Pancreas

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1

Where does the splenic vein lie to the pancreas?

card image

posteriorly medial

2

Where does the head of the pancreas lie?

card image

in the c-loop of duodenum

3

Where does the neck of the pancreas lie?

card image

anterior to the SMV

4

Where does the tail of the pancreas lie?

card image

extends into the splenic helium

5

What is the measurement of the head of the pancreas?

3.5 cm

6

What is the measurement of the neck of the pancreas?

1.5 - 2.5 cm

7

What is the measurement of the body of the pancreas?

2.5 cm

8

What is the measurement of the tail of the pancreas?

1 - 2.5 cm

9

Why does the pancreatic gland appear larger in children?

pancreas grows less than the body

10

Where is the uncinate process?

card image

posterior to the SMV

11

Does the pancreas lie in the peritoneal?

No

retroperitoneal

12

What does the Duct of Wirsung drain?

pancreas

head

body \tail

13

What does the Duct of Santori drain?

the head of the pancreas

14

What is the blood supply of the pancreas?

splenic artery from celiac

GDA

15

What are the landmarks of the pancreas?

card image
16

Is the pancreas an endocrine or exocrine gland?

both

17

What endocrine hormones does the pancreas create?

insulin

glucagon

somatostatin

18

What is produced by the alpha cells?

glucagon 20%

19

What is produced by the beta cells?

insulin 70%

20

What is produced by the delta cells?

somatostatin

21

What is insulin?

tells cells to store glucose

blood sugar goes down

22

What is glucagon?

tells liver to start glyconeogenesis

blood sugar goes up

23

What is somatostatin?

tells pancreas not to produce insulin or glucagon

24

What is GTT

Glucose tolerance test

25

How much pancreatic juice does the pancreas produce?

2 liters / day

26

How is pancreatic juice described?

as most versitile and active of all digestive enzymes

27

What does pancreatic juice do?

aides in digestion

28

What enzymes are in pancreatic juice?

lipase

amylase

trypsin

NaHCO3

Nuclease

29

What is lipase?

secreted by pancreas only

breaks down fat

30

What is probable if lipase is high?

acute pancreatitis

31

What is amylase

breaks down carbs

secreted by other organs as well

32

What is probable if amylase is high?

acute pancreatitis

* amylase is normal in chronic

33

What other organs secrete amylase?

parotid - mumps

GYN system - pelvic inflammatory

bowel - ischemic bowel

34

What is trypsin?

breaks down proteins to amino acids

35

What are the amino acids made from trypson?

chymotrypsin

carboxy pep trypsin

36

What is NaHCO3?

sodium bicarbonate

neutralizes food in duodenum

37

What is Nuclease?

breaks down nucleic acids

38

What is the sonographic appearance of the pancreas?

homogeneous

slightly less echogenic than surrounding tissue

slightly more echogenic than liver

depends on amount of fat and fibrous tissue

39

What hormones are released into the duodenum?

Cholecystokinin

gastrin

secretin

40

What is Cholecystokinin?

produced in the small intestines

causes sphincter of oddi to relax to allow GB contents into duodenum

41

What is gastrin?

produced in antrum of stomach

stimulates production of gastric acid

42

What is secretin?

neutralizes chyme

43

Where do masses generaly occur on the pancreas?

head

44

What is the prep for a pancreatic exam?

NPO 6+ hours

45

What transducer should be used for a pancreatic exam?

3.5 - 5 MHz

46

What windows for a pancreatic exam?

Liver

water filled bladder

47

What images are required for a pancreatic exam?

3 sagittal images

1 transverse of head

48

What are the congenital abnormalities of the pancreas?

  • Ectopic Pancreas tissue
  • Annular Pancreas
  • Fibrocystic Disease of the pancreas
  • Congenital cysts 3-5 mm
49

What is Ectopic Pancreas tissue?

tissue where it does not belong

50

What is a Annular Pancreas?

the head of the pancreas partially or completely wraps around the duodenum

51

What are the measurement of Congenital cysts of the pancreas?

