Chapter 5: Pancreas (Penny)
head, neck, body, tail
Four parts of the pancreas
uncinate process
Some people have an extension of the posteriomedial head known as __________ ____________
true pancreatic cyst
associated with von Hippel-Lindau disease and autosomal DOMINANT polycystic kidney disease.
insulin
beta cells produce
courvoisier GB
clinical detection of an enlarged, palpable GB caused by a biliary obstruction in the area of the head of the pancreas
zolliner-ellison syndrome
clinical findings of islet cell tumors - gastrinoma
low blood sugar symtptoms
clinical findings of islet cell tumors - insulinoma
the main pancreatic duct, the duct of wirsung, travels
length of the pancreas
Chyme
partially digested food
phlegmon
peripancreatic fluid collection that results from the inflammation of the pancreas
choledocholithiasis
presence of a gallstone or gallstones in biliary tree
islets of langerhans
small islands of tissue found within the pancreas that produce hormones (insulin and glucagon)
cystic mass that may appear solid and echogenic secondary to the small size of the cyst.
sonographic appearance of serous cystadenoma
CBD
the inferior (posterior) fish eye is the
pancreatic tail
the splenic vein marks the posterior border of this part of the pancreas?
GDA
the superior (anterior) fish eye is the
Whipple procedure
the surgical procedure on patients with pancreatic adenocarcinoma that removes the head of the pancreas, gallbladder and some of the bile ducts and proximal duodenum; aka pancreaticoduodenectomy
1-2cm
the tail should measure
true
true or false. islet cell tumors can be malignant or benign.
Von hippel-linau disease
what is associated with development of cysts within the pancreas?
exocrine process
1. enzymes drain from pancreas into duct of wirsung 2. into ampulla of vater where the enzymes mix with bile from liver and are released into the duodenum through sphincter of oddi 3. this liquid is mixed with chyme in the duodenum to breakdown food components
c. zollinger-ellison syndrome
A gastronome of the pancreas can produce: a. autosomal recessive PCKD b. von hippel-lindau disease c. zollinger-ellison syndrome d. hyperinsulinemia
Zollinger-Ellison syndrome
A syndrome that includes an excessive secretion of acid by the stomach caused by a functional GASTRINOMA within the pancreas.
c. weight gain
All of the following are classic clinical features of acute pancreatitis except: a. leukocytosis b. back pain c. weight gain d. fever
1. elevated amylase (within 24 hours) 2. elevated lipase (within 72 hours) 3. abdominal pain 4. back pain 5. fever 6. nausea / vomiting 7. leukocytosis 8. severe acute pancreatitis can lead to hemorrhaging and decreased hematocrit
Clinical findings of acute pancreatitis:
1. asymptomatic 2. persistent epigastric pain 3. jaundice 4. back pain 5. possible elevation in amylase or lipase
Clinical findings of chronic pancreatitis:
1. elevated amylase and/or lipase 2. loss of appetite 3. weight loss 4. jaundice 5. courvoisier GB 6. epigastric pain 7. loss of
Clinical findings of pancreatic adenocarcinoma
c. adenocarcinoma in the head of the pancreas
Courvoisier gallbladder is found in the presence of: a. hepatitis b. cholecystitis and chronic pancreatitis c. adenocarcinoma in the head of the pancreas d. islet cell tumor in the tail of the pancreas
ampulla of vater
Merging point of the pancreatic duct and CBD just before the sphincter of oddi; aka hepatopancreatic ampulla
d. lesser sac
One of the most common locations for a pancreatic pseudocyst in within the: a. paracolic gutters b. groin c. spleen d. lesser sac
exocrine gland that aids in digestion
Primary function of the pancreas?
alpha cells
Promotes the release of glucose by the liver (increases blood sugar levels)
1. heterogeneous, atrophic gland with poor margins 2. calcifications within the gland 3. pancreatic pseudocyst 4. dilated pancreatic duct 5. stones within the pancreatic duct that may lead to biliary obstruction 6. possible portosplenic vein thrombosis
Sonographic findings of chronic pancreatitis:
a. head
The most common location of adenocarcinoma of the pancreas is within the: a. head b. neck c. body d. tail
a. head
The most common location of focal pancreatitis is within the: a. head b. neck c. body d. tail
b. sphincter of Oddi
The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the: a. sphincter of vater b. sphincter of Oddi c. ampulla of vater d. ampulla of oddi
endocrine and exocrine
The pancreas functions as an __________ and ___________ gland
1. drink a cup of water 2. turn the patient LLD
What can help visualize the pancreas?
trypsin, chymotrypsin, and carboxypolypeptidase
What other enzymes does it secrete?
amylase, lipase, and sodium bicarbonate
What vital digestive enzymes does it secrete?
b. lipase
Which lab value listed below appears to be more specific for acute pancreatitis? a. amylase b. lipase c. AST d. SGOT
b. von hippel-lindau disease
Which of the following is associated with development of cysts within the pancreas? a. autosomal recessive polycystic kidney disease b. von hippel-lindau disease c. zollinger-ellison syndrome d. endoscopic retrograde cholangiopancreatography
c. insulinoma
Which of the following is the most common islet cell tumor? a. granuloma b. gastrinoma c. insulinoma d. cystadenoma
b. production of glucagon
all of the following are part of the exocrine function of the pancreas except for: a. production of lipase b. production of glucagon c. production of amylase d. production of sodium bicarbonate
d. diffusely hypoechoic pancreas
all of the following are sonographic features of chronic pancreatitis except: a. dilated pancreatic duct b. calcification within the pancreas c. pancreatic pseudocyst d. diffusely hypoechoic pancreas
glucagon
alpha cells produce
Pancreatic cystadenomas or cystadenocarcinoma
can be serous, which is small and always benign, or mucinous, larger and have malignant potential. Most often found in the body or tail.
