Pancreas Anatomy and Physiology
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Questions and Answers

What is the anatomical position of the pancreas in relation to the inferior vena cava (IVC)?

  • Superior to the IVC
  • Posterior to the IVC
  • Anterior to the IVC (correct)
  • Lateral to the IVC

Which part of the pancreas is located anterior to the second part of the duodenum?

  • Neck
  • Head (correct)
  • Body
  • Tail

What is a key reason for the technical difficulty in imaging the pancreas?

  • Its size and shape
  • Its encapsulated nature
  • Surrounding bowel gas and gastrointestinal structures (correct)
  • The presence of other abdominal organs

What is the appropriate patient preparation for a sonographic evaluation of the pancreas?

<p>NPO for 8-12 hours (C)</p> Signup and view all the answers

Which pancreatic structure is described as the largest anteroposterior (AP) dimension of the gland?

<p>Head (B)</p> Signup and view all the answers

What is the most significant liver allograft pathology that can occur following transplantation?

<p>Biliary strictures (B)</p> Signup and view all the answers

What echogenicity characteristics might thrombus in the portal vein exhibit?

<p>Anechoic/hypoechoic to echogenic (B)</p> Signup and view all the answers

Which of the following complications can arise following a liver transplant?

<p>Dysfunction of sphincter of Oddi (C)</p> Signup and view all the answers

What waveform indicates a proximal stenosis in the hepatic artery?

<p>Tardus parvus waveform (C)</p> Signup and view all the answers

At what point post-transplant is it crucial to assess for portal vein stenosis?

<p>On the first follow-up ultrasound (D)</p> Signup and view all the answers

What is a common finding in spectral Doppler when there is post-stenotic jet?

<p>Increased maximum flow velocity (B)</p> Signup and view all the answers

Which imaging modalities can help evaluate the health of an allograft post-transplant?

<p>CT, nuclear medicine, and biopsies (A)</p> Signup and view all the answers

What is an essential aspect for ensuring accuracy and reproducibility in follow-up examinations?

<p>Proper annotation of images and anatomy labeling (B)</p> Signup and view all the answers

What is a contraindication for performing a gastroscopic exam?

<p>Patient has undergone gastroscopic exam within 6 hours (B)</p> Signup and view all the answers

Which function is associated with the exocrine pancreas?

<p>Digestive enzyme secretion through ductal system (C)</p> Signup and view all the answers

What is the normal measurement of the main pancreatic duct?

<p>2mm or less (A)</p> Signup and view all the answers

What is the most common congenital anomaly of the pancreas?

<p>Pancreas divisum (B)</p> Signup and view all the answers

What is the main hormone produced by the beta cells of the pancreas?

<p>Insulin (B)</p> Signup and view all the answers

What condition leads to improper digestion and pancreatic dysfunction mainly in Caucasian populations?

<p>Cystic fibrosis (C)</p> Signup and view all the answers

What is a likely presentation associated with an annular pancreas?

<p>Double-bubble sign with dilated stomach (A)</p> Signup and view all the answers

Which pancreatic condition can be associated with increased echogenicity and gland atrophy?

<p>Chronic pancreatitis (C)</p> Signup and view all the answers

Which hormone primarily regulates the release of insulin and glucagon?

<p>Somatostatin (D)</p> Signup and view all the answers

Which pancreatic duct drains the smaller portion of the pancreas in cases of pancreas divisum?

<p>Duct of Santorini (A)</p> Signup and view all the answers

What percentage of pancreatic cystic tumors are malignant?

<p>1% (B)</p> Signup and view all the answers

What is indicated by an elevation of amylase in laboratory tests?

<p>Acute pancreatitis (B)</p> Signup and view all the answers

In cystic fibrosis, which is a notable characteristic affecting the pancreas?

<p>Viscous secretions leading to dysfunction (B)</p> Signup and view all the answers

Which type of cystic neoplastic lesion is considered benign?

<p>Serous cystadenoma (C)</p> Signup and view all the answers

What is the most common cause of drug-induced liver injury (DILI) leading to acute liver failure?

