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126 Cards in this Set
- Front
- Back
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Parts of the Pancreas
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1. Head
2. Uncinate Process 3. Body 4. Tail |
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The majority of the pancreas lies where?
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Retroperitoneal Cavity, except for a small portion of the head that is surrounded by peritoneum.
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Why is the pancreas considered to be technically challenging?
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Due to it's location which is posterior to the stomach, duodenum, and proximal small bowel
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What is the normal length of the pancreas?
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about 15 cm
Range (12-18 cm) |
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The pancreatic head is bordered by the following.
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1. Anterior to the IVC
2. Cauded to the Portal Vein 3. to the RT of the portal Splenic Confluence 4. Inferior to the caudate lobe of the liver |
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What is the thickest part of the pancreas and it's measurements?
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The HEAD and it measures between 2.0 and 3.5 cm A/P
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Describe the uncinate process.
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It is the small curved tip at the end of the head of the pancreas.
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The uncinate process is bordered by the following:
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1. Anterior to the IVC
2. Posterior Medial to the SMV |
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The pancreatic neck is bordered by the following:
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Anterior to the portal-splenic confluence
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Where is the pancreatic neck located?
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Between the head and the body and is often included as part of the body
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What is the measurement of the pancreatic neck?
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1.5-2.5 cm A/P
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What section/division of the pancreas is the largest?
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BODY
The head is the thickest and the body the largest portion. |
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What is the sonographic pancreatic landmark?
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The Splenic Vein and it courses across the posteromedial surface of the pancreas to join the main portal vein
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What is the measurement of the pancreatic body?
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2.0 to 3.0 cm A/P
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Can the tail of the pancreas be difficult to image?
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Yes, due to it's location
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The following are the borders of the pancreatic tail?
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1. Begins to the left of the aorta and extends toward the Splenic Hilum
2. Anterior border is the Splenic Artery and Stomach 3. Posterior border is the Splenic Vein |
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What is the measurement of the pancreatic tail?
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1.0 to 2.0 cm A/P
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Describe the difference between children's pancreas' and adult pancreas'.
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Children's is larger and less echogenic
***Child larger and darker**** |
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What is most likely the cause of Jaundice in a child?
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Biliary Atresia
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What on ultrasound can mimic a pancreatic mass?
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DUODENUM
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How does the pancreas look as a person becomes old and why?
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more echogenic due to fatty replacement of the gland's tissue
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The pancreatic duct is also known as ...
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Duct of Wirsung
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The pancreatic duct extends...
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the entire length of the gland (pancreas)
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The pancreatic duct enters...
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the duodenum with the CBD at the ampulla of Vater
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What is the function of the pancreatic duct?
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To carry pancreatic enzymes to the duodenum for digestion.
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What is the measurement of the pancreatic duct/Winsung?
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less than 2mm and tapers as it reaches the tail
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The pancreatic duct/Winsung is what in most patient's via ultrasound?
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NOT SEEN
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Where is the location of the accessory duct/ Duct of Santorini?
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secondary (accessory duct) that drains the upper anterior head
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The Duct of Santorini enters...
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the duodenum at the minor papilla about 2 cm proximal to the ampulla of Vater
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What is the Sphinicter of Oddi and where located?
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Muscle within the ampulla of Vater
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What is function of the Sphincter of Oddi?
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The muscle relaxes to allow pancreatic juices and bile to enter the duodenum.
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What is digestive and hormonal glands of the pancreas?
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Digestive (Exocrine Gland)
Hormonal (Endocrine Gland) |
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What is the primary function of the exocrine gland?
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to produce pancreatic juice which enters duodenum together with bile
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What is the primary function of endocrine gland?
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to produce the hormone insulin
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The exocrine gland performed by the acini cells of the pancreas produces how much pancreatic juice per day?
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2 liters
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Where does the pancreatic duct enter the duodenum?
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through the duct of Wirsung
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What are the enzymes of the pancreatic juice that aid in digestion?
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1. Lipase = fats
2. Carboxpeptidase, Trypsin, and Chymotrypain = proteins 3. Nucleases =nucleic acids 4. Amylase = carbohydrates |
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The endocrine gland function is located....
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in the islets of Langerhans in the pancreas
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What are the specialized cells within the islets of Langerhans?
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1. Alpha Cells
2. Beta Cells 3. Delta Cells |
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Alpha Cell function is to
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Hormone Glucagon = Glycogen to Glucose
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Beta Cell function is to
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Hormone Insulin = Glucose to Glycogen
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Delta Cell function is to
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Hormone Somatostatin = Alpha and Beta inhibitor
DELTA SERVES AS THE CHECKS AND BALANCE OF THE Enzymes |
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Exocrine function comes from what part of the pancreas?
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HEAD
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Endocrine function comes from what part of the pancreas?
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BODY and TAIL
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What are the three laboratory test and which are the primary two test?
