Pancreas (uniquelee93)

Which cells carry out the exocrine function of the pancreas?

Acinar cells

True pancreatic cysts are uncommon. Multiple pancreatic cysts are associated with what two syndromes?

Autosomal dominant (adult) polycystic kidney disease and Von Hippel-Lindau syndrome

Mucinous cystadenocarcinomas of the pancreas are most often located within which parts of the pancreas?

Body and tail

What are pancreatic pseudocysts?

Collections of pancreatic fluid encapsulated by fibrous tissue

Name two structures posterior to the first portion of the duodenum.

Common bile duct and gastroduodenal artery

Pancreatic adenocarcinoma is sonographically seen as a solid focal hypoechoic mass typically (70%) in the head of the pancreas. What additional findings are associated with pancreatic adenocarcinoma? (6)

Dilated biliary system Dilated pancreatic duct Liver metastases Ascites Lymphadenopathy Pseudocyst formation

What is an additional name for the accessory duct of the pancreas?

Duct of Santorini

What is the name for the main pancreatic duct?

Duct of Wirsung

Name four sonographic indications of portal vein thrombosis

Echogenic thrombus Increase in portal vein diameter Portosystemic collateral circulation Cavernous transformation

Name 3 clinical findings associated with pancreatic adenocarcinoma

Epigastric pain, weight loss, jaundice

Which part of the pancreas is located right lateral to superior mesenteric vein, anterior to inferior vena cava, and inferior to portal vein?

Head

Name 5 different parts of the pancreas.

Head, neck, body, tail, uncinate process

What lab value is increased with the presence of pseudocyst(s)?

Increased levels of serum amylase

Which hormone is released by the pancreas that encourages the body's use of glucagon?

Insulin

What is the most common islet cell tumor?

Insulinoma

What are the branches of the celiac axis?

Left gastric, common hepatic, splenic arteries

Which laboratory value is more specific for acute pancreatitis?

Lipase

Which part of the pancreas is located anterior to portal confluence?

Pancreatic neck

Name six tumors associated with Multiple Endocrine Neoplasia syndrome.

Pituitary adenoma Parathyroid adenoma Medullary thyroid carcinoma Pancreatic islet cell tumors Pheochromocytoma Ganglioneuromatosis

Name two cystic masses associated with the pancreas in patients without a history of autosomal dominant (adult) polycystic kidney disease.

Pseudocysts and Cystadenomas

Name 4 characteristics of cystadenomas.

Rare fluid collections Arise from epithelium of the pancreatc duct Primarily cystic with septations and thick walls Increased levels of serum amylase

What are the sonographic signs of chronic pancreatitis? (4)

Small echogenic gland Calcifications Pancreatic duct dilatation Pseudocyst formation

What are Islet Cell Tumors?

Small, well circumscribed masses, found within the pancreatic body and tail

The muscle that controls the emptying of the bile and pancreatic juices into the duodenum is the

Sphincter of Oddi

The pancreatic tail is outlined posteriorly by what vascular structure?

Splenic vein

Which vessel courses adjacent to the posterior and inferior surface of the pancreatic body?

Splenic vein

What two vessels form the main portal vein?

Splenic vein and superior mesenteric vein join at the confluence adjacent to the head of the pancreas

Are Islet Cell Tumors benign or malignant?

They are the most common benign tumors of the pancreas but they can also be malignant.

Which of the following is associated with development of cysts within the pancreas?

Von Hippel-Lindau disease

What is the most common location of a pancreatic pseudocysts?

Within the anterior pararenal space of the retroperitoneum and the lesser sac of the peritoneum

The most common form of malignancy of the pancreas is

adenocarcinoma

What are the two most common causes of pancreatitis?

alcohol abuse and biliary calculi

Exocrine Function of the pancreas produces:

amylase, lipase, carboxypeptidase, trypsin, and chymotrypsin

Tail of the pancreas is ______ to the upper pole of the left kidney.

anterior

The head of the pancreas is __________ to the inferior vena cava.

anterior

The superior mesenteric artery and vein are __________ to the third portion of the duodenum.

anterior

The superior mesenteric artery and vein are __________ to the uncinate process of the pancreas.

anterior

The pancreas is a nonencapsulated, retroperitoneal structure located between the second portion of the duodenum and the splenic hilum. What space in the retroperitoneum is the pancreas located?

