Chapter 12: the pancreas (workbook)

Define pancreatic pseudocyst.

"Sterile abscess" collection of pancreatic enzymes that accumulate in the available space on the abdomen, usually in or near the pancreas.

Define leukocytosis.

Abnormal increase in white blood cells caused by infections.

Exocrine function is performed by _______ of the pancreas.

Acini cells

The most common primary neoplasm of the pancreas is ________.

Adenocarcinoma

There are specific enzymes of the pancreas that may become altered in pancreatic disease, namely _______ and ______.

Amylase; lipase

The head of the pancreas lies _____ to the inferior vena cava.

Anterior

The portal vein is _____ to the inferior vena cava.

Anterior

The major posterior vascular landmarks of the pancreas are the ____ and ______.

Aorta; inferior vena cava (IVC)

Fluid collections around the pancreatic ______, along the _______ spaces, within the _______ pouch, and around the _______ my be present in a patient with acute pancreatitis.

Bed; Pararenal; Morison's; Duodenum

An acute attack of pancreatitis is commonly related to _______ and _______.

Biliary tract disease; alcoholism

Define caudal pancreatic artery.

Branch of splenic artery that supplies the tail of the pancreas.

Define dorsal pancreatic artery.

Branch of the splenic artery that supplies the body of the pancreas.

Define acini cells.

Cells that perform exocrine function.

The tail of the pancreas is more difficult to image because it lies anterior to the left kidney and posterior to the left _____ and ______.

Colic flexure; transverse colon

The _____ duct crosses the anterior aspect of the portal vein to the right of the proper hepatic artery.

Common bile

Define hyperlipidemia.

Congenital condition in which elevated fat levels cause pancreatitis.

Failure of the pancreas to furnish sufficient insulting leads to _______.

Diabetes mellitus

Define ileus.

Dilated loops of bowel without peristalsis; associated with various abdominal problems, including pancreatitis, sickle cell crisis, and bowel obstruction.

The ______ receives tributaries from lobules at right angles and enters the medial second part of the duodenum with the common bile duct at the ampulla of Vater.

Duct of Wirsung

Define hypercalcemia.

Elevated levels of calcium in the blood.

Define Courvoisier's gallbladder.

Enlargement of the gallbladder caused by a slow, progressive obstruction of the distal common bile duct from an external mass, such as adenocarcinoma of the pancreatic head.

Define amylase.

Enzyme secreted by the pancreas to aid in the digestion of carbohydrates.

A pseudocyst develops when pancreatic escapism from the gland and break down tissue to the form sterile abscess somewhere in the abdomen.

Enzymes

The patient with pancreatitis typically presents with moderate to severe tenderness in the _______ radiating to the ______.

Epigastrium; back

Define obstructive jaundice.

Excessive bilirubin in the bloodstream caused by an obstruction of bile from the liver; characterized by a yellow discoloration of the sclera of the eye, skin, and mucous membranes.

The pancreas is both a digestive (______) and a hormonal (______) gland.

Exocine; endocrine

Define pancreatic ascites.

Fluid accumulation caused by a rupture of a pancreatic pseudocyst into the abdomen; free-floating pancreatic enzymes are very dangerous to surrounding structures.

Define C-loop of the duodenum.

Forms the lateral border of the head of the pancreas.

Define common hepatic artery.

Forms the right superior border of the body and head of the pancreas and gives rise to the gastroduodenal artery.

The ______ artery is seen along the anterolateral border of the pancreas as it travels a short distance along the anterior aspect of the pancreatic head.

Gastroduodenal

Alpha cells produce ______, a hormone that causes the cells to release glucose to meet the energy of the body.

Glucagon

______ controls the blood sugar level in the body.

Glucose

Necrosis of the blood vessels results in the development of hemorrhage areas referred to as _______ sign.

Grey Turner's

Define pancreaticoduodenal arteries.

Help supply blood to the pancreas along with the splenic artery.

Define cystic fibrosis.

Hereditary disease that causes excessive production of thick mucus by the endocrine glands.

Define insulin.

Hormone that causes glycogen formation from glucose in the liver and that allows circulating glucose to enter tissue cells.

When the pancreas is enlarged, the anterior border of the _____ may depict a slight indentation.

Inferior vena cava

Define pancreatitis.

Inflammation of the pancreas; may be acute or chronic.

The pancreatic duct may be obstructed in acute pancreatitis as a result of ______, _______, _______, _______, and _______.

Inflammation; Spasm; Edema; Swelling of the papilla; Pseudocyst formation

The beta cells are most prevalent and produce ______, a hormone that causes glycogen formation from glucose in the liver.

Insulin

The endocrine function is located in the ______ in the pancreas.

Islets of Langerhans

The pancreatic gland appears sonographically _____ to slightly more _____ than the hepatic parenchyma.

Isoechoic; hyperechoic

Define portal-splenic confluence.

Junction of the splenic and main portal vein; posterior border of the body of the pancreas.

Define duct of Wirsung.

Largest duct of the pancreas that drains the tail, body, and head of the gland; it joins the common bile duct to enter the duodenum through the ampulla of Vater.

