DMSM 105 Pancreas

DMSM 105 Pancreas

Holdorf ABDOMINAL SONOGRAPHY 1 PANCREAS PART 1 PANCREAS Parts 1 and 2: Outline Normal anatomy Spatial relationships of pancreatic anatomy

Acute pancreatitis Chronic Pancreatitis Pancreatic cysts Cystic fibrosis Pancreatic Pseudocysts Pancreas divisum Annular pancreas pancreatic adenocarcinoma

Serous cystadenoma Mucinous cystic neoplasms Islet Cell Tumors (Endocrine Tumors) Multiple Endocrine Neoplasia (MEN) Laboratory Values Summary of Anatomical spatial relationships What is asked on the

Board exams The ARDMS and ARRT board exams particularly focus in on the pancreas spatial relationships with Vascular anatomy Anatomical anatomy

Normal Anatomy The pancrease is a nonencapsulated, retroperitoneal structure that lies between the duodenal loop and the splenic hilum. The pancreas is divided into the head, uncinate process, neck, body, and tail.

The EXOCRINE function of the pancreas is to secrete trypsin, lipase and amylase through the ductal system. Netter diagram of the Pancreas

Endocrine vs. Exocrine Exocrine glands have ducts to carry their secretions to specific locations. In the pancreas, the pancreatic duct carries pancreatic fluid to the duodenum. Endocrine glands are glands of

internal secretion, whose secretions are usually spread directly into the blood. Most hormones are secreted in this manner. The endocrine function (non-ductal) of the pancreas is to secrete insulin

via the islets of Langerhans. On Cross-sectional images, the normal pancreas should measure < 3 cm. The posterior wall of the stomach overlies the anterior border of the pancreatic body and tail.

To better visualize the pancreas (specifically the pancreatic tail), a technique is used in which the patient in left lateral decubitus position, drinks water to fill the stomach.

While scanning the pancreas, the patient is then turned to the supine or right lateral decubitus position. Water in the stomach and duodenum is used as an acoustic window. Spatial Relationships of Pancreatic Anatomy

Head of the pancreas is anterior to the IVC. Head of the pancreas is medial to the duodenum. CBD is posterior / lateral to the pancreatic head. Gastroduodenal artery is anterior /

lateral to the pancreatic head. Spatial Relationships of the pancreatic anatomy GDA-CBD Spatial Relationships of Pancreatic Anatomy SMV-SMA-IVC

Cartoon-GDA, CBD Pancreas - longitudinal Blood supply to the pancreas The Posterior and Anterior Superior Pancreaticoduodenal arteries coming off of the GDA Spatial Relationships

Aorta Cartoon- Celiac Axis Superior mesenteric artery and vein are posterior to the neck of the pancreas.

Superior mesenteric artery and vein are anterior to the uncinate process. Aorta is posterior to the body of the pancreas. Celiac axis arises from the aorta at the superior border of the pancreas Superior mesenteric artery arises

from the aorta at the inferior border The celiac axis gives off the left gastric artery

and then divides into the common hepatic artery and the splenic artery. The splenic artery follows a tortuous course along the superior border of the body and tail

of the pancreas. The common hepatic artery divides into the proper hepatic and the Gastroduodenal arteries. The proper hepatic artery travels superiorly toward the liver anterior to the portal vein and left of the bile duct. The right gastric artery is a branch of proper

hepatic artery. Anastomosis of the left and right gastric arteries The gastroduodenal artery (GDA)

travels posterior to the first portion of the duodenum than anterior to the head of the pancreas. The GDA then divides into the: Right gastroepiploic artery Superior pancreaticoduodenal artery The superior mesenteric artery is

located: Inferior to the pancreas Anterior to the uncinate process Anterior to the 3rd portion of the The splenic vein is located on the

posterior aspect of the pancreas. The splenic vein joins the superior mesenteric vein to create the main portal vein. The superior mesenteric vein is located: To the right of the superior mesenteric

artery Anterior to the 3rd portion of the duodenum Anterior to the uncinate process. Spatial relationships GDA Spatial Relationships-Splenic vein

Cartoon-Main portal vein The Common bile duct travels posterior to the 1st portion of the duodenum and the head of the pancreas to lie to the right of the main pancreatic duct.

The common bile duct and the duct of Wirsung (main pancreatic duct) join to become the hepaticpancreatic ampulla (ampulla of Vater) which opens into the 2nd portion of the duodenum at the major papilla. The accessory pancreatic duct (duct of Santorini) opens into the 2nd portion of the duodenum at the minor papilla.

50% of the population has complete regression of the duct of Santorini. Spatial relationships Spatial Relationships Duct of Wirsung Duct of Santorini

Duct of Santorini Pancreas cartoon The duodenum is divided into 4 portions:

1st and 3rd portions are transverse. 2nd and 4th portions are longitudinal. The normal pancreatic duct may be imaged. The pancreatic duct is considered abnormal if it is >2.0 mm.

