Pancreas Flashcards
the head of the pancreas is the most _____ portion
inferior; lies in the C loop of the duodenum
the _____ of the pancreas is directly anterior to the portal-splenic confluence or superior mesenteric vein
neck
the _____ of the pancreas is the largest section of the gland
body
the _____ of the pancreas lies anterior to the left kidney and posterior to the left colic flexure and transverse colon
tail
what 2 ducts are seen in the pancreas?
duct of Wirsung and duct of Santorini
the duct of _____ is the primary duct extending the length of the pancreas; enters the medial second part of the duodenum with the CDB
Wirsung; should measure less and 2mm and tapers as it reaches the tail
the duct of _____ is a secondary duct that drains the upper anterior head; it enters the duodenum at the minor papilla about 2 cm proximal to the ampulla of Vater
Santorini
normal pancreas head to tail measure _____, head measures _____, neck _____, body _____, tail _____
15cm; 3cm; 1.5-2.5cm; 2-2.5cm; 1-2cm; decreases in size as you age
_____ of the body and tail, with hypertrophy of the pancreas head is a congenital defect
agenesis
_____ is a rare condition caused by the lack of fusion of the dorsal and ventral pancreatic buds; drainage of the dorsal and ventral pancreas is through the minor papilla
pancreas divisum
_____ is the most common pancreas anomaly, usually in the form of intramural nodules
ectopic pancreas tissue; tissue may be found in various places in the GI tract
_____ pancreas is a rare anomaly in which the head of the pancreas surrounds the second portion of the duodenum
annular; more common in males; may be associated with duodenum atresia
the pancreas is both a digestive ____ and hormonal _____ gland
exocrine (produce pancreatic juice); endocrine (controls the secretion of glucagons and insulin in the blood)
exocrine functions is performed by _____ of the pancreas; can produce up to 2L per day
acini cells; the enzymes of the pancreas juice that aid digestion includes lipase (digest fat), amylase (digest carbs), carbozypeptidase and trypsin (digest proteins)
the endocrine function is located in the _____ in the pancreas
islets of Landerhans; cells within the islets are called alpha (produce glucagons), beta (produce insulin), and delta (produce somatostatin) cells
a _____ level of twice normal usually indicates acute pancreatitis; as wall as urine amylase
serum amylase; other reasons could be chronic pancreatitis, obstruction of the prancreatic duct, perforated peptic ulcer, acute cholecystitis, and alcohol poisoning
the _____ test is performed to assess damage to the pancreas
lipase; rise in acute pancreatitis and carcinoma; lipase elevation persists longer than amylase
the _____ tolerance test if performed to discover whether there is a disorder of glucose metabolism
glucose; may be a decrease in blood sugar levels in tumors of the islets of Langerhans
_____ occurs when the pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts; when this occurs the pancreas tissue may be digested by its own enzymes
pancreatitis
____ pancreatitis is caused by the inflamed acini releasing pancreatic enzymes into the surrounding pancreatic tissue; hypoechoic (edema); borders irregular; head causes depression of IVC; parapancreatic fluid
acute; sudden onset of moderate to severe abdominal pain with radiation to back; nausea and vomiting; history of gallstones or alcoholism; mild fever; abdominal distention
the most common cause of pancreatitis in the united states is _____
biliary tract disease; second common is alcohol abuse
these extrapancreatic fluid collections occur within _____ from the acute onset of the pancreatitis and may resolve spontaneously
4 weeks
_____ are always acquired, they result from trauma to the gland or acute or chronic pancreatitis; defined as a collection of fluid that arises from the loculation of inflammatory processes, necrosis, or hemorrhage
pseudocyst; develops over 4 to 6 weeks after pancreatitis; well-defined mass, usually in area of pancreas, may have debris at bottom; develops when pancreatic enzymes escape from the gland and break down tissue to forma sterile abscess
the most common location of a pseudocyst is in the _____ anterior to the pancreas and posterior to the stomach
lesser sac; second most common is the anterior pararenal space
_____ pancreatitis is a rapid progression of acute pancreatitis with rupture of pancreatic vessels and subsequent hemorrhage; well defined homogenous mass in mass; foci of extravasated blood and fat necrosis are seen
hemorrhagic; decreased hematocrit and serum calcium levels; intense, severe pain radiating to back, with subsequence shock and ileus; hypotension
