Module 5 : Pancreas Flashcards Preview

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Flashcards in Module 5 : Pancreas Deck (37)
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1
Q

pancreas embryology

A
  • formed from ventral and dorsal diverticula of primitive foregut
  • dorsal bud = neck, body, tail
  • ventral bud = head and uncinate
2
Q

location of panc

A
  • retroperitoneal
  • epigastrium and left hypochondrium
  • anterior pararenal space
  • sits in C loop of duodenum
  • ## duodenal loop to splenic hilum
3
Q

structures anterior to panc

A
  • left lobe of liver
  • stomach (pylorus)
  • LESSER SAC
4
Q

thin patient - panc position

A
  • less retroperitoneal fat

- head and til more posterior to body and neck

5
Q

fat patient - panc postion

A
  • increased retroperitoneal fat
  • head and tail more anterior
  • all parts at same depth
6
Q

panc size

A
  • shrinks with age
  • 12-15 cm long
  • outline of panc should be smooth regardless of size and echogenicity
  • no focal enlargement
7
Q

panc shape

A
  • comma , sausage, dumbbell, tadpole, boomerang
8
Q

panc head structural relationships

A
  • medial to duodenum
  • anterior to ivc
  • anterior OR superior to left renal vein
  • lateral to portal/splenic confluence
  • INFERIOR TO PORTAL VEIN
  • posterior to pyloric stomach
  • INFERIOR TO HEPATIC ARTERY
  • GDA anterolateral
  • CBD posterolateral
  • uncinate
    +posterior to SMV and SMA
9
Q

panc neck structural relationships

A
  • anterior to SMV and PORTAL CONFLUENCE

- inferior to common hepatic artery

10
Q

celiac axis relationship to panc

A
  • ANYTHING OFF CELIAC AXIS WILL BE SUPERIOR TO PANC
11
Q

panc body structural relationships

A
  • posterior to stomach
  • anterior to aorta, left renal vein, splenic vein, SMA
  • inferior to celiac axis and splenic artery
12
Q

panc tail structural relationships

A
  • anteriot to left adrenal gland
  • left of aorta
  • splenic artery POSTERIOR SUPERIOR BORDER
  • splenic vein POSTERIOR INFERIOR BORDER
13
Q

pancreatic ducts

A
  • main duct = Duct of Wirsung

- accessory duct = Duct of Santorini

14
Q

Duct of Wirsung

A
  • extends along length of gland
  • wins with CBD and enters ampulla of vater
  • should not exceed diameter of 2mm
15
Q

Duct of Santorini

A
  • enters duosenum 2cm prox to main duct

- enters at minor duodenal papilla

16
Q

function of pancreas

A
  • exocrine (digestive)

- endocrine (hormones)

17
Q

exocrine function of panc

A
  • 80% of panc tissue - ductal and acini cells
  • produce pan juices which are liberates into panc duct
  • juices composed of digestive enzymes, water, bicarbonate, salt
18
Q

pan enzymes

A
  • amylase = acts on carbohydrates (starches)
  • lipase = acts on fats
  • sodium bicarbonate = neutralize hydrochloric acid
  • trypsin, chymotrypsin, carboxypeptidase = protein
  • protease - nucleic acid
19
Q

what triggers release of pan juices

A
  • food in duodenum triggers release of hormones which trigger release of panc juices
20
Q

hormone trigger digestion

A
  • secretin, pancreozymin/cholecystokinin
21
Q

secretin

A
  • stimulates production of sodium bicarbonate in pancreatic duct
22
Q

pancreozymin/cholecystokinin

A
  • stimulates acing cells to produce digestive enzymes

* also GB to contract

23
Q

endocrine function of panc

A
  • hormones produced in islets of langerhans
  • more numerous in panc tail
  • released into bloodstream
    3 types of cells
24
Q

alpha cells

A
  • produce glucagon
25
Q

beta cells

A
  • produce insulin

* diabetes effects this cell

26
Q

delta cells

A
  • produce somatostatin

+ inhibits production of insulin and glucagon

27
Q

lab tests

A
  • syrum amylase
  • lipase
  • glucose
  • urine amylase
28
Q

serum amylase

A
  • obstruction of duct or necrosis of tissue can cause enzyme to leak into tissue spaces and blood stream
  • levels increase within 3-6 hours of incident can persist for 24 hours
  • not specific for pancreatitis (amylase produced in salivary glands too)
29
Q

lipase

A
  • excreted by panc only
  • increased inflammatory conditions and some neoplasms
  • levels can stay elevated up to 14 days after amylase has dropped
30
Q

glucose

A
  • increase occurs in diabetes, chronic liver and panc diseases and over activity of endocrine glands
  • decrease in tumors of islets of langerhans and hypoglycaemia
31
Q

blood glucose

A
  • fasting blood sugar level
32
Q

glucose tolerance

A
  • measures body ability to process sugar
33
Q

urine amylase

A
  • parallels level found in blood
  • urine levels return to normal more slowly than blood
  • levels remain elevated up to 7-10 days in chronic and acute pancreatitis
34
Q

blood supply to panc

A
  • from pancreaticoduodenal arteries (branches of right gastric which is branch of hepatic artery) and branches of splenic artery
  • anterior and inferior pancreticoduodenal arteries supply head and part of duodenum
  • splenic artery supplies body and tail
35
Q

scanning technique for panc

A
  • one of first organs to image to avoid affect of gas
  • use left lobe of liver as window
  • caudal angulation / slightly counterclockwise rotation
36
Q

sonographic appearance of panc

A
  • homogenous slightly coarser than liver
  • generally isoechoic or slightly more echogenic in adults
  • panc duct visualized in transverse plane
    +double parallel line surrounded by panc tissue
    + collapsed wall of pylorus might mimic duct
    * MAKE SURE TO SEE PANC TISSUE ON BOTH SIDES OF LINE
37
Q

reasons panc is not well seen

A
  • no capsule
  • gas shadowing from pylorus of stomach
  • location in general
  • lig teres shadows head