3-5 mm

52

What is the best imaging modality for the pancreas?

CT

53

What is the #1 cause of Acute pancreatitis in children?

trauma

54

What is pancreatitis

inflamed pancreas

Pancreatic juice leaks into the surrounding parenchyma and begin attacking the pancreatic tissue.

55

What percentage of of patients with pancreatitis present with gallstones?

40% - 60%

56

What percentage of of patients with gallstones present with pancreatitis?

5%

57

What are the causes of pancreatitis?

  • Rupture of acini cells
    • Alcohol abuse
    • Trauma - #1 cause in children
    • Peptic ulcer
    • Thrombosis of vascular system
58

What are the Morphologic changes of acute pancreatitis?

desstrAlcohol abuseuction of pancreas

damage to blood vessels

hemorrhage

peri-pancreatic areas affected

inflammatory reaction

59

What is pancreatic juice compared to?

Death row inmates

60

What are the clinical signs of Acute Pancreatitis?

pain

tenderness

fever

leukocytosis

61

When is pancreatitis most likely to occur?

after a large meal or boozing session

62

Explain the back pain of someone with pancreatitis.

back pain with relief from sitting up and bending forward

63

What are the lab values with pancreatitis

↑Alk Phos

↑Direct Bilirubin

↑WBC

↑Amylase

↑Lipase

64

What is the sonographic appearance of Acute pancreatitis?

Diffuse enlargement

Hypoechoic

30% have normal appearance

65

Why does pancreatitis enlarge the liver and make it appear hypoechoic?

Due to edema (serous fluid)

66

What is Hemorrhagic Pancreatitis?

extreme Inflamed pancreas

Rapid acceleration of acute pancreatitis with rupture of blood vessels.

67

What is the sonographic appearance of Hemorrhagic Pancreatitis?

same as acute but worse

Diffuse enlargement

Hypoechoic

Mass effects

Mass changes in appearance with time

68

What is the presentation of Hemorrhagic Pancreatitis?

pain

tenderness

fever

eukocytosis

hypovolemic shock

hypotension.

69

What are the lab values of Hemorrhagic Pancreatitis?

↑Alk Phos

↑Direct Bilirubin

↑WBC

↑Amylase

↑Lipase

↓ Hemocrit

70

What are the causes of Hemorrhagic Pancreatitis?

Alcohol abuse

trauma

peptic ulcer

thrombosis of vascular system

71

Why does the mass of Hemorrhagic Pancreatitis change with time?

clot mass

clot shrinks

72

What is hypovolemic shock?

shock due to insufficient blood circulation

73

What is hematocrit?

% of RBCs by volume

74

What is Phlegmonous Pancreatitis

Sever form of Acute Pancreatitis, spreads to adjacent tissues.

75

What is the sonographic appearance of Phlegmonous Pancreatitis?

Hypoechoic

Ill-defined mass

Necrosis

76

What are the lab values for Phlegmonous Pancreatitis?

↑Alk Phos

↑Direct Bilirubin

↑WBC

↑Amylase

↑Lipase

77

What are the presentations of Phlegmonous Pancreatitis?

pain

tenderness

fever

leukocytosis.

78

What is the cause of Phlegmonous Pancreatitis?

diffuse inflammatory edema

79

What is a Pancreatic Abscess?

Complication of surgery.

*High mortality rate if not treated

80

What are the sonographic appearance of Pancreatic Abscess?

Hypoechoic

Ill-defined mass

Necrosis

81

What is the presentation of Pancreatic Abscess?

localized pain

fever

chills,

82

What are the lab values of Pancreatic Abscess?

↑WBC

83

What is Chronic Pancreatitis?

Recurrent acute pancreatitis, +3 months.

84

What is the sonographic appearance of Chronic Pancreatitis?

Diffuse enlargement

Hyperechoic

fibrofatty

stones in ducts

shadowing

85

What are the presentations of Chronic Pancreatitis?

pain

tenderness

fever l

eukocytosis.