<p>Acetaminophen overdose (B)</p> Signup and view all the answers

What is the significance of the accessory pancreatic duct, also known as the Duct of Santorini?

<p>It opens into the second portion of the duodenum (D)</p> Signup and view all the answers

What is the most common indication for a liver transplant in the United States?

<p>Hepatitis C virus (C)</p> Signup and view all the answers

What condition may lead to the development of acute pancreatitis due to ectopic pancreatic tissue?

<p>Ectopic pancreas tissue (D)</p> Signup and view all the answers

In which part of the pancreas are malignant mucinous cystic adenomas most commonly found?

<p>Body or tail (C)</p> Signup and view all the answers

What type of graft involves the native liver being left in place?

<p>Heterotopic graft (A)</p> Signup and view all the answers

What is the typical echogenic appearance of benign serous cystadenomas in the pancreas?

<p>Echogenic mass (B)</p> Signup and view all the answers

Which tumor is associated with hyperinsulinemia and typically leads to hypoglycemia?

<p>Insulinoma (A)</p> Signup and view all the answers

What percentage of vascular complications occurs in liver transplants?

<p>7% (A)</p> Signup and view all the answers

Which of the following conditions is most commonly associated with multiple endocrine neoplasia type 1?

<p>Parathyroid hyperplasia (B)</p> Signup and view all the answers

Which of these is a common post-operative complication after liver transplantation?

<p>Liver rejection (C)</p> Signup and view all the answers

Which characteristic is not typical of hepatocellular carcinoma (HCC) concerning liver transplants?

<p>Occurring exclusively in cirrhotic patients (A)</p> Signup and view all the answers

In pancreatic cystic tumors, what method is primarily used for differentiation?

<p>Clinical laboratory findings (C)</p> Signup and view all the answers

What is the most common cause of acute pancreatitis?

<p>Gallstones (C)</p> Signup and view all the answers

Which lab finding is expected to remain elevated for a longer duration during acute pancreatitis?

<p>Lipase (B)</p> Signup and view all the answers

What clinical symptom is typically associated with chronic pancreatitis?

<p>Persistent epigastric pain (B)</p> Signup and view all the answers

Which complication is not associated with acute pancreatitis?

<p>Chronic pancreatitis (C)</p> Signup and view all the answers

What appearance might pancreatic pseudocysts have on sonography?

<p>Fluid-filled, smooth-bordered structure (C)</p> Signup and view all the answers

What is the most common lab finding in pancreatic adenocarcinoma?

<p>Elevated alkaline phosphatase (D)</p> Signup and view all the answers

Which risk factor is strongly associated with the development of pancreatic adenocarcinoma?

<p>Chronic pancreatitis (D)</p> Signup and view all the answers

Which of the following is a common cause of abdominal pain for a patient with pancreatic malignancy?

<p>Obstruction of bile duct (B)</p> Signup and view all the answers

What is a characteristic finding in chronic pancreatitis?

<p>Calcifications within the parenchyma (A)</p> Signup and view all the answers

Which of the following is NOT a common complication of acute pancreatitis?

<p>Cirrhosis (C)</p> Signup and view all the answers

What type of cancer accounts for 90% of all pancreatic malignancies?

<p>Pancreatic adenocarcinoma (A)</p> Signup and view all the answers

What sign may indicate the presence of malignant growth within the pancreas?

<p>Courvoisier’s gallbladder (B)</p> Signup and view all the answers

Which procedure is typically performed for cancer of the head of the pancreas?

<p>Whipple procedure (C)</p> Signup and view all the answers

Flashcards

Pancreas location

The pancreas lies oblique in the anterior retroperitoneal space, between the duodenal loop and the splenic hilum.

Pancreas parts

The pancreas is divided anatomically into the head, uncinate process, neck, body, and tail.

Pancreatic head location

The pancreatic head is anterior to the inferior vena cava (IVC).

Pancreatic body location

The pancreatic body is anterior to the aorta, splenic vein, and superior mesenteric artery (SMA).

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Pancreatic imaging challenges

Pancreatic imaging can be challenging due to overlying bowel gas and the surrounding GI system.

