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137 Cards in this Set
- Front
- Back
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The septum transversum generates _____ at the _____.
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2 pancreatic buds, at the foregut/midgut
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The pancreatic buds fuse to form the _____.
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pancreas
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The ____ bud arise first and generates most of the pancreas.
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dorsal
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This bud arises beside the bile duct.
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ventral bud
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What does the ventral bud form?
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Part of the head of pancreas and uncinate process
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In the fetal period, _____ differentiate from _____.
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Islet cell clusters, pancreatic bud endoderm
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What do the islet cell clusters form?
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Acini and ducts
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On the edge of the cell clusters _____ also form.
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pancreatic islets
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The pancreas is a ______ structure.
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retroperitoneal
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Where is the pancreas located?
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In the epigastric and left hypochondrium region
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The pancreas lies _____ between ____ & _____.
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Transverse, between duodenum and splenic hilum
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Where does the pancreas lie in relation to the stomach?
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Posterior to the stomach
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True or False. The pancreas is a non-encapsulated organ.
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True
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What are the 4 portions of the pancreas?
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The head, neck, body, and tail.
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Which part of the pancreas is the uncinate process?
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The head
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The size of the head of the pancreas is _____ or less.
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3.5 cm or less (AP & TRV)
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The body of the pancreas measure less than ____.
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2.5 cm (AP)
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The tail is equal to or less than ____.
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2.5 cm (AP)
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What is the total length of the pancreas?
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Between 12-15 cm
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The head of the pancreas is to the _____ of the SMV.
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Right
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Where does the head of the pancreas lie in relation to the IVC?
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It is anterior to IVC
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The right lateral border of the head of pancreas is considered the _____.
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2nd portion of the duodenum
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The head of the pancreas is ____ to the IVC.
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Anterior
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The head of the pancreas is ____ to the portal vein.
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Caudal
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What is the uncinate process?
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The portion of the pancreatic head directly posterior to the SMV
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The Gastroduodenal Artery (GDA) lies at the ______ border of the head of pancreas.
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Anterio-Lateral
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Where does the Common Bile Duct (CBD) lie in relation to the head of pancreas.
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At the posterior-lateral border
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The portion of the pancreas directly anterior to the SMV is the _____.
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Neck
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The portal vein is formed _____ to the neck.
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Posterior
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What junction forms the portal vein?
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The splenic vein and SMV
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The body of the pancreas is anterior to what 4 vessels?
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Aorta, SMA, left renal vein, and splenic vein
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The _____ border of the body of pancreas is the posterior wall of stomach.
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Anterior
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The right lateral border of the pancreas is the ____.
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Neck
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The ____ represents the largest portion of the pancreas.
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Body
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What is the most difficult part of the pancreas to visualize on US?
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Tail
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Where does the tail of the pancreas begin & end?
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Begins to the left lateral bporder of vertebra and extends to splenic hilum
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The _____ courses along the posterior surface of the body & tail.
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Splenic vein
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The tail is ____ to left kidney.
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anterior
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Where is the tail in relation to the stomach?
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Posterior
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The tail is ____ to the spleen.
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Medial
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Four different shapes of the pancreas include:
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Tadpole, dumbbell, sausage, and boomerang
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What is the most common congenital anomaly of the pancreas?
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Pancreas divisum
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What is pancreas divisum?
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When the ventral and dorsal pancreatic ducts fail to fuse, therefore the pancreas is drained by 2 ducts
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With divisum, the ventral duct drains into ____.
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Major papilla
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Where does the dorsal duct drain into?
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Minor papilla
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True or False. Most people with pancreas divisum are asymptomatic.
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True
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What is the most common complication of pancreas divisum?
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Pancreatitis
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What is a sign of pancreatitis?
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Amylase elevation
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When the pancreatic head and uncinate process wrap around duodenum it is called _____ _____.
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Annular pancreas (RARE)
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What can annular pancreas cause?