86

What are the lab values for Chronic Pancreatitis?

↑Alk Phos

↑Direct Bilirubin

↑WBC

↑Lipase

*(normal amylase)

87

What are the causes of Chronic Pancreatitis?

Alcohol abuse, trauma, peptic ulcer, thrombosis of vascular system

88

Why is Chronic Pancreatitis hyperechoic while Acute is hypoechoic?

Due to fibrouses

89

What are the two types of pancreatic cysts?

true

pseudocysts

90

What are the two types of true pancreatic cysts?

acquired

congenital

91

What are the types of acquired cysts in the pancreas?

retention

parasitic

neoplastic

92

What are the cause of congenital pancreatic cysts?

anomalous development

93

What is a Pancreatic Pseudocysts?

Acquired cyst, pancreatic juice escapes and collects in space. Destroys everything, walled off

94

What is the sonographic appearance of a Pancreatic Pseudocyst?

Well defined

Anechoic

Thick walls

calcifications

Septations

Internal echoes

95

What is the most common locations of a Pancreatic Pseudocyst?

lesser sac

96

What are other locations of a Pancreatic Pseudocyst?

left pararenal space

pelvis (multiple locations)

97

What does a Pancreatic Pseudocyst contain?

Amylase

lipase

blood

digested tissue

98

What is a common complication of a Pancreatic Pseudocyst?

spontaneous rupture

99

What is the intervention of a Pancreatic Pseudocyst?

surgical removal when

4 weeks

7.5 cm

100

What is Cysatadenocarcinoma?

malignant mass

Usually originate from pancreatic duct

slow growing

mostly in females

101

What are the sonographic appearance of Cysatadenocarcinoma?

Irregular lobulated tumor

Cystic

Thick walls

Frequenctly calcified

Hypoechoic mass

102

What are the presentations of Cysatadenocarcinoma?

pain

palpable mass

103

What is Pancreatic Adenocarcinoma?

Fatal tumor

normally in head of pancreas

more often in 60-80 year old males.

104

What is the sonographic appearance of Pancreatic Adenocarcinoma?

Hypoechoic to normal

Prominent pancreatic duct

Liver & lymph mets

Displacing tumor

105

What is the presentation of Pancreatic Adenocarcinoma?

weight loss

painless jaundice

N&V

blockage of CBD

palpable mass

106

What increases the risk of Pancreatic Adenocarcinoma?

cigarettes increase risk

107

What is NonFunctional Islet Cell Tumors?

Rare malignant tumor found in the head of pancreas

  1. Insulinoma (B Cell tumor): Most common functioning islet cell tumor. 90-95% benign. Mostly in body and tail

Sonographic Appearance:

Small

Difficult to image

Presentation: hypoglycemic

Lab Values: ↑Insulin

108

What is the sonographic appearance of NonFunctional Islet Cell Tumors?

Small

Difficult to image

109

What is a Insulinoma?

B-Cell tumor

Most common functioning islet cell tumor. 90-95% benign. Mostly in body and tail

110

What is the sonographic appearance of a Insulinoma?

Small

Difficult to image

Presentation: hypoglycemic

Lab Values: ↑Insulin

111

What are the lab values of a Insulinoma?

↑Insulin

112

What is Gastrinoma?

G Cell tumor

2nd common functioning islet cell tumor.

Associated with peptic ulcer disease

113

What is the sonographic appearance of a Gastrinoma?

Small

Difficult to image

114

What are the lab values for Gastrinoma?

↑ gastrin

115

What are the Appropriate reasons for the pancreatic exam?

Pain

Tenderness

Fever

Chills

Leukocytosis.

Hypovolemic shock hypotension

Localized pain

Palpable mass

Weight loss

Painless jaundice

Nausea

Vomiting

Blockage of CBD

116

Pertinent laboratory values of a pancreatic exam?

↑Alk Phos

↑Direct Bilirubin

↑WBC

↑Amylase

↑Lipase

↑ gastrin

↑Insulin

↓ Hematocrit