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2011-12-10 18:49:30
12 pancreas

the pancreas
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  1. ileus
    • dilated loops of bowel without peristalsis
    • paralyzed gut
    • pancreatitis
  2. panc size
    • 3 x 2 x 2 cm
    • 12-18cm
    • duct <2mm
    • first and second lumbar
    • retroperitoneal
    • head neck body tail
  3. head
    • c-loop of duodenum
    • uncinate process wraps around smv
    • anterior to ivc and post to smv
  4. neck
    anterior to portosplenic confluence/smv
  5. body
    • largest segment
    • anterior to ao
    • sa superior
    • sv posterior
  6. tail
    • anterior to lf kidney
    • left lateral border of ao to splenic hilum
  7. duct
    • duct of wirsung and duct of santorini
    • enter duodenum at ampulla of vater
  8. agenesis of panc
    agenesis of body and tail with hypertrophy of head
  9. pancreas divism
    rare condition caused by lack of fusionof dorsal and ventral buds
  10. ectopic pancreatic tissue
    • most common pan anomonly
    • tissue can be found in places like GI
  11. annular pancreas
    • rare anomonly
    • head surrounds duodenum
    • males
  12. exocrine function of panc
    acini cells- produce panc juices

    • lipase-fats
    • amylase-carbs
    • trypsin/chymotrypsin- protiens
    • nucleaes- nucleic acids

    gastrin and cholecystokinin- hormomes that stimulate juice formation
  13. endocrine function of panc
    • islets of langerhans
    • alpha, beta, delts cells
  14. beta cells
    insulin- horomone that causes glycogen formation from glucose in liver
  15. alpha cells
    produce glucagon- horomone that causes cells to release glucose to meet energy needs
  16. pancreas lab tests
    • amylase- digestive enzyme for carbs
    • escape panc tissue and cause necrosis, pain, inflammation
    • 2xs normal= acute pancreatitis

    urine amylase- pancreatitis, may not be elevated when serum amyl is

    • lipase- rises in pancreatitis- stays elevated longer than amylase
    • lipase may be elevated with obst of duct

    glucose- controls blood sugar, increased in over activity of endocrine glands
  17. pancreatitis
    • inflammation of pancreas
    • chronic or acute
    • panc digested by its own enzymes
  18. acute pancreatitis
    • inflammed acini releasing enzymes into surrounding tissue
    • associated with biliary tract disease and alcoholism
    • severe pain
  19. pancreatic pseudo cyst
    • acquired
    • collection of fluid that arises from loculation of inflammatory processes necrosis or hemorrhage
    • 4-6 weeks after onset of pancreatitis
    • enzymes escape break down tissue and make sterile abcesss
    • false cyst
    • lesser sac anterior to panc and post to stomach
    • spontaneous rupture is most common cmplication (50%) mortality
  20. pancreatic ascites
    when pseudo cyst ruputures into abdomen
  21. hemorrhagic pancreatitis
    rapid progression of acute pancreatitis with rupture of pancreatic vessles and hemorrhage
  22. grey turners syndrome
    hemmorhage makes flanks to discolor
  23. phlegmonous pancreatitis
    • inflammatory process causing areas of inflammatory edema and necrosis
    • usually lesser sac
  24. pancreatic abcess
    • low incidence but serious complications
    • related to degree of necrosis
    • mortality if untreated
  25. chronic pancreatitis
    • recurrent attacks of acute
    • continual destruction of pancreatic parenchyma
    • chronic alcoholism or biliary disease

    • hypercalcemia and hyper lipidemia more predisposed
    • scarring, nodular irregular surface,calcification
    • echogenic, smaller
  26. autosomal dominant polycystic disese
    • most common in liver but can be panc, spleen, edometrium, ovaries, thyroid
    • have epithilial lining
  27. von hipple-lindau syndrome
    autosomal dominant condition cns and retinal hemangioblatoma, visceral cyts, pheochromocytomas, rcc

    pancreatic cysts
  28. congenital cystic lesions of pancreas
    • multiple
    • underlying disease that effects other organs
    • 3-5 cm
  29. cystic fibrosis
    • hereditary disease that causes excess mucous production by endocrine glands
    • fatty repacment of panc with calcif
    • obstruct ducts
    • cysts can be mm to cm in size
  30. fibrocystic disease of panc
    • hereditary disorder of exocrine in childrena nd young adults
    • cysts small
    • acini and ducts are dilated
    • acini replaced by fiberous tissue
    • panc secretion gradually lost
  31. true cysts
    • microscopic sacs that may be congenetal or acquired
    • epithelial lining
  32. lymphoepithelial cysts
    • rare
    • middle age to elderly
    • 1-17cm
    • squamous lining
    • contain keratinous material
  33. adenocarcinoma
    • most common primary neoplasm of panc
    • fatal tumor
    • involves exocrine portion of gland
    • 90% panc malignant tumors
    • 4th cancer death after lung, breast, colon
    • head tumor-courvosiers sign
    • arise from ductal epithelium
    • dilated duct, compression of ivc, portal thrombus, splenomegally
  34. microcystic adenoma
    (cystadenoma, serous adenoma, glycogen-rich adenoma)
    • rare
    • benign women 60yrs
    • lesion in von hippel lindau
    • well defined with internal lobulation
    • hypervascular
    • difficult to differentiate benign from malignant
  35. macrocystic adenocarcinoma
    (mucinous cysadenoma or cystadenocarcinoma)
    • uncommon
    • slow growing tumor
    • arise from ducts
    • large cyst with or without septations
    • significant malignant potential
    • most common in tail then body
  36. intraductal papillary muscinos tumor (IMPT)
    • form of muscinous cystic neoplasm
    • from main panc duct
    • 60-70s
    • benign to malignant
  37. most common functioning islet cell tumor
    insulinoma 60%
  38. insulinoma
    b-cell tumor
    • endocrine
    • most common functioning islet cell tumor
    • 40-60s
    • hypoglycemic symptioms resolved with iv glucose
    • usualy benign
    • small well encapsulated hyper vascular some calcifications
  39. gastrinoma
    G-cell tumor
    • endocrine
    • second most common functioning islet cell tumor
    • caused by non insulin secreting panc tumors that secrete excess gastrin
    • stimulates stomach to secrete pepsin which causes peptic ulceration
    • young adults
    • 60% malignant
  40. nonfunctioning islet cell tumors
    • 33% of islet neoplasms
    • large tumor in head with high malignancy
    • panc contour changes peak suspicion
  41. mets to panc
    • uncommon- 10%
    • melanoma, breast, gi, lung
  42. lymphomas
    • malignant neoplasms from lymphoid tissues
    • nodes seen along the panc, duodenum, porta hep, and smv