The most common location of a pseudocyst is in the ________, anterior to the pancreas and posterior to the stomach.

Lesser sac

Define head of the pancreas.

Lies in the C-loop of the duodenum; the gastroduodenal artery is the anterolateral border, and the common bile duct is the posterolateral border.

Define body of the pancreas.

Lies in the midepigastrium anterior to the superior mesenteric artery and vein, aorta, and inferior vena cava.

Define superior mesenteric vein.

Lies posterior to the neck or body of the pancreas and anterior to the uncinate process of the gland.

Both amylase and lipase rise at the same rate, but the elevation in ______ concentration persists for a longer period in pancreatitis.

Lipase

When swelling does occur, the gland is hypoechoic to anechoic and is less echogenic than the liver because of the increased prominence of ______ and ________.

Lobulations; congested vessels

The most frequent parapancreatic neoplasm is ________.

Lymphoma

Define lymphoma.

Malignant neoplasm that arises from the lymphoid tissues.

The ________ become obstructed with a buildup of protein plugs with resultant calcifications along the duct in ________ pancreatitis.

Pancreatic ducts; chronic

Define lipase.

Pancreatic enzyme that breaks down fats; enzyme is elevated in pancreatitis and remains increased longer than amylase.

Define serum amylase.

Pancreatic enzyme that is elevated during pancreatitis.

When the pancreas becomes damaged and malfunctions as a result of increased secretion and blockage of ducts, ______ occurs.

Pancreatitis

An inflammatory process that spreads along fascism pathways, causing localized areas of diffuse inflammatory edema of soft tissue, is knows as _______.

Phlegmon

Define islets of Langerhans.

Portion of the pancreas that has an endocrine function and produces insulin, glucagon, and somatostatin.

Patients with acute pancreatitis may develop complications, such as ______, ________, _________, ________, and _________.

Pseudocyst; Phlegmon; Abscess; Hemorrhage; Duodenal obstruction

The pancreas is located in the _____ cavity posterior to the stomach, duodenum, and proximal jejunum of the small bowel.

Retroperitoneal

Define superior mesenteric artery.

Serves as the posterior border to the body of the pancreas.

Define duct of Santorini.

Small accessory duct of the pancreas found in the head of the gland.

Define neck of the pancreas.

Small area of the pancreas between the head and the body; anterior to the superior mesenteric vein.

Define uncinate process.

Small, curved tip of the pancreatic head that lies posterior to the superior mesenteric vein.

Delta cells are the smallest composition of endocrine fissure and produce ______.

Somatostatin

Define pseudocyst.

Space or cavity that contains fluid but has no true endothelial lining membrane.

The ______ is a muscle surrounding the ampulla of Vater that relaxes to allow pancreatic juice and bile to empty into the duodenum.

Sphincter of Oddi

The tortuous _____ is the superior border of the pancreas.

Splenic artery

The blood supply got the pancreas is from the ______ artery and the ______ arteries.

Splenic; pancreaticoduodenal

Define glucagons.

Stimulates the liver to convert the glycogen to glucose; produced by alpha cells.

Name the structures that should be identified as landmarks to locate the pancreas.

Superior mesenteric artery, superior mesenteric vein, portal vein, splenic vein, aorta, inferior vena cava, common bile duct, gastroduodenal artery, left renal vein, duodenal bulb, posterior wall of the stomach, and pancreatic duct.

The ______ crosses anterior to the uncinate process of the head of the gland and posterior to the neck and body.

Superior mesenteric vein (SMV)

Define tail of the pancreas.

Tapered end of the pancreas that lies in the left hypochondrium near the hilus of the spleen and main portal vein; posterior border of the body of the pancreas.

Define exocrine.

The kind of pancreatic function that involves the production and digestion of pancreatic juice.

Define endocrine.

The kind of pancreatic function that involves the production of the hormone insulin.

Describe how a pseudocyst develops.

The pancreatic enzymes that escape the ductal system cause enzymatic digestion of surrounding tissue and pseudocyst development. The walls of the pseudocyst form in various potential spaces in which escaped pancreatic enzymes are found. The pseudocyst usually present few symptoms until it becomes large enough to cause pressure on surrounding organs.

Explain how fat influences the echogenic of the pancreas on ultrasound.

The parenchyma like texture of the pancreas depends on the amount of fat between the lobules and to a lesser extent of the interlobular fibrous tissue. The internal echoes of the pancreas consist of closely spaced elements of the same intensity with uniform distribution throughout the gland. Fat is strongly echogenic.

Describe the water technique used to image the pancreas with ultrasound.

The patient should drink 32 to 300 ml of fluid through a straw in the erect or right lateral decubitus position. The fluid fills the duodenal cap to outline the lateral margin of the head of the pancreas. The upright position allows air to move from the gastric antrum to the fundus of the stomach and causes the upper viscera to move downward for a better sonic window.

List the clinical findings in the posting with carcinoma of the pancreas.

Weight loss, painless jaundice, nausea, vomiting, and changes in stool.