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Abdominal
Pancreas Anatomy - physiology - pathology
141
Medical
Undergraduate 2
12/04/2010

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Term
How is the Pancreas formed?
Definition
by fusion of the dorsal and ventral bud
Term
What is the main pancreatic duct?
Definition
The duct of Wirsung
Term
Where is the Duct of Wirsung seen and what does it look like on ultrasound?
Definition
seen in the body as 2 echogenic lines with hypoechoic central line
Term
Where does the duct of wirsung empty?
Definition
in duodenum at ampulla of vater
Term
What is ampulla of vater surrounded by?
Definition
sphincter of oddi
Term
What is the accessory duct of the pancreas called?
Definition
duct of santorini
Term
What does the duct of santorini do?
Definition
drains head of pancreas
Term
Where is the pancreas in relation to the lesser sac?
Definition
posterior
Term
Where is the pancreas in relation to the stomach and duodenum?
Definition
posterior
Term
Where does the pancreas lie in relation to the pararenal space btwn duodenal loop and splenic hilum?
Definition
anterior
Term
What are the parts of the pancreas?
Definition
Head, neck, body and tail
Term
What is the anterior border of the pancreas head?
Definition
posterior wall of the stomach
portion to the right of the SMV
anterior to the IVC
caudal to PV
anterior to SMV
Term
Where is the CBD located?
Definition
Posterior and Lateral to head
Term
Gastroduodenal artery is located where?
Definition
anterior and lateral to head
Term
The Splenic vein and SMV join together to form what?
Definition
portal confluence
Term
What is the Uncinate process of the pancreas?
Definition
small curved tip portion of the head
located directly posterior to the SMV
Inferior to caudate lobe
Term
Where is the neck of the pancreas located?
Definition
directly anterior to the SMV
between body and head
Term
What is the largest section of the pancreas?
Definition
body
Term
Where is the body of the pancreas located?
Definition
anterior to aorta, SMA, LRV, adrenal gland and left kidney
Term
What is the superior border of the Body of the pancreas?
Definition
ciliac
Term
where is the pancreatic tail located?
Definition
just left lateral border of aorta and vertebral body
anterior to left kidney
posterior to the stomach
medial to spleen

extends to splenic hilum
Term
What is the anterior border of the pancreatic tail?
Definition
splenic artery
Term
What is the posterior border of the pancreatic tail?
Definition
splenic vein
Term
What is the texture of a normal pancreas?
Definition
homogenous
Term
Compared to the liver the pancreas' texture is what
Definition
isoechoic
hyperechoic to liver
Term
Where does the celiac axis originate?
Definition
anterior aorts
Term
What are the three branches of the celiac axis?
Definition
left gastric
common hepatic
splenic artery
Term
Where the the splenic artery arise from?
Definition
celiac axis
Term
What are the four branches of the splenic artery?
Definition
suprapancreatic
pancreatic
prepancreatic
prehilur
Term
Where does the splenic artery course?
Definition
along superior border of pancreas
anterior and superior to SMV
Term
Where does the common hepatic artery arise from?
Definition
celiac axis
Term
Where does the common hepatic artery course?
Definition
along superior margin of 1st part of duodenum
Term
as common hepatic artery crosses portal vein what does it divide into?
Definition
proper hepatic and gastroduodenal artery
Term
Where is the CBD located?
Definition
lies lateral to the proper hepatic artery
Term
What is anterolateral border of pancreatic head?
Definition
Gastroduodenal artery
Term
Where is the SMA located in respect to the pancreas?
Definition
Posterior to neck of pancreas and anterior to uncinate process
posterior to bancreatic body
courses anterior to the 3rd portion of the duodenum to enter the small bowel mesentery
Term
Portal vein is formed posterior to neck of pancreas by the junction of what 2 veins?
Definition
SMV and Splenic Vein
Term
Where does the splenic vein course?
Definition
from the splenic hilum to the portal confluence
Term
When joined by the SMV, what does the Splenic vein form behind the neck of the pancreas?
Definition
Portal confluence
Term
Where is the Portal confluence seen?
Definition
posterior to the neck and anterior lateral to the SMA in trv.
Term
What is pancreatic agenesis?
Definition
body and tail may be absent with hypertrophic head
Term
What is pancreatic agenesis?
Definition
body and tail may be absent with hypertrophic head
Term
What is pancreatic agenesis?
Definition
body and tail may be absent with hypertrophic head
Term
What is an annular pancreas?
Definition
pancreatic head encircles the duodenum
can cause complete or partial atresia
susceptible to pancreatic disease
Term
Where can ectopic pancreatic tissue be found?
Definition
in GI tract, stomach, duodenum, small or large intestine
Term
What diseases can occur in ectopic pancreatic tissue?
Definition
acute pancreatitis
pancreatic tumor
Term
What is fibrocystic disease?