Pancreatic duct dilation is typically due to stones within Wirsungs duct from chronic pancreatitis or a stone in the ampulla of Vater. Dilated pancreatic duct Acute Pancreatitis

Inflammatory disease producing temporary pancreatic changes. Diagnosis is usually based on clinical and laboratory findings. The most common causes of acute pancreatitis are: Biliary tract disease

Chronic alcohol abuse. Acute pancreatitis Sonographic findings: Enlarged hypoechoic gland Acute Pancreatitis can take several

directions: Resolution Pseudocyst formation Chronic pancreatitis Acute pancreatitis Complications of acute pancreatitis include:

Pseudocyst formation Abscess Pancreatic necrosis Hemorrhage Venous thrombosis Pseudoaneurysm formation Pancreatic phlegmon (focal pancreatitis)

An inflammatory mass formed by edema and leakage of pancreatic enzymes. It forms as a complication of acute pancreatitis. Definition of a Phlegmon A spreading diffuse inflammatory reaction to an infection which forms a isolated lesion.

Acute Pancreatitis Chronic pancreatitis Irreversible destruction by repeated bouts of pancreatic inflammation. Patient presents with intermittent attacks of severe pain.

Causes of chronic pancreatitis include: Alcoholism (most common) Cystic fibrosis Hereditary pancreatitis Congenital abnormalities (Pancreas divisum) Blunt abdominal trauma Idiopathic chronic pancreatitis

Cystic Fibrosis a genetic condition in which the lungs and digestive system become clogged with thick sticky mucus. Symptoms usually start in early childhood and include persistent cough

recurring chest and lung infections poor weight gain Elevation of serum amylase and lipase are found only during acute attacks of pancreatitis. Sonographic findings include:

Small and echogenic gland Calcifications Pancreatic duct dilatation Pseudocyst formation Bile duct dilatation Portal vein thrombosis Chronic Pancreatitis

FIN

Recently Viewed Presentations

  • Appropriate Behavior for Confucianism - WordPress.com

    Appropriate Behavior for Confucianism - WordPress.com

    Appropriate Behavior for Confucianism . Elders for reach groups. Other members will stand, bow, and say. We are honored to learn from such a wise and noble teacher . Confucianism…. Five Key Relationships. Family unit of harmony will inspire others...
  • Multiple Meaning Words - Jefferson County Schools, TN

    Multiple Meaning Words - Jefferson County Schools, TN

    Multiple Meaning Words Grade 4 Multiple Meaning Words are words that have several meanings depending upon how they are used in a sentence. Let's Practice Read the underlined word in each sentence. Choose the sentence in which the word has...
  • Warm Up - Katy ISD

    Warm Up - Katy ISD

    The energy level or coefficient of the s and p-sublevel is equal to the row or period number. The energy level or coefficient of the d-sublevel is one less than the period number and for the f-sublevel two less than...
  • Cluster Analysis - Boston University

    Cluster Analysis - Boston University

    Social Networks Themes in data analysis for social networks Structure and function of the class Structure and function of the class Introductory Lectures Measuring Networks Degree distributions Power-law distributions Power-law signature Examples Exponential distribution The basic random graph model A...
  • Getting Started What is Java?  A programming language

    Getting Started What is Java? A programming language

    Get started quickly Write less code Write better code Develop programs faster Avoid platform dependencies with 100% pure Java Write once, run anywhere Distribute software more easily Java Applications and Java … lets Stand-alone Applications Just like any programming language...
  • Reptile Theory in Insurance Coverage and Bad Faith Litigation

    Reptile Theory in Insurance Coverage and Bad Faith Litigation

    Reptile Theory in Insurance Coverage and Bad Faith Litigation. By Matt Ellison. FOWLER BELL PLLC. Lexington, KY. and. Pete Dworjanyn. COLLINS & LACY, PC. Columbia, SC
  • Heat-Integrated Distillation Column* Stephanie N. English**, Su Zhu**,

    Heat-Integrated Distillation Column* Stephanie N. English**, Su Zhu**,

    2:1 compression ratio, heat transferred from tray 28 to tray 33. Furnace temperature reduced by duty equal to heat integrated. Heat-Integrated Distillation Column (increased stripping trays) 2:1 compression ratio, heat transferred from tray 28 to tray 49. Furnace temperature reduced...
  • Diapositiva 1 - Weebly

    Diapositiva 1 - Weebly

    Contour Plowing: plowing that follows the curve of the land to slow water flow and save rich topsoil. Strip Planting: alternates strips of plants to reduce erosion by creating natural dams for water. No-Till Farming: way of growing plants from...