Pancreas Flashcards
What are the segments of the pancreas?
Head, neck, body, tail, uncinate process
What is the pancreas location?
Retroperitoneal, posterior, closer to spine
Lies transverse in the body, extending from
The duodenum to splenic hilum
Location of GDA in relationship to pancreas
Anterior, lateral and enters the head of panc antero-superior
Location of CBD in relationship to panc
Postero-lateral, entering head of panc postero-superior
Where does the GDA arise from?
Common hepatic artery
Location of the neck of panc
Anterior to the PC
Anterior to the SMV
Location of the body of panc
Anterior to Splenic Vein
Anterior to SMA
Posterior to Stomach
Inferior to Splenic Artery
Location of tail of panc
Anterior to splenic vein
Close to spleen
Location of uncinate process of panc
Postero-medial portion of the head
Posterior to SMV and SMA
Anterior, medial to IVC
Pancreatic measurements
Head AP 2-3 cm
Body AP 1-2 cm
Tail AP 1-3 cm
Total length 17cm
What is the vasculature of the panc?
GDA, SMA, and splenic artery
What is the normal size of the duct of wirsung?
AP <2 mm
What is the duct of wirsung?
Pancreatic duct that leads to the duodenum at the ampulla of vater through the sphincter of oddi
Wirsung duct variant
Duct of santorini, accessory duct. Non-functional since bypasses ampulla of vater
As what kind of gland does the pancreas serve?
Exocrine- secretes enzymes through ducts
Endocrine- secretes hormones directly into blood stream
What percentage of panc is for digestion and why?
80%
Since its digestive enzymes amylase, lipase, and trypsin are released into the c loop of duodenum.
What are the functions of the enzymes produced by the panc?
Amylase- sugar/carb breakdown
Lipase- fatty splitting enzyme, most destructive, very toxic
Trypsin- protein breakdown
Endocrine function of panc
Hormone producing cells of panc are islets of langerhans or pancreatic islets
They create alpha, beta and delta cells
What do the cells of the endocrine function of panc produce?
Alpha cells produce glucagon
Beta cells produce insulin
Delta cells produce somatostatin
What kind of pancreatic congenital anomalies are there?
Congenital cysts
Cystic fibrosis
Pancreas divisum
Annular pancreas
Pancreatic neoplasm kinds
Adenocarcinoma
Serous cystadenoma
Mucinous cystadenoma and cystadenocarcinoma
Islet cell tumor
Multiple cysts in the panc are associated with?
Adult polycystic kidney disease and Von Hipple-Lindau Syndrome.
What is Cystic Fibrosis?
Exocrine gland disorder
Viscous secretions cause pancreatic dysfunction
U/S appearance
Increased echogenicity, glandular atrophy associated with fibrosis and fatty replacement and cysts due to ductal obstruction
What is pancreas Divisum?
Failure of the dorsal and ventral pancreatic buds to fuse during embrionic development
The smaller santorini’s duct drains the pancreatic body and tail (dorsal panc)
Suggested association with pancreatitis
What is annular pancreas?
Uncommon congenital anomaly wherein a ring of normal pancreatic tissue encircles the duodenum secondary to abnormal migration of the ventral pancreas
Suggested association with pancreatitis
What is Auto-digestion?
When the enzymes of the panc are active inside it and begin to eat away at the panc
Etiology of acute pancreatitis
Biliary tract diseases Chronic alcohol abuse Peptic ulcer Abdominal trauma Lupus- autoimmune disorder A venomous sting from a scorpion Infection such as mumps, hep a, b or salmonella Presence of a tumor (auto-digestion)
What are the clinical signs and symptoms of acute pancreatitis?
More common in men
Epigastric and back pain, can worsen after meal
Nause
Vomiting
Unexplained weight loss
Fever
Tachycardia
Severe cases can cause hypotension due to dehydration
In extreme cases, bleeding of panc can lead to shock
Pulmonary and renal failure
Lab signs of acute pancreatitis
Elevated amylase in the 1st 24 hrs, return to normal after 72 hrs
Elevated lipase after 48 hrs and continues to rise for 1-2 weeks
Elevated WBC
What are the complications of acute pancreatitis?
