Pancreas reverse Flashcards
reverse
retroperitoneal organ
lies posterior to the stomach, duodenum, proximal jejunum of the small bowel, also the transverse colon run horizontallyh acraoss the ab
contained in the anterior pararenal space
drapes across the mid aspect of the ab, just under the xyphoid process
Pancreas Anatomy
reverse
4 primary
head
neck
body
tail
pancreas segments
reverse
cradled in the C-loop of the duodenum,
IVC posterior
GDA anterolateral border
CBD posterior and lateral
pancreas head
reverse
located anterior to the IVC and posterior to the SMV
Pancreas Uncinate process
reverse
aorta
IVC
SMA
SMV
splenic vein
portal vein
Pancreas vascular landmarks
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duct of Wirsung
courses entire lenght of pancreas
enters duodenum via the ampulla of vater
Main pancreatic duct
reverse
Duct of Santori
drains the anterior segment of the head
>2mm internal measurment is abnormal
pancrease accessory duct
reverse
right lateral to SMV
anterior to IVC
inferior to portal vein
Vascular structure pancreatic head
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posterior to SMV
may completely surround SMV
anterior to aorta
Vascular structure Uncinate process
reverse
anterior to portal confluence
vascular structure neck
reverse
anterior to SMV
splenic vein
SMA
vascular structure body
reverse
splenic vein marks posterior border
vascular structure tail
reverse
primary duct extending entire length of pancreas
seen as 2 echogenic lines especially in neck/body
receives tributaries from the lobules
enters the duodenum with the common bile duct at the ampulla of vater
sphincter of Oddi-small muscle that guards the ampulla of vater
Duct of Wirsung
Main pancreatic duct
reverse
drains the upper anterior head
endters the duodenum at the minor papilla
2cm proximal to the ampulla of vater
just draions the head
not normally seen on ultrasound
duct of santorini
secondary duct
reverse
runs inferior in the free edge of the lesser omentum to level of the duodenum
travels posterior to the first portion of duodenum where it forms a common trunk with the pancreatic duct and opens into the duodenum
ducts have smooth muscle surrounding them to make it easier to transport the pancreatic fluid
Common bile duct
CBD
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longest segment
antrum of the stomach lies anterior
Pancrease body
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most difficult to visualize
course left lateral aspect of the body, extending to the hillum of the spleen
splenic vein serves as the posterior border
left kidney is posterior to the tail
pancreas tail
reverse
supplied by the splenic artery and the pancreaticoduodenal arteries
veinous drainage is through tributaries of the splenic and SMV
Pancrease vascular supply
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Agenisis
pancreas divisum
ectopic
annular
Panreatic congential anomilies
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missing body and tail with a large (hypertropic) head
Agenesis
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lack of fusion of the dorsal and ventral pancreatic buds
pancreas divisum
reverse
most common anomalie
pancreatic nodules are found throughout the GI tract
.5-2.0cm in size
acute pancreatitis and tumor may be found in these nodules
ectopic
reverse
head of the pancreas surrounds the second portion of the duodenum
male prevalence
annular
reverse
Exocrine
Endochrine
pancreas functions
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digestive function
Exocrine
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produces up to 2 liters of pancreatic juice per day
arranged in sac-like structures
juice converges into the two ducts which drain the juice into the duodenum for digestion
pancreatic juice enzymes capable of completing almost all of the digestion of our food
Acini cells
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produces pancreatic juice to aid in digestion
enzymes
lipase
trypsin
amylase
nucleases
sodium bicarbonate
Excocrine function
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breaks down fats
lipase
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digest proteins
trypsin
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digest carbohydrates
amylase
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digest nucleic acids
nucleases
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neutralizes gastric acids
ph of juice needs to be almost neutral for best action
sodium bicarbonate
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chyme (partially digested food) in the duodenum triggers release of hormones that start pancreatic juice formation
gastrin
cholecystokinin
aceytlcholine
secretin (sodium bicarbonate)
these now enter duodenum after allowing the sphincter of Oddi to relax
Exocrine enzyme triggers
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produces glucagons and insulin
Endocrine function
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alpha, beta and delta cells within the islets of Langerhans
insulin production
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regulates the metabolism of sugars
insufficient leads to diabetis mellitus
hormone that causes glycogen formation from teh glucose stored within the liver
Insulin
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changes the forms of sugar
hormone that causes our cells to release glucose to meet the bodies energy needs
stimulates the liver to convert glycogen to glucose and increase sugar levels
glucagon
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autoregulator
inhibits the production of both insulin and glucagon
gastrin
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most prevalent cells
produces insulin
enables cells within insulin receptors to take up clucose which lowers blood sugar
Beta cells
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produce glucagon
alpha cells
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smallest number of cells
produce gastrin
delta cells
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digestive enzyme produced by the pancreas as well as the parotid glands, bowel and gynecological system
certain types of pancreatic disease escapes into the surrounding tissue causing death of tissue, resulting in severe pain and inflammation
Amylase
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blood test twice normal usually indicates acute pancretitis, or obstruction of panc duct, acute cholecystitis, perforated peptic ulcer, alcohol poisoning
differentials include mumps, ischemic bowel disease, pelvic inflammatory disease
ANypase lab tests
reverse
may be elevated in pancreatitis
diseases not affectin the pancreas may cause an elevation of blood serum amylase with elevation
urine amylase
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enzyme excreted only by the pancreas
small amounts pass into the blood
used to assess damage to the pancreas
rises at teh same rate as amylase, but persists for a longer period of time
Lipase
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obstruction of panc duct
pancreatic CA
acute cholecystitis
lipase differentials
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controls the blood sugar lever in the body
GTT performed to asses a disorder of glucose metablolism
glucose
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diabetes
chronic liver disease
overactivity of several of the endocrine glands
elevated Glucose differentials
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tumor of the islets of langerhans
decreased glucose differential
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echogenicity is caompared to liver
echo intensity is slightly less than surrounding retroperitoneum and slightly greater than liver
texture depends on amount of fat dispersed between the lobules
fat is strongly echogenic so may be isoechoic with surround retroperitoneal fat
echotexture-homogeneous
surface smooth to slightly lobular
normal pancreatic tissue sonographically
reverse
NPO 6-8 hrs
2.5-5Mhz adults
5-7Mhz peadiatrics
left lobe for window
deep inspiration to allow liver to displace inferior
supine, oblique and upright positions (distends vascular structures) also valsalva
Scanning pancreas
reverse
head
Neck
Body
tail
Pancread normal size
reverse
>liver
<>spleen (depends on fibrous/fatty content)
pancrease normal echogenicity