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Amylase, Lipase, and Glucose
The two main are Amylase and Lipase |
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What does twice the normal levels of Amylase suggest?
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Acute Pancreatitis
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What happens to Amylase and Lipase in the rate the levels rise and which one stays elevated the longest?
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both Amylase and Lipase rise at the same rate, but Lipase concentration persists for a long period
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What happens with increased levels of Glucose?
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Severe diabetes, Chronic liver disease, and overactivity of several of the endocrine glands
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What does a patient need to do in order to help visualize the pancreas?
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Be NPO or fast for 6-8 hours
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Since eating does not affect the pancreas while scanning then why must a patient be NPO for 6-8 hours?
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To eliminate the accumulation of gas from the stomach and duodenum, because gas hinders the view of the pancreas while scanning.
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How is the pancreas related to the liver in appearance?
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the pancreas is equal to or slightly more echogenic than the liver
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Where is the main duct often identified and what are it's measurements?
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Body of the Pancreas and it measures less than 2 mm
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Congenital anomalies of the pancreas are...
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RARE
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Congenital anomalies include:
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1. Ectopic pancreatic tissue
2. Annular pancreas 3. Fibrocystic disease of the pancreas |
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Which of the congential anomalies is the most common?
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ECTOPIC PANCREATIC TISSUE
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Where can Ectopic Pancreatic Tissue end up?
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Various places of the GI Tract
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What are the places in the GI tract can ectopic pancreatic tissue end up?
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Stomach
Duodenum Small and Large Bowel |
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Is ectopic pancreatic tissue in large or small amounts when found?
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generally small
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Annular pancreas is or is not common?
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not common
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Where does the second portion of the duodenum surround?
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head of the pancreas
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Annular pancreas is more common in which sex?
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Males
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What may be annular pancreas associated with?
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Complete or Partial attresia of the duodenum
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Fibrocystic disease of the pancreas is a ___________________.
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Hereditary disorder of the exocrine gland
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Fibrocystic disease is more likely to be seen in_________ and __________.
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children and young adults
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Fibrocystic disease cysts are of what size?
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very small
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What occurs in fibrocystic disease?
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Normal tissue is replaced by fibrous tissue
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What happens to the pancreatic secreations with Fibrocystic disease?
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it is slowly lost
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What is acute pancreatitis?
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Inflammation of the pancreas
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What is the most common cause of pancreaitis in the US?
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Bilitary Tract Disease
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Gallstones are present in ______of the patients with acute pancreatitis.
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40-60%
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What is the second most common cause of pancreatitis?
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Alcohol abuse
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What are the other causes acute pancreatitis?
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Trauma
Inflammation from adjacent peptic ulcer Abdominal infections Drugs |
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What are the clinical findings of acute pancreatitis?
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Acute Edematous (swollen) pancreatitis often resolves sponaneously
Moderate to severe tenderness in the epigastrium radiating to the back RUQ pain especially following large meals with alcohol intake |
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What are the lab values of acute pancreatitis?
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Serum Amylase increase within 24 hours
Serum Lipase increases within 72-94 hours Leukocytosis Fever |
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What is the sonographic appearance of acute pancreatitis?
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Normal size or focal to diffuse enlargement
The echogenically varies depending on he severity but frequently is hypoechoic Pancreatic duct may be enlarged Borders are usually regular, but may be ill-defined 40-60% have gallstones Pseudocysts |
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What usually causes chronic pancreatitis?
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Repeated, persistent or prolonged subacute attacks of pancreatitis
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What causes parenchymal destruction in chronic pancreatitis and what does it heal into?
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repeated attacks of acute pancreatitis and the parenchymal destruction heals into fibrosis
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What are the clinical findings of Chronic Pancreatitis?
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non-specific
Patient may present with chronic epigastric and RUQ pain that radiates to the back and is aggravated by ingestion of alcohol of fatty food |
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What are the lab values of chronic pancreatitis?
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Increase Amylase
Increased Lipase |
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What is the sonographic characteristics of chronic pancreatitis?
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1. gland is usually smaller
2. irregular borders 3. dilated pancreatic duct 4. diffuse echogenicity 5. Echotexture may be heterogeneous because of fibrosis or calcifications 6. May have pseudocyst |
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What is the most severe form of pancreatitis?
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Hemorrhagic
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Where does hemorrhagic pancreatitis come from?
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Rapid progression of acute pancreatitis
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Describe hemorrhagic pancreatitis.
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There is diffused enzymatic destruction of the pancreatic substance caused by a sudden escape of active pancreatic enzymes into glands tissue
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The enzymes from Hemorrhagic pancreatitis cause....
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focal (fluid) areas of necrosis in and around the pancreas which leads to rupture of pancreatic vessels and hemorrhage
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What are the clinical findings of Hemorrhagic Pancreatits?
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1. Intense and severe pain radiating to the neck
2. Discoloration of the flanks |
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In hemorrhagic pancreatitis discoloration of the flanks is called?
