THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac...
-
Upload
merry-daisy-flowers -
Category
Documents
-
view
212 -
download
0
Transcript of THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac...
![Page 1: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/1.jpg)
THE PANCREAS
![Page 2: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/2.jpg)
I. Introduction/General Information
A. Located in epigastric & left hypochondriac regions
B. Dimensions:1. 5 - 6” length x 2. 1-1/2” width x 3. 1/2 - 1” thick
C. Lies retroperitoneally at ~T-12/L-1 to L-3
![Page 3: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/3.jpg)
The Pancreas in situ
Right lobe of liver
Falciform ligament
Gallbladder
Pancreas
Duodenum
L-3
![Page 4: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/4.jpg)
Pancreas, Introduction, continued …
D. Head fills concavity of duodenum
E. Body crosses left kidney
F. Tail reaches hilus of the spleen
G. Related anteriorly to transverse colon
![Page 5: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/5.jpg)
Pancreas in situ
Duodenum
Head of Pancreas
![Page 6: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/6.jpg)
Pancreas, Introduction, continued …
H. Aorta, IVC lie posterior
I. Uncinate process:
a. Lies posterior to SMA and SMV
b. Lies anterior to aorta
J. Neck lies anterior to SMV, with pylorus just above
![Page 7: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/7.jpg)
Venous Drainage of the Pancreas
IVC
SMV
![Page 8: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/8.jpg)
Introduction, continued
L. Body related posteriorly to left crus, left adrenal, left renal vein, and splenic vein
K. Celiac Axis (trunk, artery) lies superior to body
![Page 9: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/9.jpg)
II. Detailed Anatomy
A. Landmark structures
1. Splenic Artery:
a. Branch of celiac trunk
b. passes right to left
c. Course is along upper margin of body and tail
![Page 10: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/10.jpg)
Detailed Anatomy, con’t…
2. Hepatic Artery: a. Branch of celiac trunkb. courses left to right c. along upper margin of neck and
head
3. Superior Mesenteric Artery: at its origin from aorta, points at body of pancreas
![Page 11: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/11.jpg)
Arterial Supply to Pancreas
Common Hepatic Artery
Proper Hepatic Artery
Superior Mesenteric Artery
![Page 12: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/12.jpg)
Landmark structures, continued …
4. Splenic Vein: a. runs parallel to artery b. on posterior surface of pancreasc. Terminates in portal vein
![Page 13: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/13.jpg)
Landmark structures, continued …
5. Superior & Inferior Mesenteric Veins: a. pass (inferior to superior) deep
to pancreas
b. merge with splenic vein
c. Terminate in portal vein
![Page 14: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/14.jpg)
Landmark structures, continued …
6. Common Bile Duct: a. passes behind first portion of
duodenum b. then through head of pancreasc. Terminates at ampulla of vater
![Page 15: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/15.jpg)
Detailed Anatomy continued …
B. Head of Pancreas
1. Important clinically because:a. Numerous ducts and vessels traverse it b. Carcinoma usually located here
![Page 16: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/16.jpg)
Head of Pancreas, Detailed Anatomy, continued …
2. Tumor will compress surrounding structuresa. First indication may be jaundiceb. Tumor may compress
duodenumc. May involve local vessels
*Metastases may spread through these vessels*
![Page 17: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/17.jpg)
Head of Pancreas, Detailed Anatomy, continued …
3. Lymphatics from head of pancreas
a. Drain to celiac nodes
b. metastases may follow lymph
c. Metastases may spread via lesser omentum to liver
d. Some terminate in lumbar nodes
![Page 18: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/18.jpg)
Head of Pancreas, Detailed Anatomy, continued …
4. Vessels supplying head of pancreas a. Superior & inferior pancreaticoduodenal arteriesb. Both divide into two parallel
vessels c. one anterior and one posterior to
head
![Page 19: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/19.jpg)
Head of Pancreas, Detailed Anatomy, continued …
1. Anterior branch of pancreaticoduodenal artery
a. superior branch:anterior superior
pancreaticoduodenal arteryb. inferior branch:
anterior inferior pancreaticoduodenal artery
![Page 20: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/20.jpg)
Head of Pancreas, Detailed Anatomy, continued …
2. Posterior branch of pancreaticoduodenal artery
a. superior branch:posterior superior
pancreaticoduodenal artery
b. inferior branch:posterior inferior
pancreaticoduodenal artery
**extensive blood supply**
![Page 21: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/21.jpg)
Anterior Pancreaticoduodenal Artery
•Branches are continuous with one another
•Superior branches originate from the GDA
•Inferior branches originate from the SMA
![Page 22: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/22.jpg)
Detailed Anatomy, continued …
C. Body & Tail of Pancreas:
1. Supplied by splenic artery 2. Have three surfaces:
a. Anterior surface 1. Concave2. Deep to stomach3. Separated from stomach
by lesser sac of peritoneum (aka omental bursa)
![Page 23: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/23.jpg)
Anterior surface of pancreas
Anterior surface of pancreas
Epiploic foramen
![Page 24: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/24.jpg)
Lesser sac, continued …
4. Lesser sac bounded by:a. Liver, superiorlyb. Below, extends to greater omentumc. Anteriorly: lesser omentum, stomach,
greater omentum
![Page 25: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/25.jpg)
Lesser sac, continued …
d. Posteriorly: greater omentum transverse colon, transverse mesocolon
e. Laterally:
1. Foramen of Winslow on right
2. Spleen on left
![Page 26: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/26.jpg)
Detailed Anatomy, continued …
f. Foramen of Winslow (AKA: Epiploic Foramen):
1. Lies between greater & lesser sacs of peritoneum
2. posterior to free edge of lesser omentum
3. close to porta hepatis
![Page 27: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/27.jpg)
Three Surfaces, continued …
2. Posterior surface: separated from vertebrae by
a. Aortab. Splenic vein c. Left kidney and renal vesselsd. Left adrenal glande. Left Crus of diaphragmf. SMA and SMV
![Page 28: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/28.jpg)
Three surfaces, continued …
3. Inferior surface of Pancreatic body:a. Rests on duodeno-jejunal flexureb. Left extremity (tail)
1. Rests on splenic flexure2. Abuts hilus of spleen
![Page 29: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/29.jpg)
Detailed Anatomy, continued …
D. Pancreatic Duct System
1. Pancreatic Duct (of Wirsung) a. Course is left to right b. Receives numerous small ductsc. @ neck of pancreas, duct turns
inferior, posterior & to the right
d. AKA “main pancreatic duct’
![Page 30: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/30.jpg)
Duct of Wirsung (Main pancreatic duct)
![Page 31: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/31.jpg)
Pancreatic Duct System, continued …
d. joins CBD at Ampulla of Vater 3 - 4” below pylorus
e. results from fusion of ducts during fetal development
1. One from ventral pancreas
2. One from dorsal pancreas
(see Netter’s Embryology, p. 142, for Pancreas development)
![Page 32: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/32.jpg)
Duct of Wirsung
Duct of Wirsung
![Page 33: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/33.jpg)
Pancreatic Duct System, continued …
2. Duct of Santorini:
a. accessory pancreatic duct
b. Not universally identified
c. joins duodenum @ minor papilla
d. part of duct from dorsal pancreas
![Page 34: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/34.jpg)
Duct of Santorini
![Page 35: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/35.jpg)
Pancreatic Duct System, continued …
3. In 10% of population a. ducts fail to fuse b. result is drainage of tail, body, &
most of head through minor papillac. Not pathological
![Page 36: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/36.jpg)
III. Scanning Anatomy
A. Depends on recognition of pancreaticmargins
B. Sonography best used as screening procedure
1. May be interference from bowel gas (especially in tail region)
![Page 37: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/37.jpg)
Scanning Anatomy, continued …
2. Extremely accurate in detection of pseudocysts
3. U/S can show texture of organ
4. By ID-ing vessels, can delineate head, portions of body
![Page 38: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/38.jpg)
Scanning Anatomy, continued …
5. U/S can frequently detect dilation of pancreatic duct
6. Splenic Vein: landmark vessela. usually seen along posterior
margin of body, tailb. May be anterior (~30%)
![Page 39: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/39.jpg)
Scanning Anatomy, continued …
C. Head: 1. SMV outlines medial head to neck
region2. Duodenum & GB outline lateral head3. Superiorly, delineated by gastroduodenal artery (GDA)4. Inferiorly, bounded by CBD
![Page 40: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/40.jpg)
Scanning Anatomy, continued …
D. Further delineation by vascular landmarks:
1. SMA: a. Lies immediately posterior to body, points to it! b. Recognized by echogenic fat
collar surrounding vessel
![Page 41: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/41.jpg)
Vascular Landmarks of the Pancreas
Pancreatic sonography depends largely on identifying surrounding landmark vessels
![Page 42: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/42.jpg)
Scanning Anatomy, continued …
2. SMV: a. Delineates medial head b. Larger diameter than SMA c. Lies to right of SMA
d. Uncinate process wraps it (and SMA), lies posterior & medial
![Page 43: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/43.jpg)
Vascular Landmarks of the Pancreas
Venous landmarks of the pancreas include the SMV and renal veins
![Page 44: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/44.jpg)
Scanning Anatomy, continued …
3. Left Renal Vein:a. as it enters IVC b. head & uncinate process should lie within 1 – 2 cmc. Landmark vessel posterior
to body of pancreas
![Page 45: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/45.jpg)
