Penny Ch 5
Endocrine functions of the Pancreas (Isles of Langerhans)
1. Alpha Cells - Glucagon - promotes the release of glucose by the liver (increases blood sugar level 2. Beta Cells - Insulin - stimulates the body to use up glucagon to produce energy 3. Delta cells - Somatostatin - Restrains insulin and glucose levels
Clinical findings of Islet cell tumors
1. Insulinoma - low blood sugar symptoms 2. Gastrinoma - Zollinger-Ellison syndrome
Exocrine Functions of the pancreas (Acinar cells)
1. amylase - digests carbohydrates 2. Lipase - digests fats 3. Sodium bicarbonate - neutralizes stomach acids 4. Trypsin, chymotrypsin and carboxypolypeptidase - digests proteins
Clinical findings of chronic pancreatitis
1. asymptomatic 2. persistent epigastric pain 3. jaundice 4. back pain 5. possible elevation in amylase and lipase (but they may remain normal)
Sonographic appearance of serous cystadenoma
1. cystic mass that may appear solid and echogenic 2ndary to the small size of the cysts
Clinical findings of acute pancreatitis
1. elevated amylase (within 24 hrs) 2. elevated lipase (within 72 hrs) 3. abdominal pain 4. back pain 5. fever 6. nausea and vomiting 7. leukocytosis 8. severe acute pancreatitis may lead to hemorrhage and a decreased hematocrit
Clinical findings of pancreatic adenocarcinoma
1. elevated amylase and/or lipase 2. loss of appetitie 3. weight loss 4. jaundice 5. courvousier GB 6. epigastric pain
Sonographic findings of chronic pancreatitis
1. heterogenous, atrophic gland with poor margins 2. calcifications within the gland 3. pancreatic pseudocyst 4. dilated pancreatic duct 5. stone(s) within the pancreatic duct that may lead to biliary obstruction 6. possible portosplenic vein thrombosis
Sonographic findings of pancreatic adenocarcinoma
1. hypoechoic mass in the head of the pancreas 2. dilated CBD and Pancreatic duct (double-duct sign) 3. Liver and other abdominal organs should be evaluated for possible metastasis 4. enlarged GB
Sonographic findings of Islet Cell Tumors
1. hypoechoic mass that may contain calcifications 2. visualization is hard b/c of their small size
Sonographic appearance of mucinous cystadenoma and cystadenocarcinoma
1. multilocular cystic masses that may contain mural nodules and calcifications 2. there may be associated dilation of the pancreatic duct
sonographic findings of acute pancreatitis
1. the pancreas may appear normal 2. diffusely enlarged, hyposechoic pancreas 3. focal hypoechoic area within the pancreas 4. unencapsulated anechoic fluid collection 5. pancreatic pseudocyst 6. abscess formation can occur and is seen as echogenic fluid containg gas bubbles 7. biliary obstruction may be present 8. vascular complications such as thrombosis (SV) and pseudoaneurysms (SA)
Sonographic findings of True Pancreatic cysts
1. well-defined, anechoic mass with posterior enhancement
Which cells carry out the exocrine function of the pancreas?
Acinar cells
The most common form of malignancy of the pancreas is:
Adenocarcinoma
Courvoisier GB is found in the presence of this pancreas pathology:
Adenocarcinoma in the head of the pancreas
Pancreatic neck - Adjacent Vasculature
Anterior to Portal Confluence
Pancreatic Body - Adjacent Vasculature
Anterior to SMV, SV and SMA
What is an additional name for the accessor duct of the pancreas?
Duct of Santorini
What is the name for the main pancreatic duct?
Duct of Wirsung
Is production of glucagon and endocrine or exocrine function of the pancreas?
Endocrine
The arterial blood supply to the head of the pancreas is via the:
Gastroduodenal artery
Which part of the pancreas is located right lateral to the SMV, anterior to the IVC and inferior to the GB
Head
The most common location of focal pancreatitis is within the:
Head of the pancreas
The most common echogenicity of an acutely inflamed pancreas is:
Hypoechoic
Which hormone released by the pancreas that encourages the body's use of glucacon?
Insulin
Which is the most common islet cell tumor?
Insulinoma
Once of the most common locations for a pancreatic psudocyst is within the:
Lesser Sac
Which laboratory value is more specific for acute pancreatitis (amylase, lipase, AST or SGOT)?
