The document discusses various congenital anomalies of the pancreas including annular pancreas, pancreas divisum, ectopic pancreatic tissue, horseshoe pancreas, and variations in pancreatic ductal anatomy. It describes the embryological development of the pancreas and defines important anatomical structures such as the pancreatic ducts. Imaging features of different pancreatic anomalies on modalities like CT, MRI, ERCP, and ultrasound are provided.
Embryology of pancreas and Imaging of pancreatitissrikanth reddy
1) The pancreas develops from two buds, the dorsal and ventral buds, which arise from the duodenum and fuse during development.
2) CT is the preferred imaging modality for evaluating acute pancreatitis to confirm the diagnosis, assess severity and complications such as necrosis, pseudocysts and fluid collections.
3) Acute pancreatitis is classified on CT imaging as interstitial edematous pancreatitis or necrotizing pancreatitis depending on the presence of pancreatic or peripancreatic necrosis. CT also guides management by identifying complications.
The foregut gives rise to the esophagus, stomach, liver, gallbladder and bile ducts, pancreas, and upper duodenum. The esophagus develops from the foregut just caudal to the lung buds. Errors in formation of septa can lead to tracheoesophageal fistulas or esophageal atresia. The stomach develops through rotation such that the left side moves ventrally and the right dorsally. Differential growth forms the greater and lesser curvatures. The pyloric sphincter separates the stomach and duodenum; errors can cause pyloric stenosis. The liver and pancreas arise from the foregut endoderm induced by nearby mesoderm.
The foregut gives rise to the esophagus, stomach, liver, gallbladder and bile ducts, pancreas, and upper duodenum. The esophagus develops from the foregut just caudal to the lung buds. Errors in formation of septa can lead to tracheoesophageal fistulas or esophageal atresia. The stomach develops through rotation such that the left side moves ventrally and the right dorsally. Differential growth forms the greater and lesser curvatures. The pancreas has dorsal and ventral components that fuse together. Rotation of the duodenum brings the pancreas into a retroperitoneal position and can cause annular pancreas if fusion is abnormal.
The pancreas develops from endoderm of the primitive duodenum in two parts - a dorsal and ventral part. The dorsal part forms the body, tail, and part of the head, while the right ventral bud persists to form the head and uncinate process.
The pancreas has both exocrine and endocrine functions. It is located in the retroperitoneum with the head adjacent to the duodenum. The pancreatic duct arises in the tail and drains into the ampulla of Vater after joining the common bile duct. Arterial blood supply comes from the celiac trunk and SMA, while venous drainage is via the splenic and portal veins.
Congenital anomalies include
Radiological anatomy of pancreas and spleenPankaj Kaira
This document provides an overview of the radiological anatomy of the pancreas and spleen. It describes the locations and structures of the pancreas including the head, neck, body and tail. It also describes the pancreatic duct and its branches. For the spleen it describes the location, size, weight and blood supply. It then discusses several anatomical variations and congenital anomalies that can occur for both the pancreas and spleen such as pancreas divisum, annular pancreas, ectopic pancreas, polysplenia, splenosis and wandering spleen.
The document discusses anorectal malformations (ARMs) in newborns. It covers the embryology, classification, anatomy, pathophysiology and approach to a case of ARM. Some key points include:
- ARMs occur in about 1 in 5,000 births and involve defects in the development of the anus and rectum.
- Embryologically, ARMs occur when the urorectal septum fails to fully divide the cloaca into the urogenital sinus and anorectal canal.
- ARMs are classified based on the level of defect (high, intermediate, low). The most common are rectourethral fistula in males and rectovestibular fist
Sonological features of Pancreatitis.pptxvinodkrish2
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Acute pancreatitis
Last revised by Rohit Sharma on 27 Sep 2023
Citation, DOI, disclosures and article data
Acute pancreatitis (plural: pancreatitides) is an acute inflammation of the pancreas and potentially life-threatening.