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Pancreatic Exocrine Function

The pancreas's role in secreting digestive enzymes into the duodenum.

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Pancreatic Endocrine Function

The pancreas's role in producing hormones, like insulin and glucagon, released into the bloodstream.

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Insulin's Role

Insulin allows cells to absorb glucose from the blood and store it as glycogen. Low insulin leads to diabetes.

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Pancreas Divisum

A congenital condition where pancreatic ducts don't fuse properly, potentially causing inadequate digestive enzyme drainage.

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Annular Pancreas

A congenital condition where the pancreatic head encircles the duodenum, potentially blocking food passage.

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Amylase

A digestive enzyme that breaks down carbohydrates.

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Lipase

A digestive enzyme that breaks down fats.

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CBD

Common Bile Duct, travels behind the first part of the duodenum and the head of the pancreas.

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Main Pancreatic Duct (Duct of Wirsung)

Main pancreatic duct that joins with the CBD to form the hepato-pancreatic ampulla.

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Pancreatic Duct Measurement

2mm or less considered normal.

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Cystic Fibrosis

A genetic disorder causing viscous secretions that affects the pancreas and other organs for poor digestion

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Polycystic Disease

Presence of multiple small cysts affecting the pancreas and other organs.

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Von Hippel-Lindau Disease

A genetic disorder affecting the nervous system with associated pancreatic abnormalities.

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Amylase Elevation

Enzyme levels elevated in cases of possible pancreas issues within 5-8 hrs and elevated for approximately 24 hours.

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Acute Pancreatitis

Inflammation of the pancreas, often sudden and severe, with pain in the upper abdomen.

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Pancreatic Pseudocyst

A fluid-filled sac that forms in the abdomen, caused by a collection of fluid and necrotic debris from the pancreas.

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Chronic Pancreatitis

Inflammation of the pancreas that develops over time (years), eventually leading to permanent damage.

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Pancreatic Adenocarcinoma

Most common type of pancreatic cancer.

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Whipple Procedure

Surgical removal of the head of the pancreas, portion of the bile duct, gallbladder, and duodenum to treat pancreatic cancer.

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Biliary Tract Disease

Problem in the bile ducts and gallbladder.

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Pancreatic Duct Obstruction

Blockage of the pancreatic duct making it hard for pancreatic juices to flow.

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Pancreatic Cancer

Cancer located in or around the pancreas.

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Double duct sign

Bile duct and pancreatic duct dilation, found on imaging techniques.

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Courvoisier's gallbladder

A swollen gallbladder that's not associated with gallstones.

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Pancreatic Malignancy

A general term for any cancerous tumor in or around the pancreas.

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Pancreatic Enzymes

Digestive enzymes secreted by the pancreas.

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Pancreatic Necrosis

Death of pancreatic tissue.

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Pancreatic Cyst Types

Pancreatic cysts can be either benign serous cystadenomas (microcystic) or malignant mucinous cystic adenomas (macrocystic).

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Mucinous Cystic Adenoma Size

Malignant mucinous cystic adenomas are usually larger than 2 cm, often with multiple cysts, septations, and debris.

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Serous Cystadenoma Size

Benign serous cystadenomas are composed of multiple cysts smaller than 2 cm.

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Mucinous Cystic Adenoma Location

Malignant mucinous cystic adenomas are more commonly found in the body or tail of the pancreas.

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Serous Cystadenoma Location

Benign serous cystadenomas are more often found in the head of the pancreas.

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Islet Cell Tumors

Tumors arising from the pancreatic islet cells, commonly associated with conditions like MEN-1 and Von Hippel-Lindau.

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Insulinomas

Islet cell tumors that produce excess insulin, leading to hypoglycemia.

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Gastrinomas

Islet cell tumors that produce excess gastrin causing gastric acid hypersecretion and ulcers.

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Glucagonomas

Islet cell tumors that produce excess glucagon, typically smaller and harder to detect on ultrasound.

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MEN Syndrome

An inherited endocrine disorder that affects multiple glands, including parathyroids, pancreas, pituitary, adrenals, and thyroid.

