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