PANCREAS

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CONTENTS
 Anatomy of pancreas
 Function of pancreas

 Sonographic appearance

 Indication

 Laboratory results

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PANCREAS

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ANATOMY
Pinkish yellow gland
15 – 20 cm long


Retroperitoneal organ
Lobulated outline

Lies on posterior abdominal wall

No true capsule

Infiltrated by retroperitoneal fat in obese patient

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ANATOMY
Head in “c” of duodenal
loop

Body and tail extend

obliquely to left

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
Tail lies in lienorenal ligament
Uncinate process extend postero-inferiorly around the

smv
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 2 FUNCTIONS OF PANCREAS

Exocrine (acinar cell)

Produce digestive enzyme

Amylase  starch

Lipase  lipid

Peptidase  protein

Endocrine (islet cell)

hormonal - islets of Langerhans

insulin  blood sugar levels
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SONOGRAPHIC APPEARANCE

 Homogenous

 > echogenic than liver

 Decrease in size with age, more echogenic


< echogenic in children, larger

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Young Adult


Veins
 splenic vein to portal vein
 superior mesenteric vein which then
becomes the portal vein 10

Old
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NORMAL RANGE
Pancreatic duct < 2mm
Pancreatic thickness (AP diameter)

 Head = 2.5 – 3.5 cm

 Body = 1.75 – 2.5 cm

Tail = 1.5 – 3.5 cm

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5 PARTS OF PANCREAS

Head

Uncinate process

Neck

Body

Tail

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 13

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HEAD OF PANCREAS

• Lies within curve of duodenum (C-loop)

• Inferior and to right of body and tail
• Superior mesenteric artery and vein crosses
this process. 14
UNCINATE PROCESS

• Part of head
• Medial and posterior extension of head
• Wraps behind superior mesenteric artery and
vein 15
• Lie adjacent to ascending part of duodenum
NECK OF PANCREAS

• Constricted portion to left of head

• Touch pylorus above 16
• Anterior surface
• Separated from stomach by omental
bursa 17

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OMENTAL Isolated portion of peritoneal cavity
•lying dorsal to stomach and opening into the general
BURSA peritoneal cavity at epiploic foramen

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OMENTAL BURSA

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• extends into lienorenal ligament (spleen to
left kidney)
•  support splenic artery and vein
• Largest area of pancreas
• Ant to upper pole of left kidney 20

• Cephalad to body of pancreas

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PANCREATIC DUCT
• major pancreatic duct of Wirsung +
common bile duct major duodenal papilla

• accessory pancreatic duct of Santorini 

minor duodenal papilla

The main pancreatic duct

(arrowhead) is normally up to
2 mm in diameter

(arrow = CBD) 22
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 PANCREATIC ARTERIES & VEINS


Arteries
 small branches from the splenic
 superior pancreaticoduodenal - from the
gastroduodenal
 inferior pancreaticoduodenal - from the 24

superior mesenteric
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 Neck

Body

Head

Tail

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 26

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Name the 1 stomach
structures
2 pancreas
3 portal vein
4 SMA
5 splenic vein
6 IVC
7 aorta
8 spine

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1Gastroduodenal artery
2 Common bile duct
3 Portal confluence
4 SMA
5 Left renal vein
6 Splenic Vein
7 IVC
8 Aorta

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SONOGRAPHIC LANDMARKS
Head of pancreas
in the curve of duodenal loop with IVC, renal vessel and CBD
•

Neck of pancreas

splenic + SMV (post) = portal confluence
pylorus + GDA (ant)


Body of pancreas

lesser sac (ant)

Tail of pancreas

left kidney, adrenal, spleen 29
INDICATION
 Evaluation of acute or chronic pancreatitis
 Suspected pancreatic tumor
 Courvoisier’s sign
 presence of palpable gall bladder
 painless jaundice

 Possible endocrine tumor

 Islet cell tumor

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BIOCHEMICAL ANALYSIS
 Many pancreatic diseases
 production of digestive pancreatic enzymes is compromised
 either by obstruction of duct draining pancreas
 or by destruction of pancreatic cells
 which produce enzymes.
 Result in malabsorption of food and/or diarrhoea

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BIOCHEMICAL ANALYSIS
 The pancreas produces
 Digestive enzymes
 Amylase
 Lipase
 Peptidase
 trace amounts in blood
 If pancreas is damaged or inflamed
 release of enzymes into blood stream
 causes an increase
 serum amylase and lipase levels

 Enzymes also pass from blood stream into urine

 urinalysis 32
also contribute to diagnosis
DIGESTIVE ENZYMES
 Pancreas  digestive enzyme
 Amylase , Lipase , Peptidase
 In trace amount in blood

 Pancreas damaged/ inflamed

 Release enzyme into blood
 Increase in serum amylase, lipase level

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LABORATORY VALUES
 Serum amylase INCREASE
 Acute pancreatitis
 Chronic pancreatitis
 Obstruction of pancreatic duct
 Acute cholecystitis

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LABORATORY VALUES
 Urine amylase INCREASE
 Pancreatitis

 Lipase INCREASE
 Pancreatitis
 Pancreaticduct obstruction
 Carcinoma of pancreas
 Acute cholecystitis

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