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Liver Transplant Indications

Common indications for liver transplant include Hepatitis C, alcoholic liver disease, autoimmune liver disease, primary biliary cirrhosis, and early stages of hepatocellular carcinoma.

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Liver Transplant Survival Rates

Liver transplant survival rates are over 75% at 5 years and over 87% at 1 year.

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Liver Transplant Complications

Common complications after liver transplant include infection, rejection, and malignancy.

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Liver Transplant Types

Liver transplants can be either orthotopic (native liver removed) or heterotopic (native liver left in place).

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Liver Transplant Vascular Connections

Liver transplants require 4 vascular connections: hepatic artery, portal vein, IVC, and bile duct.

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Biliary Strictures

Narrowing of bile ducts, a common complication after liver transplant, affecting up to 25% of patients.

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Hepatic Artery Thrombosis

A serious complication after liver transplant where the hepatic artery, which supplies blood to the liver, is blocked by a blood clot.

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Hepatic Artery Stenosis

Narrowing of the hepatic artery, less serious than a thrombosis but still a concern after liver transplant.

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Tardus Parvus Waveform

A specific blood flow pattern seen on Doppler ultrasound indicating a narrowing (stenosis) in the hepatic artery.

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Hepatopetal Flow

Blood flow in the correct direction, towards the liver, in the hepatic artery.

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Portal Vein Stenosis

Narrowing of the portal vein, a concern after liver transplant as it can affect blood flow to the liver.

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Post-Stenotic Jet

A high-velocity blood flow pattern seen on Doppler ultrasound after a narrowing (stenosis) in a blood vessel, indicating increased speed due to constriction.

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Dampened Waveform

A weakened or less prominent blood flow pattern seen on Doppler ultrasound, indicating reduced blood flow.

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Study Notes

Pancreas Anatomy and Physiology

  • The pancreas is a non-encapsulated organ located obliquely in the anterior pararenal space, situated between the duodenal loop and splenic hilum.
  • It's divided into the head, uncinate process, neck, body, and tail, each with varying sizes (head: 3.5mm, body: 2.5mm, tail: 1.5mm).
  • The head is anterior to the inferior vena cava (IVC) and medial to the second part of the duodenum.
  • The uncinate process extends posteriorly and medially from the head, posterior to the superior mesenteric vein (SMV) and portal vein (PV) confluence, and anterior to the IVC.
  • The neck is anterior to the SMV and PV confluence and superior to the body.
  • The body is anterior to the abdominal aorta and superior mesenteric artery (SMA), and the tail is anterior and medial to the splenic hilum.
  • The complex location of the pancreas, surrounding the gastrointestinal (GI) tract, can make imaging challenging, especially sonography, due to overlying bowel gas and GI structures obstructing visualization.

Pancreatic Imaging Techniques

  • Essential techniques for optimal pancreatic sonographic assessment:
  • Proper patient preparation, such as fasting (NPO) for 8-12 hours to minimize bowel gas, particularly crucial for patients who have undergone recent endoscopy due to introduced air.
  • Utilizing left lobe liver midline for acoustic windows, angled inferiorly to avoid the stomach and duodenum.
  • Patients may drink water to fill the stomach while scanning, used as an acoustic window in right or left decubitus positions (RLD/LLD).

Pancreatic Sonographic Appearance

  • Shapes: Horseshoe, dumbbell, comma, or tadpole.
  • Echogenicity: Typically hyperechoic to the liver, however age and body habitus can affect appearance. Normal pancreas' echogenicity can vary due to fat deposits.
  • Adult hypoechoic pancreas is typically considered abnormal.

Pancreatic Physiology

  • Exocrine function: secretes digestive enzymes (trypsin, chymotrypsinogen, lipase, amylase) via the ductal system for digestion and absorption; up to 4 liters of exocrine fluid per day.
  • Endocrine function: secretion of hormones like insulin from the Islets of Langerhans (beta cells). Insulin converts glucose into glycogen for storage. Glucagon from alpha cells converts glycogen to glucose for energy. Somatostatin from delta cells controls glucagon and insulin release.