a _____ is an inflammation process that spreads along fascial pathways, causing localized ares of diffuse inflammatory edema of soft tissue that may proceed to necrosis and suppuration
phlegmon; appears hypoechoic with good through-transmission
the majority of patients develop _____ secondary to pancreatitis that develops from postoperative procedures; unilocular or multilocular and can spread superiorly into the mediastinum
abscess; hypotension; tender abdomen; hypoechogenic mass with smooth borders; thick walls; echo-free to echogenic
______ pancreatitis results from recurrent attacks of acute pancreatitis and causes continuing destruction of the pancreatic parenchyma; malabsorption; fatty stools; signs of diabetes; weight loss; jaundice
chronic; the ducts become obstructed with a build-up of protein plugs with resultant calcifications along the duct; small and fibrotic gland; irregular borders; mixed echogenicity; dilated pancreatic duct
_____ disease has cysts that vary from microscopic to several centimeters in diameter and have an epithelial lining; often found in patients with polycystic renal disease
autosomal dominate polycystic; well-defined mass with serous fluid
_____ is an autosomal dominant condition characterized by central nervous system and retinal hemangioblastomas, visceral cysts, pheochromocytomas, and renal cell carcinoma
Von Hippel-Liudau Disease; well-defined mass with thick fluid; calcifications; single or multiple; size varies from microscopic to several cm
_____ cysts of the pancreas result from the anomalous development of the pancreatic duct
congenital; usually multiple and range from small to 3 to 5 cm in size
______ is a hereditary disease that causes excessive production of thick mucus by the endocrine gland; most common pancreatic abnormality found is fatty replacement of pancreas
cystic fibrosis; well-defined mass with serous fluid; size varies; fibrous replacement will occur throughout the parenchyma
_____ cysts are microscopic sacs that may be congenital or acquired; often found in infants
true; well-defined mass with serous fluid; unilocular or multilocular
the most common primary neoplasm of the pancreas is _____; loss of normal pancreatic parenchyma; hypoechoic poorly defined mass; focal mass with irregular borders; enlargement of pancreas; if located in the head look for hydrops
adenocarcinoma; involves the exocrine portion of the gland; wight loss; nausea vomiting, stool changes, pain radiating to back, painless jaundice; matastasizes to lymph nodes, liver, lung, bone, duodenum, peritoneum, and adrenal gland
enlargement of the _____ in the pancreatic area may lead to encasement of the celiac axis or SMV artery
lymph node
dilation of the pancreatic and common duct is common with the _____ tumor
ampullary
what are the 2 types of cystic pancreatic neoplasms?
microcyctic (serous) adenoma and macrocystic (mucinous) adenoma
the _____ adenoma is one of the pancreatic lesions found in von Hippel-Lindau disease; vary from 1 to 20 mm
microcystic; well-defined tumors with external lobulation; cyst walls thicker than the membranes between miltilocular cysts; hypervascular
______ adenocarinoma is an uncommon, slow-growing tumor that rises from the duct as a cystic neoplasm; large cyst; significant malignant potential
macrocystic; more common in the tail and body; foci and calcification may be seen; smooth surfaced; irregular lobulated cystic tumor; hypoechoic mass; thick walls
_____ is the most common functioning islet cell tumor
insulinoma (B-cell tumor); hypoglycemic symptoms; palpitations; headaches; confusion; pallor; sweating; coma; small, well encapsulated, and hypervascular
______ is the second most common functioning islet cell tumor and produces the Zollinger-Ellison syndrome; caused by non-insulin secreting pancreatic tumors but secretes excessive amounts of gastrin
Gastrinoma (G-cell tumor); diarrhea; multiple; extrapancreatic; malignant
______ tumors have a tendency to present as large tumors in the head of the pancreas with high incidence of malignancy
nonfunctioning islet-cell tumors
______ is uncommon but primary tumors that can include melanomas, breast, gastrointestinal, and lung
metastasis
_____ are malignant neoplasms that rise from the lymphoid tissue; most frequent parapancreatic neoplasm
lymphomas; hypoechoic mass or with necrosis a cystic mass in the pancreas; multiple nodes are seen
