Pancreas - Part 2

Question 1

What are the 2 ducts of the pancreas?

Answer 1

1. Duct of Wirsung

2. Duct of Santorini

Question 2

What is the primary duct of the pancreas?

Answer 2

Duct of Wirsung

Question 3

What does the Duct of Wirsung join to?

Answer 3

Joins the distal CBD entering the descending portion of the duodenum
through the ampulla of Vater

Question 4

What is the secondary duct of the pancreas?

Answer 4

Duct of Santorini

Question 5

What does the Duct of Santorini do?

Answer 5

Drains the upper anterior portion of the pancreas

Question 6

Where does the Duct of Santorini enter the duodenum?

Answer 6

At the minor papilla approximately 2cm proximal to the

ampulla of Vater

Question 7

What are 4 congenital anomalies of the pancreas?

Answer 7

1. Pancreatic divisum
2. Annular pancreas
3. Ectopic pancreatic tissue
4. Cystic fibrosis

Question 8

Pancreatic divisum

Answer 8

Failure of the normal fusion of the ducts of Wirsung and Santorini

Question 9

What drains the majority of the pancreas?

Answer 9

Duct of Wirsung

Question 10

What is pancreatic divisum associated with?

Answer 10

Pancreatitis

Question 11

What is annular pancreas caused by?

Answer 11

The failure of a normal regression of the left ventral bud

Question 12

Is annular pancreas more common in males or females?

Answer 12

Males

Question 13

Where can ectopic tissue of the pancreas by located? (3)

Answer 13

1. Stomach
2. Duodenum
3. Small or large intestines

Question 14

How does ectopic pancreatic tissue look like?

Answer 14

Small, polypoid appearing mass

Question 15

Is ectopic pancreatic tissue more common in males or females?

Answer 15

Males

Question 16

Cystic fibrosis

Answer 16

Autosomal recessive exocrine gland disorder in which organs become clogged with mucus secreted by the exocrine glands

Question 17

What happens to the pancreas as a result of fibrosis?

Answer 17

It becomes hyper echoic

- small cysts may be present

Question 18

What is the size of the pancreatic head?

Answer 18

< 3cm

Question 19

What is the size of the pancreatic neck?

Answer 19

< 2.5cm

Question 20

What is the size of the pancreatic body?

Answer 20

< 2.5cm

Question 21

What is the size of the pancreatic tail?

Answer 21

< 2cm

Question 22

What is the US appearance of the pancreas? (4)

Answer 22

1. Smooth or coarse homogeneous parenchyma
2. Adult pancreas is either isoechoic or hyper echoic when compared to the normal liver
3. May appear hypo echoic in young children and hyper echoic in older adults
4. May demonstrate a cobblestone appearance

Question 23

What is the US appearance of the pancreatic duct? (2)

Answer 23

1. Anechoic non-vascular tubular structure

2. Smooth parallel hyper echoic walls measuring 3mm in the head/neck and 2mm in the body

Question 24

What can be used to decrease artifacts in the pancrease? (2)

Answer 24

1. Harmonics
2. Decreasing dynamic range
   - compression

Question 25

What are 9 indications for a pancreas US?

Answer 25

1. Severe epigastric pain
2. Elevated pancreatic enzymes
3. Biliary disease
4. Abdominal distention with hypoactive bowel sounds
5. Pancreatitis
6. Weight loss
7. Anorexia
8. Pancreas neoplasm
9. Evaluate mass from previous imaging study (i.e., CT).

Question 26

What is the normal range for serum amylase?

Answer 26

25-125U/L

Question 27

What does serum amylase increase with? (4)

Answer 27

1. Acute pancreatitis
2. Pancreatic pseudocyst
3. Intestinal obstruction
4. Peptic ulcer disease

Question 28

What does serum amylase decreases with? (2)

Answer 28

1. Hepatitis

2. Cirrhosis

Question 29

How long does serum amylase remain elevated in episodes of acute pancreatitis?

Answer 29

24 hours