Pancreatic pseudocyst Peripancreatic fluid collection Phlegmon or phlegmatous pancreatitis Hemorrhagic pancreatitis Abscess Pseudoaneurysm
What is pancreatic pseudocyst?
Results from acute pancreatitis or flare ups of chronic pancreatitis
It is an accumulation of fluid and necrotic debris confined by retroperitoneum. This occurs in an attempt to wall off the panc solutions to prevent further tissue damage
Can form anywhere in the body where fluid traps
Most commonly found in lesser sac (between stomach and panc)
What is used to differentiate between cancer and pseudopancreatitis?
Normal serum amylase
What is chronic pancreatitis?
Irreversible destruction by repeated bouts of pancreatic inflammation
What causes chronic pancreatitis?
Alcoholism- most common cause Hereditary recurrent pancreatitis Cystic fibrosis High levels of calcium in blood High blood fat When digestive enzymes attacking and destroy the panc and nearby tissue. May also be triggered by one acute attack
What is the sonographic appearance of chronic pancreatitis?
Small, echogenic Microcalcifications Irregular contours Dilated duct of wirsung Bile duct dilation Pseudocyst formation Portal vein thrombosis
Lab signs of chronic pancreatitis?
Non specific
Later stages- endocrine and exocrine dysfunction
What is the treatment for chronic pancreatitis?
Whipple procedure
What is hemorrhagic pancreatitis?
Form of acute pancreatitis with significant fat necrosis leading to rupture of pancreatic vessels and secondary hemorrhage
Incidence: 2-5% of all acute pancreatitis cases
What is the clinical presentation of hemorrhagic pancreatitis?
Severe abdominal pain Nausea and vomiting Abdominal distention and varying degree of ileus Periumbilical ecchymosis (Cullen sign) Flank ecchymosis (grey-turner sing) Infrainguinal ecchymosis (fox sign)
Lab signs of hemorrhagic pancreatitis
Increased serum and urine amylase and serum lipase
Decreased hematocrit and serum calcium
What percentage of neoplasm in panc will be in the head?
70%
What is serous cystadenoma?
Aka microcystic cystadenoma
Benign
Associated with Von Hipple-Lindau syndrome
Well defined lobulated mass
Appearance varies from echogenic mass (microcystic) to a multicystic mass (small cysts)
Risk factors for pancreatic cancer
More common in men African American >30 years of age Smoker Fatty diet Chronic pancreatitis Cirrhosis or diabetes
Which is the most common pancreatic cancer and where does it arise from?
Adenocarcinoma
Acinar cells
Associated findings of adenocarcinoma
Bile duct dilation Courvoisier GB Dilated panc duct Pancreatitis Ascites Liver mets Lymphadenopathy Pseudocyst formation
What are other names for mucinous cystadenoma?
Cystadenocarcinoma, macrocystic cystadenoma
Sonographic appearance of mucinous cystadenoma
Well defined, multicystic mass Solid component (papillary projections)within cystic mass
What lab sign will be present with cystadenocarcinoma?
Increased CEA (carcino embryogenic antigen)
What kind of rumors can arise from islet cells?
Alpha cells: glucagononma
Beta cells: insulinoma
Delta cells: gastrinoma
Typically located in the pancreatic tail
Associated with MEN syndrome (multiple endocrine neoplasia)
Which is the most common islet cell tumor?
Insulinoma
Usually benign
Hyperglycemic symptoms due to hyperinsulinism
What is the second most common islet cell tumor?
Gastrinoma
Causing gastric and duodenal ulceration
Zollinger-Ellison syndrome is another name for it
Sonographic appearance of Zollinger-Ellison Syndrome
Round mass with variable echogenicity
Usually 1-2 cm in size
Lymphadenopathy, especially in periportal region