Scanning Anatomy, continued …
E. Tail of Pancreas
1. May be visualized through fluid-filled stomach
2. Tail seen as 2-3 cm rounded mass anterior to hilus of left
kidney
![Page 46: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/46.jpg)
IV. Pancreatic Disorders
A. Pancreatitis: diagnosis depends on clinical evidence
1. Usually secondary to biliary tract disease
2. Surgery of biliary tract or stomach, alcoholism are other causes
![Page 47: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/47.jpg)
Pancreatitis, Pancreatic Disorders, continued …
3. Infrequent causes:a. Infectious diseases b. Trauma d. Drugs
e. Hyperparathyroidism
4. Inflammation may be diffuse or spotty
![Page 48: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/48.jpg)
Pancreatitis, Pancreatic Disorders, continued …
5. Important factor is release of protein kinins
a. Increase permeability of vessels & cellsb. Releases tissue fluid c. Edema may compress vesselsd. Tissue damage occurs
![Page 49: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/49.jpg)
Pancreatitis, Pancreatic Disorders, continued …
6. WBC’s may increase to 20,000/ml
7. Increase in pancreatic enzymes
a. serum bilirubinase (by 25%)
b. serum amylase
c. serum lipase
![Page 50: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/50.jpg)
Pancreatic Disorders, continued …
B. Pseudocysts:
1. “False” cysts that may arise
a. due to tissue necrosis
b. From enzymatic destruction
2. May persist after inflammation subsides
3. Usually near or in pancreas
![Page 51: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/51.jpg)
Pancreatic Disorders, continued …
4. Rarely, may be elsewhere
a. in abdomen or pelvis
b. Rarely, mediastinum
5. Pseudocyst appearance
a. unilocular or multilocular
b. echoes from pus & cellular debris
![Page 52: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/52.jpg)
Pancreatic Diseases, continued
C. Acute Pancreatitis
1. Diffuse enlargement
2. Less echogenic due to edema
3. Echogenicity usually > liver parenchyma
![Page 53: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/53.jpg)
Pancreatic Diseases, continued …
D. Chronic Pancreatitis
1. organ usually appears as small, atrophic
2. Contains scattered echoes from calcifications
3. Primary cause is alcoholism
![Page 54: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/54.jpg)
Pancreatic Diseases, continued …
E. Dilation of Pancreatic Duct
1. Seen in acute or chronic pancreatitis
2. Frequently associated with neoplasm of pancreas
3. Biliary tract problems
![Page 55: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/55.jpg)
Pancreatic Diseases, continued …
F. Abscess or Hemorrhagic Pancreatitis 1. Similar in sonographic appearance 2. Hemorrhagic:
a. Mass with inhomogeneous texture b. Acute hemorrhage: sonolucent to
echogenic c. CT scan used for differentiation
![Page 56: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/56.jpg)
Pancreatic Disorders, continued …
G. Pancreatic Tumors
1. Malignant tumors usually arise as adenocarcinomas
2. In head of Pancreas: Sxa. Painless jaundiceb. Anorexia
![Page 57: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/57.jpg)
Pancreatic Tumors, In head, continued …
c. Nausea
d. Weight loss
e. Increased plasma amylase
f. Increased alkaline phosphatase
g. May involve compression of pancreatic duct, CBD
![Page 58: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/58.jpg)
Pancreatic Tumors in the Head
Tumors in the head may compress biliary ducts or pancreatic ducts
![Page 59: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/59.jpg)
Pancreatic tumors, continued …
3. In Body of Pancreas: Sxa. Gnawing pain radiating to backb. Pain increases after eating or lying downc. Weight loss, anorexiad. Large tumor may compress IVC, portal vein
![Page 60: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/60.jpg)
Pancreatic tumors, continued …
4. In Tail of Pancreas: Sxa. Often silent until local metastasis occursb. May metastasize to: 1. para-aortic lymph nodes
2. spleen
![Page 61: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/61.jpg)
Pancreatic tumors, continued …
5. Identified by organ enlargement, subtle echo changes, irregular outline
6. Metastases to stomach, liver & lungs are common
7. Often causes dilation of ducts
![Page 62: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/62.jpg)
Pancreatic Disorders, continued …
H. Fibrocystic Disease
1. Result of cystic fibrosis
2. Diagnosed by methods other than ultrasound
![Page 63: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/63.jpg)
Pancreatic Disorders, continued …
I. Pancreaticolithiasis
1. Characteristic stone echoes in pancreatic duct
2. May see atrophied pancreatic parenchyma
3. Associated with chronic alcoholic pancreatitis
4. Contours of body, tail show irregularities
![Page 64: THE PANCREAS. I.Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions: 1. 5 - 6” length x 2. 1-1/2” width.](https://reader030.fdocuments.us/reader030/viewer/2022032723/56649d005503460f949d175d/html5/thumbnails/64.jpg)
Pancreatolithiasis, continued …
5. Incidence slightly higher in head
6. Associated with occult pancreatic carcinoma
a. Mass < 2mm diameter
b. Seen with dilation of pancreatic duct or CBD