Pancreatic Ducts

  • The common bile duct (CBD) and the main pancreatic duct (duct of Wirsung; MPD) join to form the hepatopancreatic ampulla (ampulla of Vater), which opens into the duodenum at the major papilla.
  • The accessory pancreatic duct (duct of Santorini) opens into the duodenum at the minor papilla, 2 cm superior to the ampulla of Vater. This duct frequently regresses in 50% of the population.
  • Normal MPD diameter is 2mm or less.

Congenital Pancreatic Pathology

  • Pancreas divisum: Failure of dorsal and ventral ducts to fuse; most common congenital anomaly (5-10% of population). May cause inadequate enzyme drainage and potentially pancreatitis.
  • Annular pancreas: Ventral pancreas surrounds the duodenum, sometimes presenting with duodenal obstruction; more common in males.
  • Ectopic pancreas: Pancreatic tissue grows in other organs, commonly stomach, duodenum, intestines; can cause pancreatitis or tumours.
  • Agenesis: Extremely rare complete or partial absence of the dorsal pancreas.
  • Cystic fibrosis: Causes viscous secretions that impair pancreatic function, manifesting with recurrent acute or chronic pancreatitis and meconium ileus.

Acquired / Non-neoplastic Pancreatic Pathology

  • Polycystic disease: Multiple small cysts in kidney, liver, and sometimes the pancreas (10%), eventually leading to renal failure.
  • Von Hippel-Lindau disease: Autosomal dominant disorder, frequently associated with cystic or solid pancreatic lesions and conditions in nervous system.

Pancreatic Pathology: Labs and Imaging

  • Amylase and Lipase: Elevated levels indicate pancreatic inflammation (acute pancreatitis). Amylase elevation occurs within 5-8 hours, and Lipase persists longer.
  • Acute pancreatitis: Sudden severe abdominal pain, radiating to the back, nausea/vomiting, mild fever. Causes include gallstones, alcohol abuse.
  • Pancreatic pseudocysts: Fluid-filled sacs formed from leaked pancreatic enzymes; can arise from acute pancreatitis, chronic pancreatitis, trauma, obstructions. Imaging shows smooth borders, various internal echoes.
  • Chronic pancreatitis: Irreversible destruction from repeated inflammation; common cause is alcoholic pancreatitis, also possible autoimmune, hereditary, hereditary pancreatitis or cystic fibrosis. Imaging shows small, echogenic gland, calcifications, duct dilation.
  • Pancreatic adenocarcinoma: Fourth leading cause of cancer-related death in US, often originates in the head of the pancreas (80%). Symptoms may include abdominal pain, jaundice, weight loss. Imaging shows solid hypoechoic mass.

Pancreatic Procedures and Lesions

  • Whipple procedure: Surgical removal of the head of the pancreas, bile duct, gallbladder, and duodenum for pancreatic cancer.
  • Cystic neoplasms: 10% of pancreatic neoplasms; includes benign serous cystadenomas/microcystic adenomas and malignant mucinous cystic adenomas/cystadenocarcinomas; body/tail location more common. Imaging may show numerous small cysts or large cystic masses, septations.
  • Islet cell tumors: Uncommon, difficult to visualize; include insulinomas, gastrinomas, glucagonomas (mostly benign).

Liver Transplants

  • Major indications for liver transplants include hepatitis C, alcoholic liver disease, and autoimmune liver disease.
  • Common causes of death in liver transplant patients include infection and rejection.
  • Types include allograft (between non-identical individuals) and orthotopic/heterotopic based on surgical position.
  • Vascular complications (hepat artery thrombosis, portal vein thrombosis, IVC thrombosis) are frequent and require ongoing monitoring with Doppler Ultrasound.
  • Biliary complications (strictures, leaks) are also common post-transplant.

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Description

This quiz covers the detailed anatomy and physiology of the pancreas, focusing on its location, structure, and relationships with surrounding organs. Understand the divisions of the pancreas, including the head, neck, body, and tail, and their significance in the digestive system.

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