Definition
disorder of exocrine glands suuch as pancreas, lungs, intestines
become clogged with mucous
Term
What is pancreas divisum
Definition
lack of fusion of dorsal and ventral pancreatic buds
Term
with pancreas divisum, drainage of the ventral portion goes through what?
Definition
major papilla
Term
with pancreas divisum drainage of the dorsal portion goes through what?
Definition
minor papilla
Term
What are some indications of pancreatic disease?
Definition
severe epigastric pain
abdominal pain that radiates to the back and decrease when patient is sitting, leaning foward or laying down
abdominal distention with hypoactive bowel sounds
abnormal lipase and amylase
modality of choice in adults is CT scan
Term
Demonstration of the pancreatic head surrounding the duodenum is consistent with
Definition
annular pancreas
Term
which enzyme is responsible for the breakdown of proteins into amino acids
Definition
trypsin
Term
This part of the pancreas is posterior to the superior mesenteric vein
Definition
uncinate process
Term
What is the most common complication associated with acute pancreatitis?
Definition
psuedocyst
Term
Islet cells of Langerhans secrete hormones directly into the
Definition
bloodstream
Term
In a whipple procedure, normal pancreatic tissue is attached to the
Definition
duodenum
Term
Extension of pancreatic inflammation into the peripancreatic tissues is called
Definition
phlegmon
Term
The most common cause of acute pancreatitis is
Definition
biliary disease
Term
Pseudocyst formation is most commonly located in which of the following abdominal recesses?
Definition
lesser sac
Term
Which enzyme changes fats into fatty acids and glycerol?
Definition
lipase
Term
Which region of the pancreas is located most superiorly?
Definition
tail
Term
Ectopic pancreatic tissue is most commonly located in which organ
Definition
stomach
Term
This pathology accounts for half of the cysstic neoplasms involving the pancreas
Definition
microcystic cystadenoma
Term
In acute pancreatitis, this lab value remains elevated longest.
Definition
lipase
Term
The main pancreatic duct is most commonly visualized in which section of the pancreas?
Definition
body
Term
The majority of nonfunctioning islet cell tumors are malignant or benign
Definition
malignant
Term
The pancreas and surrounding vascular landmarks should be examined from the level of the
Definition
celiac axis to below the renal veins
Term
The diameter of the pancreatic duct in the head neck regional should not exceed
Definition
3mm
Term
The majority of pancreatic malignancies involve which portion of the pancreas
Definition
head
Term
In which section of the pancreas are islet cell tumors most commonly located?
Definition
body and tail
Term
The tail of the pancreas generally extends toward the
Definition
splenic hilum
Term
The leakage of pancreatic enzymes into the surrounding peritoneal space describes
Definition
psuedocyst
Term
A sheath of muscle fibers surrounding the distal common bile duct describes
Definition
sphincter of oddi
Term
Are acini cells exocrine or endocrine tissue?
Definition
exocrine
Term
What are the types of pancreatic juices (exocrine)
Definition
amylase
lipase
trypsin and chymotrypsin
sodium bicarbonate
Term
trypsin and chymotrypsin is an enzyme that digests what
Definition
proteins
Term
This is released by mucosa of duodenum to stimulate production of gastric juices
Definition
gastrin
Term
This stimulates production of sodium bicarbonate
Definition
secretin
Term
List the endocrine cells
Definition
1. alpha
2. beta
3. delta
Term
this produces and secretes glucagon to increase blood sugar
Definition
alpha cell
Term
thi produces and secretes insulin to lower blood sugar
Definition
beta cells
Term
This produces and secretes somatostain which regulates the production glucagon and insulin
Definition
delta
Term
intestinal obstruction causes large amounts of gas
Definition
ileus
Term
pancreatic juice escapes into the lesser sac and pararenal space causing irritation and or inflammation
Definition
acute pancreatitis
Term
This pathology includes the gray turner sign which is discoloration of abdomen due to necrosis
Definition
acute pancreatitis
Term
pancreas is better imaged in children - true or false
Definition
true
Term
Is the echogenicity of the pancreas in children more hypoechoic or hyperechoic?
Definition
hypoechoic
Term
this type of acute pancreatitis is caused by sudden escape of pancreatic juices into parenchyma causing focal necrosis in and around pancreas
Definition
hemorrhagic pancreatitis
Term
Spreading of diffuse inflammatory edema of soft tissue outside the pancreas
Definition
phlegmonous pancreatitis
Term
Phlegmonous pancreatitis includes which 3 areas
Definition
lesser sac
pararenal space
transverse mesocolon
Term
Irreversible damange due to repeated attacks of acute pancreatitis
Definition
chronic pancreatitis
Term
Hyperlipidemia and hypercalcemia are two causes of which disease
Definition
chronic pancreatitis
Term
True cysts can be unilocular or multilocular - true or false
Definition
true
Term
true pancreatic cysts arise from which part of the pancreas
Definition
head
Term
collection of fluid (pancreatic juices, debris, blood) arising from loculation of inflammation process, necrosis, or hemorrhage
Definition
pancreatic pseudocyst
Term
pancreatic pseudocysts are congenital or acquired
Definition
acquired
Term
most common complication of pancreatitis
Definition
pseudocyst
Term
pancreatic psuedocysts are usually asymptomatic until quite large - true or false
Definition
true
Term
What are the two locations of pseudocysts
Definition
most often lesser sac
2nd anterior pararenal space
Term
pseudocysts locations?