On this page:
Article:
Terminology
Epidemiology
Diagnosis
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
Differential diagnosis
See also
Related articles
References
Images:
Cases and figures
Terminology
Two subtypes of acute pancreatitis are described in the Revised Atlanta Classification 1:
interstitial edematous pancreatitis
the vast majority (90-95%)
most often referred to simply as "acute pancreatitis" or "uncomplicated pancreatitis"
necrotizing pancreatitis
necrosis develops within the pancreas and/or peripancreatic tissue
Epidemiology
The demographics of patients affected by acute pancreatitis reflect the underlying cause, of which there are many (see Pathology below).
Diagnosis
The diagnosis of acute pancreatitis is usually based on clinical criteria or a combination of clinical and radiographic features 1.
Diagnostic criteria
Two of the following three criteria are required for the diagnosis 1:
acute onset of persistent, severe epigastric pain (i.e. pain consistent with acute pancreatitis)
lipase/amylase elevation >3 times the upper limit of normal
characteristic imaging features on contrast-enhanced CT, MRI, or ultrasound
ADVERTISEMENT: Supporters see fewer/no ads
Clinical presentation
Classical clinical features include 3:
acute onset of severe central epigastric pain (over 30-60 min)
poorly localized tenderness and pain
exacerbated by supine positioning
radiates through to the back in 50% of patients
Elevation of serum amylase and lipase are 90-95% specific for the diagnosis 3.
A normal amylase level (normoamylasaemia) in acute pancreatitis is well-recognized, especially when it occurs on the ground of chronic pancreatitis. A normal lipase level has also been reported (<10 case reports) but is extremely rare 16.
(Rare) signs of hemorrhage on the physical exam include:
Cullen sign: periumbilical bruising
Grey-Turner sign: flank bruising
Pathology
There continues to be debate over the precipitating factor leading to acute pancreatitis, with duct occlusion being an important factor, but neither necessary nor sufficient.
Mechanism notwithstanding, activation of pancreatic enzymes within the pancreas rather than the bowel leads to inflammation of the pancreatic tissue, disruption of small pancreatic ducts, and leakage of pancreatic secretions. Because the pancreas lacks a capsule, the pancreatic juices have ready access to surrounding tissues. Pancreatic enzymes digest fascial layers, spreading the inflammatory process to multiple anatomic compartments.
Etiology
gallstone passage/impaction: most common cause of acute pancreatitis (up to 15% develo
Embryology of pancreas and Imaging of pancreatitissrikanth reddy
1) The pancreas develops from two buds, the dorsal and ventral buds, which arise from the duodenum and fuse during development.
2) CT is the preferred imaging modality for evaluating acute pancreatitis to confirm the diagnosis, assess severity and complications such as necrosis, pseudocysts and fluid collections.
3) Acute pancreatitis is classified on CT imaging as interstitial edematous pancreatitis or necrotizing pancreatitis depending on the presence of pancreatic or peripancreatic necrosis. CT also guides management by identifying complications.
The foregut gives rise to the esophagus, stomach, liver, gallbladder and bile ducts, pancreas, and upper duodenum. The esophagus develops from the foregut just caudal to the lung buds. Errors in formation of septa can lead to tracheoesophageal fistulas or esophageal atresia. The stomach develops through rotation such that the left side moves ventrally and the right dorsally. Differential growth forms the greater and lesser curvatures. The pyloric sphincter separates the stomach and duodenum; errors can cause pyloric stenosis. The liver and pancreas arise from the foregut endoderm induced by nearby mesoderm.
The foregut gives rise to the esophagus, stomach, liver, gallbladder and bile ducts, pancreas, and upper duodenum. The esophagus develops from the foregut just caudal to the lung buds. Errors in formation of septa can lead to tracheoesophageal fistulas or esophageal atresia. The stomach develops through rotation such that the left side moves ventrally and the right dorsally. Differential growth forms the greater and lesser curvatures. The pancreas has dorsal and ventral components that fuse together. Rotation of the duodenum brings the pancreas into a retroperitoneal position and can cause annular pancreas if fusion is abnormal.
The pancreas develops from endoderm of the primitive duodenum in two parts - a dorsal and ventral part. The dorsal part forms the body, tail, and part of the head, while the right ventral bud persists to form the head and uncinate process.