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Partial/complete duodenal atresia or obstruction.
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Absence of a usual body opening is known as ____ ____.
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Duodenal atresia
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What is the annular pancreas caused by?
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Failure of the ventral & dorsal buds to fuse
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What are 5 types of congenital anomalies of the pancreas?
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Annular pancreas, agenesis, cystic fibrosis, ectopic pancreatic tissue, and congenital cysts.
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_____ is a rare absence of the body and tail of pancreas.
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Agenesis
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Anomalous development of ducts lead to _____ _____.
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Congenital cysts
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What are the 5 main landmarks for the pancreas?
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Portal vein, Splenic artery, SMA, GDA, and CBD
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The splenic vein is found on the _____ aspect of the pancreas.
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Posterior-superior
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The SMV runs _____ to the neck & ____ to the uncinate process.
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posterior, and anterior
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The splenic artery runs along the ____ margin of the pancreas.
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Anterior-superior
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The common hepatic artery (CHA) arises from the ____ ____.
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Celiac artery
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The common hepatic artery courses along the ____ margin of the _____.
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Superior margin of the 1st portion of duodenum
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The common hepatic artery divides into the ____ & ____ when it crosses the PV
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Proper hepatic artery and GDA
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The CBD is ____ to the proper hepatic artery
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Lateral
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The ____ is less frequently seen as it travels a short distance before it divides.
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Gastroduodenal Artery (GDA)
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The SMA arises ______ to the pancreatic body.
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Posterior
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The SMA courses _____ to the _____.
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Anteriorly, to the 3rd portion of duodenum
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Where does the SMA enter into?
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Small bowel mesentary
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The CBD crosses the ____ aspect of the PV.
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Anterior
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The CBD is located to the ____ of the proper hepatic artery.
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Right
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The CBD travels _____ to the 1st portion of the duodenum.
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Posterior
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After going to the duodenum the CBD travels ____ & ____ to the head of pancreas.
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Inferiorly and posteriorly
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What duct does the CBD join with at the ampulla of vater?
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The main pancreatic duct
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After the CBD and pancreatic duct join, where does it enter?
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Enters the 2nd portion of duodenum @ ampulla of vater
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The pancreatic duct is also known as the _______.
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Duct of Wirsung
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The pancreatic duct is not usually visualized, but when it is seen what does it look like?
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Appears as echogenic line (or 2) encasing a thing stripe of fluid
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The duct of wirsung is most frequently visualized in the ____ of pancreas.
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Body
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An enlarged accessory duct known as the _______ may be seen in pancreas head on US.
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Duct of Santorini
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The main pancreatic duct cannot be more than ____.
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2 mm
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What is the AP diameter of the pancreatic duct on a TRV scan?
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Head/neck= 3 mm
Body= 2 mm |
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What is considered abnormal for the pancreatic duct?
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If it is over 2 mm, has non-parallel walls, or a convex outward appearance
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What 4 structures can mimic the pancreatic duct?
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Splenic vein & artery, posterior wall of stomach, and retroperitoneal fat
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What is the sonographic appearance of the pancreas?
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Comma-shaped, homogeneous, course echotexture
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The normal pancreas is ____ to the normal liver.
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Isoechoic or hyperechoic
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The pancreas becomes more ____ with age.
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Echogenic & small
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Why is the pancreas more echogenic in adults?
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Because adults have more internal pancreatic fat
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In young children, the pancreas may be _____ than the liver.
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less echogenic
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The pancreas is responsible for ____% of digestion.
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80%
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True or False. The pancreas is an endocrine and exocrine gland.
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True
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Highly digestive enzymes are secreted by ____ cells and arranged in ____ clusters.
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acinar, arranged in sac-like clusters
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When digestive enzymes are released by the acinar cells it is considered an _____ function.
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Exocrine
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What are the digestive enzymes that are secreted?
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Amylase, lipase, and trypsin.
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What does amylase break down?
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Carbohydrates
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Lipase breaks down ____.
