Where does the splenic vein lie to the pancreas?
Where does the head of the pancreas lie?
in the c-loop of duodenum
Where does the neck of the pancreas lie?
anterior to the SMV
Where does the tail of the pancreas lie?
extends into the splenic helium
What is the measurement of the head of the pancreas?
What is the measurement of the neck of the pancreas?
1.5 - 2.5 cm
What is the measurement of the body of the pancreas?
What is the measurement of the tail of the pancreas?
1 - 2.5 cm
Why does the pancreatic gland appear larger in children?
pancreas grows less than the body
Where is the uncinate process?
posterior to the SMV
Does the pancreas lie in the peritoneal?
What does the Duct of Wirsung drain?
What does the Duct of Santori drain?
the head of the pancreas
What is the blood supply of the pancreas?
splenic artery from celiac
What are the landmarks of the pancreas?
Is the pancreas an endocrine or exocrine gland?
What endocrine hormones does the pancreas create?
What is produced by the alpha cells?
What is produced by the beta cells?
What is produced by the delta cells?
What is insulin?
tells cells to store glucose
blood sugar goes down
What is glucagon?
tells liver to start glyconeogenesis
blood sugar goes up
What is somatostatin?
tells pancreas not to produce insulin or glucagon
What is GTT
Glucose tolerance test
How much pancreatic juice does the pancreas produce?
2 liters / day
How is pancreatic juice described?
as most versitile and active of all digestive enzymes
What does pancreatic juice do?
aides in digestion
What enzymes are in pancreatic juice?
What is lipase?
secreted by pancreas only
breaks down fat
What is probable if lipase is high?
What is amylase
breaks down carbs
secreted by other organs as well
What is probable if amylase is high?
* amylase is normal in chronic
What other organs secrete amylase?
parotid - mumps
GYN system - pelvic inflammatory
bowel - ischemic bowel
What is trypsin?
breaks down proteins to amino acids
What are the amino acids made from trypson?
carboxy pep trypsin
What is NaHCO3?
neutralizes food in duodenum
What is Nuclease?
breaks down nucleic acids
What is the sonographic appearance of the pancreas?
slightly less echogenic than surrounding tissue
slightly more echogenic than liver
depends on amount of fat and fibrous tissue
What hormones are released into the duodenum?
What is Cholecystokinin?
produced in the small intestines
causes sphincter of oddi to relax to allow GB contents into duodenum
What is gastrin?
produced in antrum of stomach
stimulates production of gastric acid
What is secretin?
Where do masses generaly occur on the pancreas?
What is the prep for a pancreatic exam?
NPO 6+ hours
What transducer should be used for a pancreatic exam?
3.5 - 5 MHz
What windows for a pancreatic exam?
water filled bladder
What images are required for a pancreatic exam?
3 sagittal images
1 transverse of head
What are the congenital abnormalities of the pancreas?
- Ectopic Pancreas tissue
- Annular Pancreas
- Fibrocystic Disease of the pancreas
- Congenital cysts 3-5 mm
What is Ectopic Pancreas tissue?
tissue where it does not belong
What is a Annular Pancreas?
the head of the pancreas partially or completely wraps around the duodenum
What are the measurement of Congenital cysts of the pancreas?
What is the best imaging modality for the pancreas?
What is the #1 cause of Acute pancreatitis in children?
What is pancreatitis
Pancreatic juice leaks into the surrounding parenchyma and begin attacking the pancreatic tissue.
What percentage of of patients with pancreatitis present with gallstones?
40% - 60%
What percentage of of patients with gallstones present with pancreatitis?
What are the causes of pancreatitis?
- Rupture of acini cells
- Alcohol abuse
- Trauma - #1 cause in children
- Peptic ulcer
- Thrombosis of vascular system
What are the Morphologic changes of acute pancreatitis?
desstrAlcohol abuseuction of pancreas
damage to blood vessels
peri-pancreatic areas affected
What is pancreatic juice compared to?
Death row inmates
What are the clinical signs of Acute Pancreatitis?
When is pancreatitis most likely to occur?
after a large meal or boozing session
Explain the back pain of someone with pancreatitis.
back pain with relief from sitting up and bending forward
What are the lab values with pancreatitis
What is the sonographic appearance of Acute pancreatitis?