The pancreas has both exocrine and endocrine functions. It is located in the retroperitoneum with the head adjacent to the duodenum. The pancreatic duct arises in the tail and drains into the ampulla of Vater after joining the common bile duct. Arterial blood supply comes from the celiac trunk and SMA, while venous drainage is via the splenic and portal veins.
Congenital anomalies include
Radiological anatomy of pancreas and spleenPankaj Kaira
This document provides an overview of the radiological anatomy of the pancreas and spleen. It describes the locations and structures of the pancreas including the head, neck, body and tail. It also describes the pancreatic duct and its branches. For the spleen it describes the location, size, weight and blood supply. It then discusses several anatomical variations and congenital anomalies that can occur for both the pancreas and spleen such as pancreas divisum, annular pancreas, ectopic pancreas, polysplenia, splenosis and wandering spleen.
The document discusses anorectal malformations (ARMs) in newborns. It covers the embryology, classification, anatomy, pathophysiology and approach to a case of ARM. Some key points include:
- ARMs occur in about 1 in 5,000 births and involve defects in the development of the anus and rectum.
- Embryologically, ARMs occur when the urorectal septum fails to fully divide the cloaca into the urogenital sinus and anorectal canal.
- ARMs are classified based on the level of defect (high, intermediate, low). The most common are rectourethral fistula in males and rectovestibular fist
Sonological features of Pancreatitis.pptxvinodkrish2
MENURadiopaedia.org
SEARCH
ARTICLES
CASES
COURSES
LOG IN
REGISTER NOW
ADVERTISEMENT: Supporters see fewer/no ads
Acute pancreatitis
Last revised by Rohit Sharma on 27 Sep 2023
Citation, DOI, disclosures and article data
Acute pancreatitis (plural: pancreatitides) is an acute inflammation of the pancreas and potentially life-threatening.
On this page:
Article:
Terminology
Epidemiology
Diagnosis
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
Differential diagnosis
See also
Related articles
References
Images:
Cases and figures
Terminology
Two subtypes of acute pancreatitis are described in the Revised Atlanta Classification 1:
interstitial edematous pancreatitis
the vast majority (90-95%)
most often referred to simply as "acute pancreatitis" or "uncomplicated pancreatitis"
necrotizing pancreatitis
necrosis develops within the pancreas and/or peripancreatic tissue
Epidemiology
The demographics of patients affected by acute pancreatitis reflect the underlying cause, of which there are many (see Pathology below).
Diagnosis
The diagnosis of acute pancreatitis is usually based on clinical criteria or a combination of clinical and radiographic features 1.
Diagnostic criteria
Two of the following three criteria are required for the diagnosis 1:
acute onset of persistent, severe epigastric pain (i.e. pain consistent with acute pancreatitis)
lipase/amylase elevation >3 times the upper limit of normal
characteristic imaging features on contrast-enhanced CT, MRI, or ultrasound
ADVERTISEMENT: Supporters see fewer/no ads
Clinical presentation
Classical clinical features include 3:
acute onset of severe central epigastric pain (over 30-60 min)
poorly localized tenderness and pain
exacerbated by supine positioning
radiates through to the back in 50% of patients
Elevation of serum amylase and lipase are 90-95% specific for the diagnosis 3.
A normal amylase level (normoamylasaemia) in acute pancreatitis is well-recognized, especially when it occurs on the ground of chronic pancreatitis. A normal lipase level has also been reported (<10 case reports) but is extremely rare 16.
(Rare) signs of hemorrhage on the physical exam include:
Cullen sign: periumbilical bruising
Grey-Turner sign: flank bruising
Pathology
There continues to be debate over the precipitating factor leading to acute pancreatitis, with duct occlusion being an important factor, but neither necessary nor sufficient.
Mechanism notwithstanding, activation of pancreatic enzymes within the pancreas rather than the bowel leads to inflammation of the pancreatic tissue, disruption of small pancreatic ducts, and leakage of pancreatic secretions. Because the pancreas lacks a capsule, the pancreatic juices have ready access to surrounding tissues. Pancreatic enzymes digest fascial layers, spreading the inflammatory process to multiple anatomic compartments.