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Fat
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____ breaks down proteins to amino acids.
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Trypsin
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The secretions than drain into the _____ to the _____.
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pancreatic duct, to the duodenum
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The main exocrine function of the pancreas is to...
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Aid in the digestion of food materials
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What hormones are released when food enters duodenum?
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Cholecystokinin, gastrin, and secretin
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What hormone stimulates secretion of pancretic enzymes?
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Cholecystokinin
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_____ hormone stimulates secretion of gastric acid and is controlled by the _____.
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Gastrin, vagul nerve
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What else does the gastrin hormone also stimulate?
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The growth of the mucosa of the exocrine pancreas
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What does the hormone secretin stimulate?
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Stimulates secretion of bicarbonate
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What does the endocrine function of the pancreas involve?
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Islet cells of langerhan secrete hormones directly into blood
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What hormones are secreted by the Islet cells of langerhans during the endocrine process?
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Alpha cells, beta cells, and delta cells
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What type of cells secrete glucagon?
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Alpha cells
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Where is glucagon stored?
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In the liver
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_____ cells secrete insulin.
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Beta Cells
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Insulin stimulates the release of what 3 things from the blood to tissues?
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Glucose, amino acids, and fatty acids
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What do delta cells secrete?
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Somatostatin
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What does somatostatin do?
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Regulates the secretion of glycagon and glucose
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Failure to produce sufficient amount of insulin leads to ____ ____.
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Diabetes Mellitus
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Three laboratory values include...
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Amylase, Lipase, and Glucose
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Within 24 hours of acute pancreatitis, the levels of serum amylase ____.
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Increases
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Another amylase also increases with pancreatitis, what is it?
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Urine amylase
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With pancreatic disease, ____ enzymes of the organ escape into surrounding tissue.
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Digestive
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When the enymes go into surrounding tissue it causes _____.
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Necrosis
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Necrosis of the tissue causes ____ & _____.
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Severe pain and inflammation
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After enzymes escape into tissue and cause necrosis, serum amylase _____.
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Increases
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Diseases that don't affect the pancreas will only affect ____ amylase.
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Serum
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What other conditions cause an increase of amylase?
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Alcohol, obstruction of ducts, Ischemic bowel disease, ulcer, cholecystitis, mumps, PID, disease of salivary glands
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This enzyme is only secreted by the pancreas.
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Lipase
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How much of lipase is passed into the blood?
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ONLY small amounts
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Typically, lipase parallels the elevation of ____.
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Amylase
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The most sensitive indicator of pancreatitis is...
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Serum Lipase
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What two things cause lipase to rise?
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Acute pancreatitis, and carcinoma of the pancreas
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Both lipase & amylase levels rise at same rate but ____ elevation persists for longer period.
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Lipase
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What type of test is done to check for a glucose metabolic disorder?
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A glucose tolerance test
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Pancreatic tumors cause a ____ in blood sugar levels.
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Decrease
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What 3 things cause an increase in blood glucose levels?
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diabetes, liver disease, and overactivity of endocrine glands
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What are some indications of pancreatic problems?
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Pain in epigastrium, abdominal pain that radiates to back, abdominal distension
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Acute pancreatitis causes a large loss of fluid into...
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pancreatic spaces, retroperitoneal cavity and abdominal cavity
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Some symptoms of acute pancreatitis include:
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tachycardia, hypotension, fever, and cool skin
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Three types of pancreatic neoplasms include:
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adenocarcinoma, cystadenoma, and islet cell tumors
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What type of transducer should be used when evaluating the pancreas?
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highest frequency transducer
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When evaluating pancreas in TRV you must document from level or ____ to _____.
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Level of celiac axis to below renal vessels
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Whenever possible the ____ is the best window for viewing the pancreas.
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Liver
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True or False. Having patient drink plenty of water provides an acoustic window.
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True
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The modality of choice for imaging the pancreas is the ____.
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CT scan
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