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Grey Tumor's Sign
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What are the lab values of Hemorrhagic Pancreatitis?
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1. Elevated amylase
2. Elevated lipase 3. Elevated WBC's 4. Decreased hematocrit 5. Decrease serum calcium levels |
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What are the sonographic appearance of Hemorrhagic Pancreatitis?
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1. Specific findings depends on the age of the hemorrhage
2. Well-defined homogenous mass in the area of the pancreas |
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What are pancreatic true cysts?
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Microscopic sacs that may be congenital or acquired
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Congenital pancreatic true cyst are the result of...
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Abnormal development of he pancreatic duct
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Acquired pancreatic true cysts are ...
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retention cyst, parasitic cyst, or neoplastic cyst
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What do true cysts walls contain?
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epithelial lining
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True cyst may contain...
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pancreatic enzymes or be found to be continues with pancreatic duct
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Pancreatic Pseudocyst's are...
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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 |
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Pancreatic Pseudocyst have______ ______ that surrounds a ___________ of ________ __________ and __________ ________.
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fibrous lining
collection pancreatic juice necrotic debris |
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Pancreatic Pseudocyst are the results from....
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rupture of the pancreatic duct secondary to pancreatitis with leakage or pancreatic juices and into the surrounding tissue
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What is the most common location of a pancreatic pseudocyst?
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in the lesser sac anterior to the pancreas and posterior to the pancreas and posterior to the stomach
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Are pancreatic pseudocyst always spherical?
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No, because they take on the contour of the available space around them
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What are the clinical findings of pancreatic pseudocyst?
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They usually occur following pancreatitis so the patient may have a history of pancreatits
Abdominal pain Fever Nausea/Vomiting May have a palpable mass |
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What are the lab values of pancreatic pseudocyst?
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Presistently elevated amylase
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What is the sonographic appearance of pancreatic pseudocysts?
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Well defined mass usually in the are of the pancreas.
Increased through transmission. Variable in size (round and oval) May have debris at the bottom |
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Islets Tumor
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There are several types and can be functional or non-functional
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Islet Tumors maybe
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Benign adenomas or malignant tumors
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Tumors occur mostly in the _____ and____of the pancreas but the greatest concentration are in the _______ of______
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BODY
TAIL ISLETS of LANGERHANS |
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Non-functioning islet tumors comprise ____of all islet cell tumors with ___being malignant.
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1/3
92% are malignant |
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What are the characteristics of Islet Cell Tumors?
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Small size makes them difficult to image.
Can be singular or multiple Occur in the body and tail Hyperechoic |
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What is the most common Islet Cell Tumor?
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Insulinoma
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Cystadenocarcinoma are....
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uncommon slow growing tumor
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Cystadenocarcinomas arise from...
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the duct as cystic neoplasm
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Cystadenocarcinoma has a significant potential of being ______
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Malignant
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What sex does cystadenocarcinoma occur more in?
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Middle Aged Females
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Cystadenocarcinoma metastases most commonly in the ______and ______
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lymph nodes
liver |
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What are the clinical findings of Cystadenocarcinoma?
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Epigastric pain
Pancreatic mass Weightloss |
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What are the lab values of Cystadenocarcinoma?
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Elevated Amylase
Elevated Bilirubin Elevated Alk Phos |
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What is the sonographic characteristics of Cystadenocarcinoma?
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Irregular lobulated cystic tumor
Thick walls |
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What is the most common primary neoplasm of the pancreas?
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Adenocarcinoma
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Majority of pancreatic malignancies occur where?
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Pancreatic Head
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Adenocarcinomas are ________ and involves the ________ portion of the gland.
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fatal
exocrine gland |
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Adenocarcinomas are more common in what sex?
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Males ages 60 to 80 years of age
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Adenocarcinomas spread what organ at the time of initial presentation?
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Liver
85% of patients |
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What site or part of the pancreas is effected and at what percent?
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Pancreatic Head
60-70% |
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What are the clinical findings of Adenocarcinomas?
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Painless Jaundice-Courvoiser Law Sign
Weight loss Abdominal Pain Palpable Mass Onset of Diabetes Pain radiating to the back Nausea/Vomiting |
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What are the lab values of Adenocarcinomas?
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Elevated Amylase
Elevated Lipase Elevated Bilirubin |
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What is the clinical finding is commonly associated with Pancreatic Adenocarcinomas?
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New On-Set of Diabetes
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What is the sonographic characteristics of Adenocarcinoma?
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Usually presents as a focal or contour deformity. (ie changes shape)
Pancreatic mass is frequently hypechoic and has irregular and ill-defined margins Occasionally it may appear as diffused enlargement of the pancreas Distal pancreatic duct may be dilated CBD and intrahepatic ducts may be dilated GB may be dilated and filled with sludge (Courvoisier's Law) |
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If adenocarcinoma is suspected the sonographer should look for what?
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Metastic spread into the liver, paraortic nods, and portal venous system
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