anterior pararenal space

Stomach is _____ and _____ to the splenic hilum.

anterior, medial

The gastroduodenal artery is __________ to the head of the pancreas.

anterolateral

Enlargement of the pancreatic head may cause:

biliary obstruction

What is the sonographic appearance of acute pancreatitis?

decreased echogenicity and increased gland size

Co-existing obstruction of the common bile duct and pancreatic duct may be referred to as the:

double duct sign

The portion of bowel that encompasses the head of the pancreas is the

duodenum

The arterial blood supply to the head of the pancreas is via the

gastroduodenal artery

Which is the landmark for the anterior-lateral aspect of the pancreas?

gastroduodenal artery

The most common location of adenocarcinoma of the pancreas is within the

head of the pancreas

What are the branches of the common hepatic artery?

hepatic proper and the gastroduodenal arteries

The most common echogenicity of an acutely inflamed pancreas is

hypoechoic

The normal AP measurement of the duct of Wirsung at the level of the body is:

less than or equal to 2mm

Name 3 clinical features of acute pancreatitis

leukocytosis, back pain, fever

One clinical sign of an insulinoma is the presence of

low blood sugar symptoms

The head of the pancreas is __________ to the second portion of the duodenum.

medial

The most common location of focal pancreatitis is within the

neck of the pancreas

A 60-year-old patient presents with painless jaundice and weight loss. The pancreatic head measures 4cm with an enlarged pancreatic duct. This is most likely:

pancreatic cancer

Tail of the pancreas is ______ to the stomach.

posterior

The aorta is __________ to the body of the pancreas.

posterior

The gastroduodenal artery and common bile duct run __________ to the first portion of the duodenum.

posterior

The superior mesenteric artery and vein are __________ to the neck of the pancreas.

posterior

The uncinate process is __________ to the superior mesenteric artery and vein.

posterior

The splenic vein is __________ to the pancreas.

posteriorinferior

The common bile duct is __________ to the head of the pancreas.

posterolateral

Name three exocrine functions of the pancreas

production of lipase production of amylase production of sodium bicarbonate

The superior mesenteric vein is to the __________ of the superior mesenteric artery.

right

In cases of acute pancreatitis, which lab value rises significantly in the early phase and decreases within a few days?

serum amylase

The celiac axis arises from the aorta __________ to the pancreas.

superior

The third portion of the duodenum passes between the _____ and the ______.

superior mesenteric artery, aorta

The portal vein is the result of the combination of the __________ and the __________.

superior mesenteric vein and splenic vein

Splenic artery is ______ and _______ to the pancreas.

superior, anterior

What are some causes of pancreatic pseudocysts? (4)

Acute pancreatitis Chronic pancreatitis Trauma Pancreatic cancer

What sign is associated with an adenocarcinoma of the pancreatic head resulting in extrinsic compression of the common bile duct and an enlarged gallbladder?

Courvoisier's sign is a palpable, nontender gallbladder due to an adenocarcinoma of the pancreatic head obstructing the biliary tract resulting in jaundice.

Cystic fibrosis is characterized by viscous secretions leading to pancreatic insufficiency. When severely affected, what is the sonographic appearance of the pancreas in a patient with cystic fibrosis?

Increased echogenicity

Name the two most common Islet Cell Tumors, and describe the symptoms related to each.

Insulinoma: hyperinsulinism and hypoglycemia Gastrinomas: gastric hypersecretions and peptic ulcer disease (Zollinger-Ellison Syndrome)

A patient presents with hypoglycemia and a hypoechoic mass in the tail of the pancreas. What is the mass in the pancreas?

Islet cell tumor (insulinoma) Seen in body or tail Causes hypersecretions of insulin which causes hypoglycemia

What is the endocrine function of the pancreas?

Islet cells of Langerhans which secretes insulin

Name two structures posterior to the inferior vena cava.

Right renal artery, right adrenal gland

What two veins join to form the main portal vein?

Superior mesenteric vein and splenic vein

The pancreatic head is __________ to the portal vein.

inferior

The superior mesenteric artery arises from the aorta __________ to the pancreas.

inferior

Name the structure posterior to the head of the pancreas.

inferior vena cava