Etiology
gallstone passage/impaction: most common cause of acute pancreatitis (up to 15% develo
The document discusses the anatomy and surgical considerations of the gallbladder and bile ducts. It describes the structures and relationships of the gallbladder, cystic duct, common hepatic duct, and common bile duct. It also discusses the blood supply, lymphatics, variations in anatomy, and imaging modalities used to investigate the biliary tract such as ultrasound, cholescintigraphy, and endoscopic ultrasound.
The document discusses the embryological development, classification, clinical features, investigations, and management of benign anorectal diseases such as imperforate anus, anorectal malformations, and rectal prolapse. It describes the normal development of the anorectum and various congenital anomalies that can occur. Evaluation methods including invertograms and defecography are outlined, as well as surgical techniques for repair of anomalies like posterior sagittal anorectoplasty.
The document discusses the anatomy and sonographic appearance of the pancreas. It describes the pancreas' location and relationships to nearby structures like blood vessels. The normal sonographic features include homogeneous echotexture and absence of duct dilation. Common pathologies like pancreatic cancer and pancreatitis are also summarized, noting how they can appear on ultrasound with features like duct obstruction or diffuse swelling. Ultrasound is established as a useful initial imaging method for evaluating the pancreas.
Anatomy of gastroesophagial junction with specail reference to hiatus hernia...Rana Singh
This document discusses the anatomy of the gastroesophageal junction, with a focus on hiatal hernia and the anatomical basis for therapeutic intervention. Key points include:
- The gastroesophageal junction is defined anatomically by the squamocolumnar junction, the transition from esophageal to gastric lining, and the junction of the esophageal and gastric musculature.
- Hiatal hernias are classified based on the location of the hernia, with type I being a sliding hernia and type II being a paraesophageal hernia where the gastric fundus herniates alongside a normal cardia.
- Indications for surgical repair of paraesophageal hernias include symptoms and the risk
Excretionurography
Also known as intravenous urography (IVU).
Most frequently employed radiologic investigation of renal rainage.
The contrast material is administered intravenously.
Best method for adults unless use of other methods is specified and is used in examinations of upper urinary tracts of infants and children.
1. Anorectal malformations are congenital anomalies of the anus and rectum that occur in approximately 1 in 5,000 live births.
2. The document describes various classifications of anorectal malformations and discusses the embryological development of the condition.
3. Key surgical procedures for repair of anorectal malformations are described, including colostomy, posterior sagittal anorectoplasty, and pull-through operations. The repair approaches are discussed depending on the specific type of malformation.
The digestive tract develops from the primitive gut tube. Abnormalities can occur during the development of the foregut, midgut, and hindgut. Foregut abnormalities include esophageal atresia and tracheoesophageal fistula. Rotation of the midgut and physiological herniation are important developmental processes. Midgut abnormalities include intestinal atresia and stenosis. Hindgut abnormalities include Hirschsprung's disease and imperforate anus. The development of organs like the stomach, liver, pancreas and derivatives like the duodenum are also described. Common anatomical anomalies associated with their development are discussed.
The document summarizes the anatomy and histology of the pancreas. It describes the pancreas as having both exocrine and endocrine functions. The pancreas has five parts - the head, uncinate process, neck, body, and tail. It is supplied by branches of the splenic artery and drains into the splenic and portal veins. The pancreas contains acini that secrete enzymes into a duct system that empties into the duodenum. Islets of Langerhans contain endocrine cells that secrete hormones like insulin. Common clinical correlates of the pancreas include pancreatitis, which can be caused by factors like gallstones, alcohol use, and genetic mutations.
This document provides information about prolapse of the rectum (rectal prolapse). It discusses the embryology, anatomy, physiology, etiology, clinical features, diagnosis and differential diagnosis of rectal prolapse. Some key points:
- Rectal prolapse is the circumferential descent of the rectum through the anus, either partially (mucosa and submucosa protrude) or completely (full thickness protrusion).
