO

Formerly microcystic cystadenomas

52
Q

What do pancreatic serous cystadenomas look like on US?

A

Cluster of grape-like cysts

External lobulation

53
Q

What do mucinous cystic neoplasms look like on US?

A

Large multicystic mass with numerous septations and debris

54
Q

What is increased in mucinous cystic neoplasm?

A

CEA levels

55
Q

What are islet cell tumors associated with?

A

MEN-1

Von Hippel-Lindau disease

56
Q

What are the islet cell tumors?

A 
Insulinoma - most common
Gastrinoma - Zollinger-Ellison Syndrome
Glucagonoma
Vipoma
Somatostinoma
57
Q

What is Multiple Endocrine Neoplasia?

A

Inherited endocrine disorder
MEN type 1 - Wermer’s syndrome
MEN type 2 - Sipple’s syndrome

58
Q

What organs does MEN affect?

A 
Parathyroids
Pancreatic islet cells
Pituitary glands
Adrenal glands
Thyroid
59
Q

Where does amylase come from?

A

Digestive enzyme for carbs, produced by pancreas and salivary glands; also kidneys

60
Q

Head of pancreas is anterior to?

61
Q

Head of pancreas is medial to?

A

2nd portion of duodenum

62
Q

CBD is posterolateral to?

A

Head of pancreas

63
Q

GDA is anterolateral to?

A

Head of pancreas

64
Q

SMA and SMV are posterior to?

A

Neck of pancreas

65
Q

Uncinate process is posterior to?

A

SMA and SMV

66
Q

Aorta is posterior to?

A

Body of pancreas

67
Q

Celiac axis is superior to?

68
Q

Splenic vein is posteroinferior to?

69
Q

SMA and SMV are anterior to?

A

3rd portion of the duodenum

70
Q

SMV is to the right of?

71
Q

Stomach is anteromedial to?

A

Splenic hilum

72
Q

Stomach is anterior to?

A

Pancreas body and tail

73
Q

Tail of pancreas is posterior to?

74
Q

Tail of pancreas is anterior to?

A

Upper pole of left kidney

75
Q

Splenic artery is superior/anterior to?

Abdominal Sonography (12 decks)

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