30% have normal appearance
Why does pancreatitis enlarge the liver and make it appear hypoechoic?
Due to edema (serous fluid)
What is Hemorrhagic Pancreatitis?
extreme Inflamed pancreas
Rapid acceleration of acute pancreatitis with rupture of blood vessels.
What is the sonographic appearance of Hemorrhagic Pancreatitis?
same as acute but worse
Mass changes in appearance with time
What is the presentation of Hemorrhagic Pancreatitis?
What are the lab values of Hemorrhagic Pancreatitis?
What are the causes of Hemorrhagic Pancreatitis?
thrombosis of vascular system
Why does the mass of Hemorrhagic Pancreatitis change with time?
What is hypovolemic shock?
shock due to insufficient blood circulation
What is hematocrit?
% of RBCs by volume
What is Phlegmonous Pancreatitis
Sever form of Acute Pancreatitis, spreads to adjacent tissues.
What is the sonographic appearance of Phlegmonous Pancreatitis?
What are the lab values for Phlegmonous Pancreatitis?
What are the presentations of Phlegmonous Pancreatitis?
What is the cause of Phlegmonous Pancreatitis?
diffuse inflammatory edema
What is a Pancreatic Abscess?
Complication of surgery.
*High mortality rate if not treated
What are the sonographic appearance of Pancreatic Abscess?
What is the presentation of Pancreatic Abscess?
What are the lab values of Pancreatic Abscess?
What is Chronic Pancreatitis?
Recurrent acute pancreatitis, +3 months.
What is the sonographic appearance of Chronic Pancreatitis?
stones in ducts
What are the presentations of Chronic Pancreatitis?
What are the lab values for Chronic Pancreatitis?
What are the causes of Chronic Pancreatitis?
Alcohol abuse, trauma, peptic ulcer, thrombosis of vascular system
Why is Chronic Pancreatitis hyperechoic while Acute is hypoechoic?
Due to fibrouses
What are the two types of pancreatic cysts?
What are the two types of true pancreatic cysts?
What are the types of acquired cysts in the pancreas?
What are the cause of congenital pancreatic cysts?
What is a Pancreatic Pseudocysts?
Acquired cyst, pancreatic juice escapes and collects in space. Destroys everything, walled off
What is the sonographic appearance of a Pancreatic Pseudocyst?
What is the most common locations of a Pancreatic Pseudocyst?
What are other locations of a Pancreatic Pseudocyst?
left pararenal space
pelvis (multiple locations)
What does a Pancreatic Pseudocyst contain?
What is a common complication of a Pancreatic Pseudocyst?
What is the intervention of a Pancreatic Pseudocyst?
surgical removal when
What is Cysatadenocarcinoma?
Usually originate from pancreatic duct
mostly in females
What are the sonographic appearance of Cysatadenocarcinoma?
Irregular lobulated tumor
What are the presentations of Cysatadenocarcinoma?
What is Pancreatic Adenocarcinoma?
normally in head of pancreas
more often in 60-80 year old males.
What is the sonographic appearance of Pancreatic Adenocarcinoma?
Hypoechoic to normal
Prominent pancreatic duct
Liver & lymph mets
What is the presentation of Pancreatic Adenocarcinoma?
blockage of CBD
What increases the risk of Pancreatic Adenocarcinoma?
cigarettes increase risk
What is NonFunctional Islet Cell Tumors?
Rare malignant tumor found in the head of pancreas
- Insulinoma (B Cell tumor): Most common functioning islet cell tumor. 90-95% benign. Mostly in body and tail
Difficult to image
Lab Values: ↑Insulin
What is the sonographic appearance of NonFunctional Islet Cell Tumors?
Difficult to image
What is a Insulinoma?
Most common functioning islet cell tumor. 90-95% benign. Mostly in body and tail
What is the sonographic appearance of a Insulinoma?
Difficult to image
Lab Values: ↑Insulin
What are the lab values of a Insulinoma?
What is Gastrinoma?
G Cell tumor
2nd common functioning islet cell tumor.
Associated with peptic ulcer disease
What is the sonographic appearance of a Gastrinoma?
Difficult to image
What are the lab values for Gastrinoma?
What are the Appropriate reasons for the pancreatic exam?
Hypovolemic shock hypotension
Blockage of CBD
Pertinent laboratory values of a pancreatic exam?