1. choledocholithiasis 2. post endoscopic retrograde cholangiopancreatography (ERCP) 3. trauma
cause of acute pancreatitis
pancreatic pseudocyst
cyst surrounded by fibrous tissue that consists of pancreatic enzyme that have leaked from the pancreas
somatostatin
delta cells produce
hyperamylasemia
elevated amylase
islet cell tumors
endocrine tumors found within the isles of Langerhans
endoscopic retrograde cholangiopancreatography
endoscopic procedure that utilizes fluoroscopy to evaluate the biliary tree and pancreas
duodenum
first segment of small intestine
acute pancreatitis
inflammation of the pancreas secondary to the leaking of pancreatic enzymes from acini cells into the parenchyma
autosomal dominant polycystic kidney disease
inherited disease that results in the development of renal, liver, and pancreatic cysts later in life; aka adult polycystic disease
duct of wirsung
main pancreatic duct
2
main pancreatic duct may be seen and should not exceed _____ mm in size
body and tail
mucinous cystadenocarcinomas are most often located
mucinous cystadenoma or cystadenocarcinoma
multilocular cystic masses that may contain mural nodules and calcifications that may be associated with dilatation of the pancreatic duct
lesser sac
one of the most common locations for a pancreatic pseudocyst is within the
duodenum
pancreas is located within the epigastrium between the C-loop and _________ and the splenic hilum
glucagon
promotes the release of glucose by the liver, which in turn increases blood sugar levels
Chronic pancreatitis
repeated bouts of pancreatic inflammation; recurring destruction of the pancreatic tissue resulting in atrophy, fibrosis, scarring, and calcifications within the gland
delta cells
restrains insulin and glucose levels
1. may appear normal 2. diffusely enlarged, hypoechoic pancreas 3. focal hypo echoic area within the pancreas 4. un-encapsulated anechoic fluid collection surrounding all or part of pancreas 5. pancreatic pseudocyst 6. abscess formation with gas bubbles 7. biliary obstruction 8. vascular complications (i.e thrombosis of SV) or (pseudo of SA)
sonographic appearance of acute pancreatitis:
1. well-defined 2. anechoic mass with posterior enhancement
sonographic appearance of true pancreatic cyst
1. hypoechoic mass that may contain calcifications 2. visualization is hard because of small size
sonographic finding of islet cell tumors:
1. hypechoic 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 metastasis 4. enlarged GB
sonographic findings of pancreatic adenocarcinoma:
beta cells
stimulates the body to use up glucagon to produce energy
insulin
stimulates the body to use up glucagon to produce energy
duct of santorini
the accessory duct to the duct of wirsung, it has its own attachment point to the duodenum
GDA
the arterial blood supply to the pancreas is via the
splenic artery and SMA
the body and trial receive blood supply from
d. adenocarcinoma
the most common form of malignancy of the pancreas is: a. cystadenocarcinoma b. islet cell tumor c. cystadenoma d. adenocarcinoma
pancreatic adenocarcinoma
the most common primary pancreatic malignancy usually found in the head
sphincter of Oddi
the muscle that controls the emptying of bile and pancreatic juices into the duodenum; aka hepatopancreatic sphincter
2-3cm
the pancreas head and body should measure
retroperitoneal
the pancreas is intraperitoneal or retroperitoneal?
false, can be functional or non-functional
true or false. islet cell tumors can only be functional.
insulinoma and gastrinoma.
two types of islet cell tumors
SMV, IMV, splenic vein, and portal veins
venous drainage is via
digest proteins
what do trypsin, chymotrypsin, and carboxypolypeptides do?
digests carbs
what does amylase do?
digests fats
what does lipase do?
neutralize stomach acids
what does sodium bicarbonate do?
a. duct of santorini
what is an additional name for the accessory duct of the pancreas? a. duct of santorini b. duct of langerhans c. duct of oddi d. duct of wirsung
pancreatic body
what is located anterior to the SMV, splenic vein, and SMA?
pancreatic neck
what is located anterior to the portal confluence?
uncinate process
what is located posterior to SMV, anterior to aorta, and may surround the SMV
pancreatic head
what is located right/lateral to the SMV, anterior to IVC, and inferior to the PV
acinar cells
what part of the pancreas carries out the exocrine process?
lipase
which laboratory value appears to be more specific for acute pancreatitis?
insulinoma
which type of islet cell tumor is more common