- Risk factors include straining from constipation/diarrhea, pregnancy, prior operations, and neurological/psychiatric conditions.
- Physiologically, it can cause fecal incontinence due to internal sphincter relaxation or damage. Reduction
The document summarizes the development of the pancreas. It notes that the pancreas develops from two buds that arise from the posterior foregut and later fuse. After fusion, the three main cell types of the pancreas - acinar, ductal, and islet cells - differentiate. The development of the ductal system is also described. Key transcription factors involved in pancreatic development like Pdx1 and Hlxb9 are discussed. Some congenital anomalies of the pancreas including annular pancreas and pancreatic divisum are then outlined, describing their presentations, diagnoses, and management approaches.
This document discusses rectal prolapse, including its anatomy, causes, types, clinical features, investigations, and management. It begins with the anatomy of the rectum and its blood supply. It then describes the causes of rectal prolapse as being related to decreased pelvic floor muscle tone. It outlines the types of rectal prolapse as partial, complete, or internal. Management involves dietary changes and injections for partial prolapse or surgery like rectopexy or STARR procedure for complete prolapse.
This document provides an overview of abdominal radiological anatomy. It discusses the anatomy of major abdominal organs including the liver, biliary tract, spleen, pancreas, kidneys, adrenal glands, and gastrointestinal tract. For each organ, it describes key anatomical features visible on imaging modalities like ultrasound, CT, and MRI. It also reviews some common anatomical variants seen in these structures.
The document summarizes normal retroperitoneal and abdominal wall anatomy. It describes the three compartments of the retroperitoneum - the anterior pararenal space, perirenal space, and posterior pararenal space. It also discusses the potential intraperitoneal spaces, including the supramesocolic space (divided into right and left spaces), inframesocolic space, and pelvic spaces. Key organs in the retroperitoneum like the kidneys, adrenal glands, pancreas, and parts of the colon and duodenum are also described.
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
The document provides an overview of abdominal ultrasound anatomy and techniques for examining various abdominal organs. It describes the liver anatomy, including Couinaud's segments. It outlines scanning techniques for the liver, gallbladder, pancreas, spleen, aorta, kidneys, bladder, prostate, uterus, ovaries, appendix, and gastrointestinal tract. For each organ, it describes the normal ultrasound appearance and optimal scanning planes and positions. Key anatomical structures are labeled on ultrasound images.
The pancreas is a retroperitoneal organ approximately 15-20cm long located at the L1 vertebral level. It has both exocrine and endocrine functions. The pancreas is composed of a head, neck, body, and tail. It develops from dorsal and ventral buds originating from the duodenum. The main pancreatic duct drains the pancreas and joins the common bile duct. The pancreas has a blood supply from the coeliac, superior mesenteric, and splenic arteries. Variations include pancreas divisum and annular pancreas.
- Anorectal malformations (ARMs) range from minor defects to complex anomalies associated with other issues. They occur in approximately 1 in 5,000 births.
- Evaluation of newborns with ARMs involves examining the anus, genitals, and spine. Imaging studies like ultrasound, MRI and contrast enemas are used to characterize the anatomy and identify any associated anomalies in other organ systems.
- Treatment depends on the specific type of ARM, but may involve procedures like colostomy to allow the distal anatomy to develop before definitive repair. The long-term goals are to establish bowel and urinary continence.
This document discusses several common causes of childhood intestinal obstruction including:
1. Rotation defects that can cause midgut volvulus like malrotation or incomplete rotation.
2. Duodenal atresia which presents with jaundice and bilious vomiting in newborns.
3. Meconium ileus which is thick meconium causing ileal obstruction in cystic fibrosis patients.
4. Congenital hypertrophic pyloric stenosis causing projectile vomiting in infants.
5. Intussusception where one segment of bowel slides into another causing obstruction.
6. Hirschsprung disease where absence of ganglion cells in a segment of colon causes constipation.
The pancreas has four regions - the head, neck, body, and tail. The head is nestled near the duodenum and contains the pancreatic duct which drains into the common bile duct. The neck lies at the level of L1-L2 near the portal vein. The body and tail are located near the spleen. Arterial blood supply comes from branches of the celiac and superior mesenteric arteries, while venous drainage involves the portal vein. The exocrine pancreas secretes enzymes to aid digestion, and the endocrine islets of Langerhans produce hormones like insulin and glucagon to regulate metabolism. Imaging techniques like ultrasound and CT are important for evaluating pancreatic anatomy and function.
