Pancreas Flashcards
The head of the panc is ___ to the IVC
Anterior
GDA and CBD location to the panc head
GDA is ant lat
CBD is post lat
The head of the pan is ____ to the 2nd pt of duodenum
Medial
The CBD is ___ to the head of the panc
Posterior lateral
The GDA is ___ to the head of the panc
Anterior lateral
The SMA and vein are ___ to the neck of the panc
Posterior
The uncinate process is ___ to the SMA and vein
Posterior
The aorta is __ to the body of the panc
Posterior
The celiac axis arises from the aorta ___ to the panc
Superior
The GDA and CBD run ____ to the 1st pt of the duodenum
Posterior
The splenic vein is ___ to the panc
Posterior inferior
The SMA arises from the aorta __ to the pancreas
Inferior
The SMA and vein are ___ to the uncinate process
Anterior
The SMA and vein are ___ to the third pt of the duodenum
Anterior
The SMV is to the ___ of the SMA
Right
The PV is the result of the combination of the ___ and the ___
SMV and splenic vein
Courvoisier Law
Enlg gb with palp mass is suggestive of pancreatic cancer
Islet cell tumor
Small, endocrine tumor, usually in tail.
MC benign tumors, some malignant
MC insulinoma: hyperinsulinism & hypoglycemia
2nd MC gastrinoma: assoc with gastric hypersecretions and peptic ulcer disease
Functioning
Nonfunctioning
Panc pseudocyst
Collection of panc fluid encapsulated by fibrous tissue,
Caused by acute pancreatitis, chronic pancreatitis, trauma, panc cancer
Mc in panc, intraperitoneal, retroperitoneal, intraparenchymal, thorax
Pancreas
Retroperitoneal gland bound ant by the stomach and duodenum, and post by the pre vertebral vessels
Located in the anterior pararenal space
Horseshoe, dumbbell, comma shape.
SMV courses ___ to the uncinate process
Anterior
Panc neck is ____ to the portosplenic confluence
Anterior
Panc body is ___ to SMA, Aorta, and splenic vein
Anterior
Panc body is ____ to stomach
Posterior
Panc body is ____ to splenic artery
Inferior
Panc tail is ____ to left kidney
Anterior
Panc tail is ___ to splenic vein
Anterior lateral
Panc tail is ____ to the stomach and splenic artery
Posterior
Normal length of pancreas
12-18cm L
Head is 2.3-3.5 cm
Panc is ___ to PV
Inferior
Blood supply to pancreas and drainage
Splenic artery, pancreaticoduodenal arteries
SMV drains to splenic vein.
Panc ducts
Main pancreatic duct/duct of Wirsung < 2 mm
Accessory duct/ Duct of Santorini
Endocrine function
Secretion of insulin, glucagon, and somatostatin
by cells in the islet of Langerhans
Exocrine function
Secretion of digestive enzymes (amylase, lipase, carboxypeptidase, trypsin, chymotrypsin
by the acini cells
Pancreatic enzymes
Amylase, lipase, carboxypeptidase, trypsin, chymotrypsin, sodium bicarbonate.
Amylase
Breaks down carbs
Lipase
Breaks down fat
Carboxypeptidase, chymotrypsin, and trypsin
Breaks down protein into amino acids.
Sodium bicarbonate
Neutralizes stomach acid
Nucleasis
Breakdown of nucleic acid
Panc lab values
Amylase, lipase, steatorrhea (fat poo), blood glucose, bilirubin
Alpha cells produce
Beta cells produce
Delta cells produce
Glucagon
Glucose
Somatostatin
Pancreatitis lab
Amylase and lipase inc. amylase dec 48-72 hours later while lipase remains elevated for up to 14 days.
MC congenital panc anomaly
Ectopic tissue
Congenital anomalies
Ectopic tissue: usually in GI tract
Annular pancreas (panc surrounds duodenum): donut shape. Assoc with duodenal atresia
Pancreas divisium (fusion failure)
Pancreatic cyst (PCD)
Cystic fibrosis (inc exocrine secretion)
Cystic Fibrosis
Hereditary, die around 40, increased mucous secretion of exocrine gland
Affects pancreas lungs intestines and biliary tract
Echogenic hetero small pancreas.
Pancreatitis
Inflammation of pancreas. Caused by bile reflux, hypersecretion and obstruction, alcohol, duodenal reflux
Acute pancreatitis
Cause: biliary tract disease #1, alcohol abuse #2
Pain, fever, n/v, pain after large meal or after alcohol binge.
Don’t give water to pancreatitis bc causes pain. Sitting up relieves.
Enlarged hypochoic with large pancreatic duct. Hetero panc.
