Penny Book Chapter 5: The Pancreas
A cystadenoma within the pancreas may be referred to as either _________________________ or ____________________________. Serous tumors are small and always benign, while mucinous tumors are larger and have malignant potential.
(microcystic) serous cystadenoma or (macrocystic) mucinous cystadenoma
pancreatic transplant fluid collection
- Abscess - Ascites - Hematoma - Urinoma (secondary to anastomosis problems at urinary bladder) - Pseudocysts
endocrine function of the pancreas
- Alpha Cells > Glucagon > promotes the release of glucose by the liver - Beta Cellas > Insulin > stimulates the body's use of glucagon - Delta Cells > Somatostatin > restrains insulin and glucose level
Pancreatic neck is
- Anterior to portal confluence
Pancreatic body is
- Anterior to superior mesenteric vein, splenic vein, and superior mesenteric artery
pancreatic transplant vascular complications
- Arterial stenosis: focal areas of increased velocities - Arterial thrombosis - Graft thrombosis - Pseudoaneurysms - Splenic vein thrombosis: elevated pulsed-wave Doppler resistive index in the arterial inflow Doppler waveform, often greater than 1.0; absent splenic inflow • Strictures: evident with turbulent flow
clinical findings of chronic pancreatitis
- Asymptomatic - Persistent epigastric pain - Jaundice - Back pain - Possible elevation in amylase or lipase (but they may remain normal) - Possible elevation in ALP - Anorexia - Vomiting - Weight loss - Constipation
sonographic findings of a serous cystadenoma
- Cystic mass - May actually appear solid and echogenic secondary to the small size of the cysts
clinical findings of acute pancreatitis
- Elevated amylase (within 24 h) - Elevated lipase (within 72 h) - Leukocytosis - Elevated ALT and other liver function labs when biliary obstruction is present 5. Abdominal pain (especially in the supine position) - Back pain - Fever - Nausea and vomiting - Severe acute pancreatitis may lead to hemorrhage and a decreased hematocrit
clinical findings of pancreatic adenocarcenoma
- Elevated amylase and/or lipase - Loss of appetite - Weight loss - Jaundice - Courvoisier gallbladder (enlarged palpable gallbladder) - Epigastric pain - Elevated ALP and possibly other liver function labs associated with biliary obstruction
sonographic findings of chronic pancreatitis
- Heterogeneous, or hyperechoic, atrophic gland with poor margins - Calcifications within the gland - Pancreatic pseudocyst - Dilated pancreatic duct - Stone(s) within the pancreatic duct that may lead to biliary obstruction - Possible portosplenic vein thrombosis
sonographic findings of chronic pancreatic transplant rejection
- Hyperechoic echotexture - Atrophy - Pancreas may contain calcifications
sonographic findings of pancreatic adenocarcinoma
- Hypoechoic mass in the head of the pancreas - Dilated common bile duct and pancreatic duct (double-duct sign) - Liver and other abdominal organs should be evaluated for possible metastasis - Enlarged (hydropic) gallbladder
sonographic findings of Islet Cell tumors
- Hypoechoic mass that may contain calcifications - Visualization is hard because of their small size
sonographic findings of acute pancreatic transplant rejection
- Hypoechoic or heterogeneous gland - Elevated resistive indices
clinical findings of islet cell tumors
- Insulinoma: low blood sugar symptoms - Gastrinoma: Zollinger-Ellison syndrome
clinical findings of cystadenomas and cystadenocarcinomas
- May be asymptomatic initially - Epigastric pain - Weight loss - Palpable mass - Jaundice
sonographic findings of mucinous cystadenoma and cystadenocarcinoma
- Multilocular cystic masses that may contain mural nodules and calcifications - There may be associated dilation of the pancreatic duct
clinical findings of true pancreatic cyst
- Possible history of von Hippel-Lindau disease or cystic fibrosis - Possible history of ADPKD
Uncinate process is
- Posterior to superior mesenteric vein; may completely surround superior mesenteric vein - Anterior to aorta
Pancreatic head is
- Right lateral to superior mesenteric vein - Anterior to inferior vena cava and inferior to portal vein
Pancreatic tail is
- Splenic vein marks posterior border of pancreatic tail
sonographic findings of true pancreatic cysts
- Well-defined, anechoic mass with posterior enhancement
sonographic findings of acute pancreatitis
1- The pancreas may appear normal - Diffusely enlarged, hypoechoic pancreas (diffuse manifestation) - Focal hypoechoic area within the pancreas (focal manifestation) - Unencapsulated anechoic fluid collection surrounding all or part of the pancreas (peripancreatic fluid) - Pancreatic pseudocyst - Abscess formation can occur and is seen as echogenic fluid containing gas bubbles - Biliary obstruction may be present (possibly choledocholithiasis) - Vascular complications such as splenic vein thrombosis and pseudoaneurysm of the splenic artery
Exocrine function of the pancreas
1. Amylase: digests carbohydrates and converts starch to sugar 2. Lipase: digests fats and converts fats to fatty acids and glycerol 3. Sodium bicarbonate: neutralizes stomach acid 4. Trypsin, chymotrypsin, and carboxypolypeptidase: digests proteins
Transplantation techniques can vary, however; and in up to 80% of the time, patients undergo a renal transplant at the same time.
