Pancreas - Part 2 Flashcards
What are the 2 ducts of the pancreas?
- Duct of Wirsung
2. Duct of Santorini
What is the primary duct of the pancreas?
Duct of Wirsung
What does the Duct of Wirsung join to?
Joins the distal CBD entering the descending portion of the duodenum
through the ampulla of Vater
What is the secondary duct of the pancreas?
Duct of Santorini
What does the Duct of Santorini do?
Drains the upper anterior portion of the pancreas
Where does the Duct of Santorini enter the duodenum?
At the minor papilla approximately 2cm proximal to the
ampulla of Vater
What are 4 congenital anomalies of the pancreas?
- Pancreatic divisum
- Annular pancreas
- Ectopic pancreatic tissue
- Cystic fibrosis
Pancreatic divisum
Failure of the normal fusion of the ducts of Wirsung and Santorini
What drains the majority of the pancreas?
Duct of Wirsung
What is pancreatic divisum associated with?
Pancreatitis
What is annular pancreas caused by?
The failure of a normal regression of the left ventral bud
Is annular pancreas more common in males or females?
Males
Where can ectopic tissue of the pancreas by located? (3)
- Stomach
- Duodenum
- Small or large intestines
How does ectopic pancreatic tissue look like?
Small, polypoid appearing mass
Is ectopic pancreatic tissue more common in males or females?
Males
Cystic fibrosis
Autosomal recessive exocrine gland disorder in which organs become clogged with mucus secreted by the exocrine glands
What happens to the pancreas as a result of fibrosis?
It becomes hyper echoic
- small cysts may be present
What is the size of the pancreatic head?
< 3cm
What is the size of the pancreatic neck?
< 2.5cm
What is the size of the pancreatic body?
< 2.5cm
What is the size of the pancreatic tail?
< 2cm
What is the US appearance of the pancreas? (4)
- Smooth or coarse homogeneous parenchyma
- Adult pancreas is either isoechoic or hyper echoic when compared to the normal liver
- May appear hypo echoic in young children and hyper echoic in older adults
- May demonstrate a cobblestone appearance
What is the US appearance of the pancreatic duct? (2)
- Anechoic non-vascular tubular structure
2. Smooth parallel hyper echoic walls measuring 3mm in the head/neck and 2mm in the body
What can be used to decrease artifacts in the pancrease? (2)
- Harmonics
- Decreasing dynamic range
- compression
What are 9 indications for a pancreas US?
- Severe epigastric pain
- Elevated pancreatic enzymes
- Biliary disease
- Abdominal distention with hypoactive bowel sounds
- Pancreatitis
- Weight loss
- Anorexia
- Pancreas neoplasm
- Evaluate mass from previous imaging study (i.e., CT).
What is the normal range for serum amylase?
25-125U/L
What does serum amylase increase with? (4)
- Acute pancreatitis
- Pancreatic pseudocyst
- Intestinal obstruction
- Peptic ulcer disease
What does serum amylase decreases with? (2)
- Hepatitis
2. Cirrhosis
How long does serum amylase remain elevated in episodes of acute pancreatitis?
24 hours
