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Pancreas Flashcards

1
Q

What structures is the neck of the pancreas anterior to?

A

SMV and PC

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2
Q

What structure is the neck of the pancreas inferior to?

A

CHA

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3
Q

What structure in the body of the pancreas posterior to?

A

Stomach

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4
Q

What structures is the body of the pancreas anterior to? (4)

A
  1. Aorta
  2. LRV
  3. SV
  4. SMA
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5
Q

What structures is the body of the pancreas interior to? (2)

A
  1. Celiac axis

2. SA

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6
Q

What structure is the tail of the pancreas anterior to?

A

Left adrenal gland

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7
Q

Is the tail of the pancreas located to the right or left of the aorta?

A

Left

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8
Q

Is the splenic artery located on the posterior superior or posterior inferior border of the pancreas tail?

A

Posterior superior border

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9
Q

Is the splenic vein located on the posterior superior or posterior inferior border of the pancreas tail?

A

Posterior inferior border

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10
Q

Where does the tail of the pancreas extend to?

A

Splenic hilum

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11
Q

What is the most difficult area of the pancreas to visualize?

A

Tail

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12
Q

Why is the tail of the pancreas the hardest to see?

A

Usually obscured by bowel gas

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13
Q

What is the pancreas formed from?

A

Ventral and dorsal diverticula of the primitive foregut

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14
Q

What buds originate from the dorsal aspect of the duodenum?

A

Dorsal buds

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15
Q

What buds originate from a common diverticula with the primitive CBD?

A

Ventral bud

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16
Q

What cavity does the pancreas lye in?

A

Retroperitoneal

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17
Q

Does the pancreas have a capsule?

A

No

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18
Q

What quadrants does the pancreas lie in?

A

Epigastrium and left hypochondrium

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19
Q

What structures are position anterior to the pancreas?

A

Lesser sac, stomach and left lobe of the liver

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20
Q

What space does the pancreas lie in?

A

Anterior pararenal space

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21
Q

What portion of the duodenum does the pancreas sit in and attach to?

A

Descending “c” shape aspect of the duo

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22
Q

A shorter duodenum would cause the pancreas head to be located more anterior or posterior?

A

Anterior

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23
Q

A longer duodenum would cause the pancreas head to be located more anterior or posterior?

A

Posterior

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24
Q

What position does the pancreas lie?

A

Horizontal oblique but varies with body habitus

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25
Q

A thin pt (less retroperitoneal fat) would have the head and tail more what, to the body and neck?

A

Posterior

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26
Q

How does an increased amount of retroperitoneal fat cause the head and tail of the pancreas to move?

A

More anterior so all parts of the pancreas are at the same length

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27
Q

What happens to the pancreas as you age?

A

Shrinks

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28
Q

What is the length of the pancreas?

A

12-15cm in length

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29
Q

How does the pancreas appear in children?

A

Enlarged

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30
Q

How does the pancreas appear in the elderly?

A

Atrophied to a thin strip of tissue (heavily fibrosed)

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31
Q

How should the outline of the pancreas always appear?

A

Smooth regardless of echogenicity

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32
Q

What would be indicative of an abnormality in the pancreas?

A

If there is focal enlargement

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33
Q

List the dimensions of each segment of the pancreas

A

Head: 2-3cm
Neck: 1.5-2.5cm
Body: 2-3cm
Tail: 1-2cm

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34
Q

What are the common shapes that describe the pancreas?

A

Comma, sausage dumbbell and tadpole shaped

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35
Q

How is the head of the pancreas located compared to the duodenum?

A

Medial to the “C” loop

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36
Q

Is the pancreas head located anterior or posterior to the IVC?

A

Anterior

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37
Q

What is the location of the pancreas head in comparison to the LRV?

A

Anterior or superior

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38
Q

What is the located of the pancreas head in comparison to the portal confluence?

A

Lateral

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39
Q

What is the located of the pancreas head in comparison to the PV?

A

Inferior

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40
Q

What is the location of the pancreas head in comparison to the stomach Antrum?

A

Posterior

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41
Q

What is the location of the pancreas head in comparison to the CHA?

42
Q

What part of the pancreas head holds the GBD?

A

Anterolateral

43
Q

What portion of the pancreas head holds the CBD?

A

Posterolateral

44
Q

What is the uncinate process?

A

Posteromedial projection of the pancreas head

45
Q

Where is the uncinate located?

A

Posterior SMV

If large enough posterior to SMA

46
Q

What is another name for the main pancreatic duct?

A

Duct of wirsung

47
Q

How long do the duct of wirsung?

A

Extends the whole length of the pancreas

48
Q

After the main pancreatic duct joins the CBD what does it enter?

A

Ampulla of vater

49
Q

What should the main pancreatic duct diameter not exceed?

50
Q

What is the accessory duct called?

A

Duct of santorini

51
Q

Where does the duct of santorini enter the duodenum?

A

2cm prox to the main duct at the minor duodenal papilla

52
Q

What % of the pancreatic tissue (ductal and acini) is part of the exocrine system?

53
Q

What small glands join together to form a “grape-like” cluster?

A

Acinus glands

54
Q

How much pancreatic juice is produced per day?

55
Q

What is pancreatic juice composed of?

A

Digestive enzymes, water, bicarbonate and salts

56
Q

What are some enzymes produced by the pancreas? (3)

A
  1. Amylase
  2. Lipase
  3. Sodium bicarbonate
57
Q

What is the function of amylase?