If this occurs, the pancreas is placed within the right side of the abdomen and the renal transplant is placed on the left.
______________ are solitary, while ____________ are often multiple and difficult to image.
Insulinomas gastrinomas
pancreatic pseudocyst
a cyst surrounded by the fibrous tissue that consists of the pancreatic enzymes that have leaked from the pancreas
Diffuse acute pancreatitis will result in
a diffusely enlarge, hypoechoic gland.
von Hippel-Lindau disease
a hereditary disease that includes the development if cysts within the pancreas an other organs
lesser sac
a peritoneal cavity located between the stomach and pancreas where the fluid accumulates
uncinate process
a posteromedial extension of the pancreatic head
The most common causes of acute pancreatitis are
alcohol abuse and biliary tract disease, such as choledocholithiasis, post endoscopic retrograde cholangeopancreatography and trauma.
Chronic pancreatitis can result in
an atrophic, hyperechoic pancreas with calcifications and a prominent pancreatic duct.
gastrinoma
an islet cell tumor found within the pancreas
insulinoma
an islet cell tumor found within the pancreas
Pancreatic divisum is the most common congenital variant of the pancreas and can lead to
both acute and chronic pancreatitis
ileus
bowel obstruction caused by the lack of normal peristalsis
double duct sign
coexisting enlargement of the common bile duct and pancreatic duct
pancreatic divisum
congenital anomaly of the pancreas that results in a shortened main pancreatic duct that only works to drain the pancreatic head and not the entire pancreas
annular pancreas
congenital anomaly of the pancreas that results in maldevelopment of the pancreas in which the most ventral part of the pancreas encases the duodenum and may consequently lead to duodenal obstruction
hypermylasemia
elevated amylase
endoscopic retrograde cholangiopancreatography
endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancreas
The arterial blood supply to the head of the pancreas comes from the
gastroduodenal artery
The normal echogenicity of the pancreas is
greater than that of the liver, and equal to, or greater than, that of the spleen in the adult
In addition to chronic alcohol abuse, other causes for chronic pancreatitis are
hyperparathyroidism, congenital anomalies (pancreatic divisum), genetic disorders, pancreatic duct obstruction, and trauma.
cystic fibrosis
inherited disorder that can affect the lungs, liver, pancreas, or other organs; this disorder changes how the body creates mucus and sweat
The pancreas is identified sonographically by
its neighboring vasculature
True pancreatic cysts
may be seen with von Hippel-Lindau disease, cystic fibrosis, or autosomal dominant polycystic kidney disease (ADPKD), the latter of which is associated with the development of cysts in many organs.
The pediatric pancreas may appear
more hypoechoic because of the lack of fat surrounding the pancreas in younger patients.
The most common primary pancreatic malignancy, which is most commonly found in men.
pancreatic adenocarcinoma
Islets of Langerhans
small islands of tissue found within the pancreas that produce insulin and glucagon
The body and tail of the pancreas receive their blood supple from the
splenic and superior mesenteric arteries
Venous drainage of the pancreas is achieved by means of the
splenic vein, superior mesenteric vein, inferior mesenteric vein, and portal vein.
duct of Santorini
the accessory duct of the pancreas
Cystadenomas are most often located in
the body and tail of the pancreas.
acinar cells
the cells of the pancreas that carry out the exocrine function and therefore produce amylase, lipase, sodium bicarbonate, and other digestive enzymes
duodenum
the first segment of the small intestine
duct of Wirsung
the main pancreatic duct
pancreatic adenocarcinoma
the most common form of pancreatic malignancy, typically found within the head of the pancreas
The most common location for a pancreatic adenocarcinoma is within
the pancreatic head
phlegmon
the peripancreatic fluid collection that results from the inflammation of the pancreas
hyperparathyroidism
the presence of elevated parathyroid hormone
chronic pancreatitis
the recurrent destruction of pancreatic tissue that results in atrophy, fibrosis with scarring, and the development of calcification within the gland
pancreaticoduodenectomy
the surgical procedure in which the head of the pancreas, the gallbladder, some of the bile ducts, and the proximal duodenum are removed because of a malignant pancreatic neoplasm; also referred to as the Whipple procedure
Whipple procedure
the surgical procedure in which the head of the pancreas, the gallbladder, some of the bile ducts, and the proximal duodenum are removed because of malignant pancreatic neoplasm, also referred to as pancreaticoduodenectomy
Zollinger-Ellison syndrome
the syndrome that includes an excessive secretion of acid by the stomach caused by the presence of a functional gastrinoma within the pancreas
islet cell tumors
tumor found within the islets of Langerhans of the pancreas
In some individuals, there exists a posteromedial extension of the pancreatic head, referred to as the
uncinate process
Acute pancreatitis will cause a rise in amylase first and then a rise in lipase,
with lipase being the most helpful laboratory finding for the diagnosis of the disease (presenting 72 hrs later)
The pancreas is considered a retroperitoneal organ located
within the epigastrium between the C-loop of the duodenum and the splenic hilum.