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Terms in this set (79)
where is the pancreas located?
posterior to the stomach, duodenum, and proximal small bowel
the majority of the pancreas lies where?
within the retroperitoneal cavity, except a small portion of the head that is surrounded by peritoneum
what is the normal length of the pancreas ?
about 15cm (12-18cm)
what are the 4 parts of the pancreas?
head, neck, body, tail
where does the head of the pancreas lie?
anterior to the IVC, caudad to the portal vein, to the right of the portal splenic confluence and inferior to the caudate lobe of the liver
what does the thickest part of the pancreas measure ?
between 2.0 and 3.5cm a/p
what is the small curved tip at the end of the head of the pancreas
where does the uncinate process lie?
anterior to the IVC and posterior medial to the SMV (posterior SMV)
what does the Neck of the pancreas measure?
1.5 - 2.5cm a/p
what is the neck of the pancreas directly anterior to?
the portal-splenic confluence
where is the neck of the pancreas on the pancreas?
between the head and the body and often is included as part of the body
what is the largest section of the pancreas?
where does the body of the pancreas lie?
anterior to the aorta and SMA
what is the landmark for finding the pancreas?
splenic vein courses across the posteromedial surface of the pancreas to join the main portal vein
what does the body of the pancreas measure?
what is the POSTERIOR border of the body and tail of the pancreas?
where does the tail of the pancreas lie?
begins to the left of the aorta and extends toward the splenic hilum
what are the ANTERIOR borders of the body and tail of the pancreas?
childrens' pancreas when compared to a normal adult's pancreas is _________ and _______ ___________.
larger and less echogenic (large and darker)
jaundice in a child is most likely caused by what ?
what can sometimes look like a mass in the head of the pancreas?
what is another name for the pancreatic duct?
Duct of Wirsung
the pancreatic duct (duct of wirsung) enters the _________ with the CBD at the Ampulla of Vater
what is the pancreatic duct (duct of wirsung)?
primary duct extending the entire length of the gland
what does the pancreatic duct (duct of wirsung) do?
it carries pancreatic enzymes to the duodenum for digestion
what size should the pancreatic duct (duct of wirsung) measure when tapering as it reaches the tail?
less than 2mm
what is the secondary (accessory duct) that drains the upper anterior head of the pancreas?
Duct of Santorini
where does the duct of Santorini enter?
the duodenum at the minor papilla about 2cm proximal to the Ampulla of Vater
what is the Sphincter of Oddi?
muscle within the Ampulla of Vater that relaxes to allow pancreatic juices and bile to enter the duodenum
what is the digestive (exocrine) and hormonal (endocrine) gland?
what is the primary function of the pancreas?
exocrine, to produce pancreatic juice which enters the duodenum together with bile
the endocrine function is to produce the hormone what?
what is the function of the exocrine ?
performed by acini cells of the pancreas, can produce 2 L of pancreatic juice per day
where does the pancreatic juice enter ?
the duodenum through the duct of Wirsung
what are the enzymes of the pancreatic juice that add in digestion?
lipase = fats
carboxpeptidase, trypsin, chymotrypain = proteins
nucleases = nucleic acid
amylase = carbohydrates
Exocrine is in the what of the pancreas?
Endocrine is in the what of the pancreas?
where is the endocrine of the pancreas located?
in the Islets of Langerhans
what are the specialized cells within the Islets of Langerhans called?
alpha, beta, delta cells
what are the alpha cells?
hormone glucagon = glycogen to glucose
what are the beta cells?
hormone insulin = glucose to glycogen
what are the delta cells?
hormone somatostatin = alpha and beta inhibitor
twice normal levels suggest acute pancreatitis
Increased levels are found in severe diabetes, chronic liver disease and overactivity of several of the endocrine glands
Lipase and Amylase rise at the same rate but the elevation in lipase concentration persists for a longer period
Normal sonographic appearance of the pancreas.
the normal pancreas is equal to or slightly more echogenic than the liver.
the echogenicity of the pancreas gradually increases with age b/c of fatty replacement of the gland's tissue.
to help visualize the pancreas, the patient should do what?
fast 6-8 hours/ is ok if pt has eaten already
what is identified less than 2mm in the body of the pancreas
congenital anomalies of the pancreas are what?
what are the 3 congenital anomalies of the pancreas?
ectopic pancreatic tissue, Annular pancreas, Fibrocystic disease of the pancreas
what is the most common pancreatic anomaly?
ectopic pancreatic tissue
where is the ectopic tissue found at in the pancreas?
various places in the GI tract ; stomach, duodenum, small and large bowel
the head of the pancreas surrounds the second portion of the what?
not a common congenital anomaly, but more common in males
what may be associated with complete or partial atresia of the duodenum
facts about Fibrocystic disease of the pancreas.
hereditary disorder of the exocrine gland, seen in children and young adults, cysts are very small, tissue is replaced by fibrous tissue, pancreatic secretion is slowly lost
inflammation of the pancreas
what is the most common cause of pancreatitis in the US ?
Biliary tract disease
what is present in 40-60-% of patients that have pancreatitis?
what is the second most common cause for acute pancreatitis?
other causes of pancreatitis are what?
trauma, inflammation from adjacent peptic ulcer or abdominal infection and drugs
clinical findings of acute pancreatitis.
moderate to severe tenderness in the epigastrium radiating to the back, RUQ pain especially following large meals with alcohol intake
sonographic characteristics of acute pancreatitis.
normal size or focal to diffuse enlargement, 40-60% have gallstones, pseudocysts, borders regular but can be ill-defined , pancreatic duct may be enlarged, frequently hypoechoic
usually results from repeated, persistent or prolonged subacute attacks of pancreatitis.
repeat attacks of acute pancreatitis may lead to what ?
parenchymal destruction heals by what?
clinical findings for chronic pancreatitis.
nonspecific, pt may present with chronic epigastric and RUQ pain that radiates to the back & is aggravated by ingestion of alcohol or fatty food
sonographic characteristics of chronic pancreatitis.
gland is usually smaller, irregular borders, dilated pancreatic duct, diffuse echogenicity, ECHOTEXTURE may be heterogeneous b/c of fibrosis or calcifications, may have pseudocyst
most severe disease of the pancreas.
what is rapid progression of acute pancreatitis ?
what happens in hemorrhagic pancreatitis?
there is diffuse enzymatic destruction of the pancreatic substance cause by a sudden escape of active pancreatic enzymes into the glands tissue ; these enzymes cause focal areas of necrosis in and around the pancreas, which leads to rupture of pancreatic vessels and hemorrhage
clinical findings of hemorrhagic pancreatitis
intense and sever pain radiating to the back and discoloration of the flanks(sides) called Grey Turner's sign
lab values for hemorrhagic pancreatitis
elevated amylase, lipase, WBC, decreased hematocrit and serum calcium levels (internal bleeding)
sonographic characteristics of Hemorrhagic Pancreatitis.
depends on the age of the hemorrhage, well defined homogeneous mass in the area of the pancreas
Microscopic sacs that may be congenital or acquired
pancreatic true cyst
what are the result of abnormal development of the pancreatic duct?
what are retention cysts, parasitic cyst or neoplastic cyst ?
what are ALWAYS ACQUIRED and may be caused by trauma to the gland or acute or chronic pancreatitis
collection of inflammatory, necrotic tissue, pancreatic secretions and blood make up what?
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