Inc serum amylase
Complications of acute pancreatitis
Panc abscess
Dehydration (renal failure)
Pulmonary edema (resp distress)
Chronic pancreatitis
Pseudocyst: 20%, contains panc juice, blood, debri. Enzymes escape & digest surrounding tissue and becomes walled off area
Hemorrhage
Phlegmon: inflamed spread diffuse pus
Biliary obstruction
Duodenal obstruction
Pseudoaneurysm
Pseudocyst
20%, contains panc fluid encapsulated by fibrous tissue
Caused by pancreatitis, trauma, and panc cancer
MC in lesser sac, pancreas, also in peritoneal cavity, within or near panc, liver/spleen/kidney, thorax
Thick borders, fluid filled, debri, septations, ca+
May spontaneous regress, may rupture and 50% die,
Hemorrhagic Pancreatitis
Panc enzymes suddenly escape into glandular tissue leads to rupture of panc vessels and hemorrhage
Intense pain, pain radiating to back, shock, ileus, dec hematocrit, hypotension, resp distress, metabolic acidosis
Homo mass in panc. Gets cystic with age.
Phlegmon
Severe form of acute panc, spread of inflammation outside of gland to soft tissue. Edema hypo
Collection of necrotic and adematous peripancreatic tissue
Abscess
Complication of panc with tissue necrosis.
Fever, chills, wbc inc
Dirty shadow.
Chronic pancreatitis
Repeated attacks of pancreatitis. Associated with alcohol abuse, usually males, inc risk for pancreatic cancer.
Epigastric pain, back pain, n/v, jaundice, fat poo, flatulence, wt loss, diabetes, obstruction
Amylase and lipase may not be elevated. Will have steatorrhea, abnl glucose, and inc bilirubin with obstruction.
Hyperechoic, small, hetero, panc ductal dilatation, ca+, irregular borders, pseudocyst formation
May be focal hyperechoic
Cystic diseases
ADPKD
Von Hippel Lindau Syndrome
Fibrocystic disease
True cyst
Acinar Cell Adenocarcinoma
MC 90% panc cancer. Exocrine part.
Head 60-70%, body 20-30%, tail 5-10%
Diffuse hetero
Back pain, epigastric pain, anorexia, wt loss, jaundice, n/v, stool changes, weak, new onset of diabetes, 80-85% with mets.
Hypo mass, irreg borders, big panc, dilated duct, hetero panc., liver mets, ascites, lymphadenopathy, pseudocyst formation
2-3 month survival
Double duct sign in panc cancer
Dilated panc duct and CBD
Macrocystic Adenoma/ Mucinous Cystadenocarcinoma
Rare, significantly malignant potential, slow growing & better prognosis
Tail 60%
Large cyst, 2-20cm, complex, ca+, with or without septations.
Microcystic Adenoma / Serous Cystadenoma
Rare, benign, assoc with Von Hippel Lindau
MC in panc body and tail
Echogenic mass containing Small cysts.
Islet Cell Tumor
MC benign tumor of panc but may be malignant. Does not mets. Usually in body & tail. Slow growing.
Functional vs Nonfunctional
MC insulinoma & presents with hypoglycemia. Small hypo. Usually fat people from overeating hypoglycemic episodes.
Functional Islet Cell Tumor
MC functional, body & tail.
Insulinoma MC 60%, benign
Gastrinoma 18%, usually malignant
Non-Functioning Islet Cell Tumor
92% malignant, tail
Easier to detect bc slow growing and symptoms don’t start until they’re large.
Homo, hypo, solitary, large are hyper and Ca+, necrotic areas suggest malignancy
Panc mets
Rare, primary melanoma, GI, breast, lung
Panc transplant
Used to reverse complications of diabetes
In iliac fossa
Acute rejection: patchy areas of dec echoes, hypo, inc size, ductal dilatation, high RI & hetero panc.
Chronic rejection: inc echoes, dec size, RI > .8
Complications: type 1 diabetes, vascular thrombus, pseudoaneurysm, arterio-venous fistula, abscess, pancreatitis, hematoma, lymphocele, urinoma, pseudocyst, ascites, anastomotic strictures
Norm Doppler RI should be <.7
Solid panc mass evaluate
Liver for mets, Biliary tree and panc duct for dilatation, regional lymphadenopathy, PV and splenic vein for thrombus
Panc head is ___ to portal vein
Inferior to
Pancreatic divisun
2 panc ducts not fused
Panc fail to fuse
MC variant
Surgery of choice of panc cancer
Whipple procedure. Remove part of panc.
MC panc Cancer
Adenocarcinoma
Usually in head
Hypo mass
Risks: chronic pancreatitis, smoking, high fatty diet, diabetes
CT image stages Cancer
Look for liver mets and lymphadenopathy
Duodenum encircles
Head of panc
Splenic vein ____ to panc
Posterior & inf/caudal to panc.
IVC _____ to panc head
Posterior