Definition
peritoneal cavity
mediastinum
small bowel mesentery into retroperitoneum to pelvis and groin
area of spleen and 2nd portion of duodenum
Term
s/a of pseudocyst
Definition
single with posterior enhancement
shape and size vary
wall sharp, smooth, well defined or thickened
anechoic or low level echoes
mostly near head and body
Term
What part of the pancreas can you find a microcystic adenoma?
Definition
body and tail
they are benign
50% of pancreatic cystic neoplasm after age 60
Term
microcystic adenoma is
Definition
a serous cystadenoma
Term
what is macrocystic adenoma
Definition
mucinous adenoma
Term
macrocystic adenoma are usually found in the
Definition
tail of the pancreas
malignant, women around age 50
Term
Demonstration of the pancreatic head surrounding the duodenum is consistant with what?
Definition
an annular pancreas
Term
What is the most common malignancy of the pancreas
Definition
adenocarcinoma
Term
Adenocarcinoma are located in the _______of the pancreas
Definition
head
Term
Indications for a sonogram of the pancreas include
Definition
biliary disease
weight loss
severe epigastric pain
elevated serum amylase
Term
s/a adenocarcinoma
Definition
metastasis to liver
portal venous system affected
splenic vein enlargement
sma may be displaced
ascited
Term
Most common islet cell tumor
Definition
insulinoma
Term
What is an enzyme responsible for the breakdown of proteins into amino acids?
Definition
trypsin
Term
Insulinoma is functiona or non functional? Where is it located?
Definition
functional
body and tail
Term
the location of the uncinate proscess is
Definition
posterior to the SMV
Term
The most common complication associated with acute pancreatitis
Definition
pseudocyst
Term
Functional islet tumors are usually benign or malignant
Definition
most benign
Term
gastrinoma is what type of islet cell tumor - functional or nonfunctional
Definition
functional
Term
Where do Islet cells of langerhans secrete hormones
Definition
directly into the bloodstream
Term
In a whipple procedure, where is normal pancreatic tissue attached?
Definition
duodenum
Term
peptic ulceration with gastric hypersecreation and non beta cell tumor of islet cells
Definition
zollinger ellison syndrome
Term
Extension of pancreatic inflammation into the peripancreatic tissues is called
Definition
phlegmon
Term
name two rare islet cell tumors
Definition
glucagonoma and vipomas
Term
the most common cause of acute pancreatitis
Definition
biliary disease
Term
non functioning islet cell tumors are located mostly in the
Definition
head
Term
type of non functioning islet cell tumors
Definition
giant cell
adenosquamous carcinomas
mucinous adenocarcinoma
anaplatic carcinoma
solid and apillary epithelial
Term
What is the most common primary site of metastatic disease to the pancreas
Definition
melanoma
Term
59 yr old male; hx of acute pancreatitis with symptoms of abdominal pain; LUQ; palpable mass; extreme elevations of pancreatic enzymes most likely describes
Definition
pseudocyst
Term
where does metastatic disease to the pancreas mets to
Definition
breast
lung
renal cell
Term
91 yr old female
s/s severe back pain; jaundice; weight loss
Definition
malignant neoplasm
Term
psuedocyst formation is most commonly located where?
Definition
lesser sac
Term
Which enzyme changes fats into fatty acids and glycerol?
Definition
lipase
Term
Ectopic pancreatic tissue is most commonly located in which organ?
Definition
stomach
Term
The pancreas and surrounding vascular landmarks should be examined from the level of
Definition
the celiac axis to below the renal veins
Term
What pathology accounts for 1/2 of the cystic neoplasms involving the pancreas
Definition
microcystic cystadenoma
Term
In acute pancreatitis which lab test remains elevated the longest?
Definition
lipase
Term
Sonographic characteristics of chronic pancreatitis
Definition
increase in parenchymal echogenicity
irregular borders
calcifications
pseudocyst formation
atrophy
prominent pancreatic duct
Term
a clinical finding commonly associated with pancreatic carcinoma
Definition
new onset of diabetes
Term
A patient presents with hx of elevated insulin levels. this is common with
Definition
islet cell tumors
Term
The tail of the pancreas generally extends toward
Definition
the splenic hilum
Term
The diameter of the pancreatic duct in the head/neck region should not exceed
Definition
3mm
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