Anatomy
Anatomy Cont.
All Things Pancreatitis
Pathology
Miscellaneous
100
Is the pancreas a retroperitoneal or intraperitoneal organ?
Retroperitoneal
100
List 3 structures posterior to the pancreas?
Common bile duct
Portal-splenic confluence
Aorta
IVC
Splenic vein
SMA
SMV
100
What are the 2 types of pancreatitis?
Acute and Chronic
100
What is the failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development?
Pancreas Divisum
100
What lab value is described?
- Can assess damage to the pancreas
- Elevates with acute pancreatitis, obstruction of pancreatic duct, acute cholecystitis, and pancreatic carcinoma
Lipase
100
What region is the pancreas located in?
Epigastric
100
How many liters of pancreatic juice are produced per day?
2 Liters
100
What pathology is inflammation of the pancreas caused by acini cells releasing enzymes into pancreatic tissue?
Acute Pancreatitis
100
Which congenital anomaly does the head of the pancreas surround the second portion of the duodenum?
Annular Pancreas
100
What lab value is described?
- 2x normal level usually indicates acute pancreatitis
- Rises in acute pancreatitis, obstructed duct, perforated ulcer, acute cholecystitis, alcohol poisoning
Amylase
100
Name the sections of the pancreas
Head, Neck, Body, and Tail
100
Which 2 main enzymes are affected with pancreatic disease?
Amylase and Lipase
100
What are the 2 most common causes of acute pancreatitis?
Biliary tract disease (most common) 40%
Alcoholism 35%
100
What is one of the most common chronic lung diseases in children and young adults that is a life-threatening disorder?
Cystic Fibrosis
100
What lab value is described?
- Increased with severe diabetes, chronic liver disease, overactive endocrine glands
- Decreased with tumors in Islets of Langerhans
Glucose
100
What is the most inferior portion of the pancreas
Head
100
Which accessory duct is located in the upper portion of the pancreatic head and enters the duodenum at the minor papilla approximately 2 cm proximal to ampulla of Vater?
Santorini's Duct
100
What are some clinical symptoms of acute pancreatitis?
Moderate to severe pain in the epigastric area radiating to the back, fever, nausea, vomiting
100
What is caused by damage to the pancreas resulting in increased secretion and blockage of the ducts and has malfunction causing pancreatic tissue to be digested by its own enzymes?
Pancreatitis
100
What lab value stays elevated longer? Amylase or Lipase
Lipase
100
What is the normal length of the pancreas?
12-15 cm
100
How long should the patient be NPO for before the exam?
8-12 hours
100
What is the sonographic appearance of acute pancreatitis?
Ranges from normal size to focal/diffuse enlargement
Hypoechoic echotexture
Irregular borders
Enlarged pancreatic duct
Parapancreatic fluid collections
40-60% have associated gallstones
100
What are walled-off collections of fluid from extravasated pancreatic secretions?
Pseudocysts
100
What is the most common cause for a child to have a pseudocyst?
Abdominal Trauma
200
What is the medial, posterior extension of the head?
Uncinate Process
200
What artery supplies blood to the head of the pancreas?
GDA
200
What complication of acute pancreatitis is an inflammatory mass formed by edema and leakage of pancreatic enzymes?
Phlegmonoous pancreatitis
200
What is the mortality rate of a spontaneous rupture of a pseudocyst?
50%
200
What surgical procedure is used to treat early-stage adenocarcinoma?
Whipple Procedure
200
What is the primary duct that extends the entire length of the gland and receives tributaries from lobules at right angles and enters the duodenum with the CBD at major papilla--Ampulla of Vater?
Wirsung’s duct
200
What 2 things does pancreatic juice consist of to neutralize gastric acid?
Digestive enzymes and sodium bicarbonate
200
What type of pancreatitis involves a rapid progression of acute pancreatitis and is caused by sudden escape of active pancreatic enzymes into the glandular parenchyma?
Hemorrhagic pancreatitis
200
What is the sonographic appearance of pseudocysts?
Generally take on contour of the available space around them, so not always spherical like true cysts
Can fill the anterior pararenal space then collect in the lesser sac of the peritoneum
Well-defined
Smooth walled
Anechoic structure
Acoustic enhancement
May appear as solid of complex
May have debris dependently
200
What are the 2 types of islet cell tumors?
Functioning and Non Functioning
200
List 3 structures that are anterior to the pancreas?
Stomach, Portion of Duodenum, Transverse Colon, and GDA
200
Which cells produce glucagon and which produce insulin?
Alpha Cells produce glucagon and Beta Cells produce insulin
200
What pathology results from recurrent attacks of pancreatitis and is progressive and irreversible?
Chronic Pancreatitis
200
What are the 2 classifications of cystic neoplasms?
Serous cystadenoma and mucinous cystic neoplasm
200
What are the first and second most common functioning islet cell tumors?
Insulinoma and Gastrinoma
200
What portion of the pancreas is found directly anterior to the portal-splenic confluence or SMV?
The Neck
200
Label This
- Common bile duct
- Gastroduodenal artery
- Portosplenic Confluence
- Superior Mesenteric Artery
- Splenic vein
- Inferior vena cava
- Aorta
200
What are 3 clinical symptoms of chronic pancreatitis?
Epigastric pain radiating to back
Malabsorption
Weight loss
Jaundice secondary to CBD obstruction
Signs of diabetes
200
Serous cystadenomas are usually seen in patients of what age?
60
200
What pathology has a cluster of grape-like cysts sonographic appearance?
Serous cystadenoma
200
What is the largest and most anterior portion of the pancreas?
Body
200
What arteries supply blood to the body and tail?
Splenic Artery and SMA
200
What is the sonographic appearance of chronic pancreatitis?
Small fibrotic gland
Irregular borders
Mixed echogenicity
Dilated pancreatic duct
Calcifications
Pseudocyst formation
Bile duct dilation
200
What pathology is an inherited endocrine disorder that involves tumors in at least two endocrine glands; tumors can also develop in other organs and tissues?
Multiple Endocrine Neoplasia (MEN)
200
What is the most common primary neoplasm of the pancreas?
Adenocarcinoma