A

Acts on carbohydrates (starches)

58
Q

What is the function of lipase?

A

Acts on fats

59
Q

What is the function of sodium bicarbonate?

A

Neutralizes hydrochloric acid

60
Q

What triggers the release of pancreatic juices?

A

Trigger found in the duo released by hormones (released into blood stream and carried to liver

61
Q

What are 2 hormones released by the duodenum?

A
  1. Secretin

2. Pancreozymin/cholecystokinin

62
Q

What is the function of secretin?

A

Stimulate production of sodium bicarbonate in pancreatic tissue

63
Q

What is the function of pancreozymin/cholecystokinin?

A

Stimulates Alina’s cells to produce digestive enzymes

64
Q

What are the 3 types of endocrine hormones related by the pancreas?

A
  1. Alpha
  2. Beta
  3. Delta
65
Q

Where are the hormones produced in the pancreas?

A

Islets of langerhans - more numerous in pancreatic tail

66
Q

Describe the alpha hormone

A

15-20% of cells

Increase blood sugar levels by stimulating the liver to convert glycogen to glucose

67
Q

What does alpha hormone produce?

68
Q

Describe the beta hormone

A

60-70% of cells
Influences body to take up sugar from the bloodstream
Lowers blood sugar levels

69
Q

What does the beta hormone produce?

70
Q

What is the function of the delta hormone?

A

Inhibits production of insulin and glucagon

71
Q

What does the delta hormone produce?

A

Somatostatin

72
Q

Side notes…under endocrine section….

A

It is thought that an inhibiting factor is secreted by the same cells that secrete exocrine enzymes

Prevents trypsin and chymotrypsin from auto digesting the protein in cell walls of the pancreas

With injury or dx the inhibiting factors are unable to prevent the activation of proteolytic enzymes

73
Q

What is the function of the enzyme is serum amylase?

A

Aids in carbohydrate digestion

74
Q

What can cause serum amylase to leak into the tissue spaces and abdomen?

A

Obstruction of the duct or necrosis of tissue

75
Q

When do levels of serum amylase increase following incident? How long can they persist?

A

3-6 post incident

Persist for 24hrs

76
Q

Is serum amylase specific for pancreatitis?

77
Q

What are the normal levels of serum amylase?

A

Less then 70 u/dl

78
Q

When are levels of lipase increased?

A

In inflammatory conditions and some neoplasms

79
Q

How long can levels of lipase stay elevated for?

A

Up to 14 days after amylase has dropped

80
Q

What is the normal valve of lipase?

A

Less then 1.5 u/dl

81
Q

What is the function of the glucose enzyme?

A

Increases glucose metabolism

82
Q

What enzyme is only secreted from the pancreas?

83
Q

What causes an increase of glucose?

A

Diabetes, chronic liver and pancreatic dx and overactivity of several endocrine glands

84
Q

What causes glucose levels decrease?

A

Tumours of islets of langerhans and hypoglycemia

85
Q

What are the 2 glucose tests that can be preformed? Describe them

A
  1. Blood glucose- fasting blood sugar (high or low)

2. Glucose tolerance- measure body ability to process sugar

86
Q

What 2 ways can the glucose oral test be taken?

A
  1. Oral glucose test- normal is the return to the fasting state within 2 hours
  2. Intravenous- normal is a return to the fasting in 1 hour
87
Q

How much urine amylase is in the body?

A

Parallel levels found in blood

88
Q

Do levels of urine amylase return to normal quicker or slower than serum levels?

89
Q

When do levels of urine amylase remain elevated? For how long?

A

Elevated for 7-10days in chronic and acute pancreatitis

90
Q

Can serum amylase be tested and come back normal but urine amylase come back positive?

A

Yes - since it take the urine amylase longer to diminish

91
Q

Where does the pancreas get it blood supply from?

A

Pancreaticoduodenal arteries and branches of the splenic artery

92
Q

What part of the pancreas does the anterior and inferior pancreaticoduodenal arteries supply?

A

Head of the pancreas

Part of the duodenum

93
Q

What parts of the pancreas does the splenic artery supply?

A

Body and tail

94
Q

What is patient prep for imaging the pancreas?

A

NPO 6-12 hours including no gum chewing or smoking

95
Q

What time of day should the exam be scheduled for? Why?

A

Morning because air is ingested through talking and swallowing

96
Q

Why should the pancreas be one of the first organs scanned?

A

To avoid gas moving into the epigastric area

97
Q

What structure should you use as a window to visualize the pancreas?

98
Q

What may help visualize the pancreas head when scanning?

A

Fluid filled duodenum- ingestion of water through a straw

99
Q

What should be the sonographic appearance of the pancreas?

A

Homogeneous appearance- can look slightly coarser then the liver
Variable echogenicity depending on age and body habitus
Generally isoechoic to the liver or slightly less echogenic

100
Q

How does the pancreas compare to the liver echogenicity in a child?

A

Less echogenic

101
Q

What is the sonographic appearance of the pancreatic duct?

A

Seen as a double parallel line surrounded by pancreatic tissue

102
Q

What structure might mimic the appearance of the main pancreatic duct?

A

Collapsed pylorus wall may lay across pancreas

Abdomin And Superficial Structures (12 decks)

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