Lipase
What is the early sonographic appearance of acute pancreatitis:
Normal
Which part of the pancreas is located anterior to the portal confluence?
Pancreatic neck
Uncinate Process - Adjacent Vasculature
Posterior to SMV / May completely surround SMV Anterior to AO
Is the pancreas intraperitoneal or retroperitoneal?
Retroperitoneal
Pancreatic Head - Adjacent Vasculature
Right lateral to SMV Anterior to IVC Inferior to PV
Pancreatic Tail - Adjacent Vasculature
SV marks posterior border of Pancreatic tail
The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the:
Sphincter of Oddi
The pancreatic tail is outlined posteriorly by what vascular structure?
Splenic Vein
A gastrinoma of the pancreas can produce this syndrome:
Zollinger-Ellison Syndrome
pancreatic pseudocyst
a cyst surrounded by fibrous tissue that consists of pancreatic enzymes that have leaked from the pancreas
von Hippel-Lindau disease
a hereditary disease that includes the development of cysts within the pancreas and other organs
lesser sac
a peritoneal cavity space located between the stomach and pancreas where fluid can accumulate
uncinate process
a posteromedial extension of the pancreatic head
The portion of the bowel that encompasses the head of the pancreas is the:
a. duodenum
autosomal dominant polycystic kidney disease
an inherited disease that results in the development of renal, liver, and pancreatic cysts late in life; also referred to as adult polycystic kidney disease
gastinoma
an islet cell tumor found within the pancreas
insulinoma
an islet cell tumor found within the pancreas
Mucinous cystadenocarcinoma of the pancreas are most often located within which parts of the pancreas?
body and tail
All of the following are classical clinical features of acute pancreatitis except: a. leukocytosis, b. back pain, c. weight gain, d. fever
c. weight gain
double-duct sign
co-existing enlargement of the common bile duct and pancreatic duct
All of the follow are clinical findings associated with pancreatic adenocarcinoma except: a. epigastric pain, b. weight loss, c. jaundice, d. decreased amylase and lipase
d. decreased amylase and lipase
All of the following are sonographic features of chronic pancreatitis except: a. dilated pancreatic duct, b. calcfications within the pancreas, c. pancreatic pseudocyst, d. diffusely hypoechoic pancreas
d. diffusely hypoechoic pancreas
Co-existing obstruction of the CBD and Pancreatic duct may be referred to as the:
double-duct sign
hyperamylasemia
elevated amylase
endoscopic retrograde cholangiopancreatography
endoscopic procedure that utilizes fluoroscopy to evalute the biliary tree and pancreas
The most common location of adenocarcnoma of the pancreas is within the:
head of the pancreas
Acute pancreatitis
inflammation of the pancreas secondary to the leakage of pancreatic enzymes from the acinar cells into the parenchyma of the organ
Courvoisier GB is defined as:
palpable DB caused by a biliary obstruction in the area of the pancreatic head
chyme
partially digested food
isles of Langerhans
small islands of tissue found within the pancreas that produce insulin and glucagon
duct of Santorini
the accessory duct of the pancreas
Acinar Cells
the cells of the pancreas that carry out the exocrine function and therefore produce amylase, lipase, and sodium bicarbonate
Courvoisier gallbladder
the clinical detection of an enlarged palpable gallbladder caused by a biliary obstruction in the area of pancreatic head
duodenum
the first segment of the small intestine
duct of Wirsung
the main pancreatic duct
Ampulla of Vater
the merging point of the pancreatic duct and CBD just before the sphincter of Oddi; also referred to as the hepatopancreatic ampulla
pancreatic adenocarcinoma
the most common form of pancreatic malignancy; typically found in the head of the pancreas
sphincter of Oddi
the muscle that controls the emptying of bile and pancreatic juices into the duodenum; also referred to as the hepatopancreatic sphincter
phlegmon
the peripancreatic fluid collection that results from the inflammation of the pancreas
choledocholithiasis
the presence of a gallstone within the biliary tree
chronic pancreatitis
the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scarring, and the development of calcification within the gland
pancreaticoduodenectomy (aka 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 a malignant pancreatic neoplasm; also referred to as the Whipple procedure
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 isles of Langerhans of the pancreas
jaundice
yellowish discoloration of the skin, mucous membranes, and the sclerae; found in presence of liver disease and/or biliary obstruction