The vertebral column consists of 33 vertebrae separated by intervertebral discs. A typical vertebra has a vertebral body and arch enclosing the vertebral foramen through which the spinal cord passes. The spinal cord has 31 pairs of spinal nerves and is composed of gray and white matter. It transmits sensory information up the posterior columns and motor commands down tracts like the corticospinal tract. Injuries can cause syndromes like complete transection with bilateral deficits or Brown-Sequard with unilateral deficits depending on the location and extent of damage.
The document describes the various cerebrospinal fluid (CSF) filled spaces, or cisterns, within the subarachnoid space. It details both supra-tentorial and infra-tentorial cisterns, providing their locations, contents such as vessels and cranial nerves, and anatomical relationships. Key cisterns mentioned include the cistern of the lamina terminalis, chiasmatic cistern, interpeduncular cistern, prepontine cistern, cisterna magna, and cerebellopontine angle cistern. The cisterns form a interconnected network facilitating CSF circulation within the subarachnoid space.
The document discusses the anatomy and surgical considerations of the gallbladder and bile ducts. It describes the structures and relationships of the gallbladder, cystic duct, common hepatic duct, and common bile duct. It also discusses the blood supply, lymphatics, variations in anatomy, and imaging modalities used to investigate the biliary tract such as ultrasound, cholescintigraphy, and endoscopic ultrasound.
The document discusses the embryological development, classification, clinical features, investigations, and management of benign anorectal diseases such as imperforate anus, anorectal malformations, and rectal prolapse. It describes the normal development of the anorectum and various congenital anomalies that can occur. Evaluation methods including invertograms and defecography are outlined, as well as surgical techniques for repair of anomalies like posterior sagittal anorectoplasty.
The document discusses the anatomy and sonographic appearance of the pancreas. It describes the pancreas' location and relationships to nearby structures like blood vessels. The normal sonographic features include homogeneous echotexture and absence of duct dilation. Common pathologies like pancreatic cancer and pancreatitis are also summarized, noting how they can appear on ultrasound with features like duct obstruction or diffuse swelling. Ultrasound is established as a useful initial imaging method for evaluating the pancreas.
Anatomy of gastroesophagial junction with specail reference to hiatus hernia...Rana Singh
This document discusses the anatomy of the gastroesophageal junction, with a focus on hiatal hernia and the anatomical basis for therapeutic intervention. Key points include:
- The gastroesophageal junction is defined anatomically by the squamocolumnar junction, the transition from esophageal to gastric lining, and the junction of the esophageal and gastric musculature.
- Hiatal hernias are classified based on the location of the hernia, with type I being a sliding hernia and type II being a paraesophageal hernia where the gastric fundus herniates alongside a normal cardia.
- Indications for surgical repair of paraesophageal hernias include symptoms and the risk
Excretionurography
Also known as intravenous urography (IVU).
Most frequently employed radiologic investigation of renal rainage.
The contrast material is administered intravenously.
Best method for adults unless use of other methods is specified and is used in examinations of upper urinary tracts of infants and children.
1. Anorectal malformations are congenital anomalies of the anus and rectum that occur in approximately 1 in 5,000 live births.
2. The document describes various classifications of anorectal malformations and discusses the embryological development of the condition.
3. Key surgical procedures for repair of anorectal malformations are described, including colostomy, posterior sagittal anorectoplasty, and pull-through operations. The repair approaches are discussed depending on the specific type of malformation.
The digestive tract develops from the primitive gut tube. Abnormalities can occur during the development of the foregut, midgut, and hindgut. Foregut abnormalities include esophageal atresia and tracheoesophageal fistula. Rotation of the midgut and physiological herniation are important developmental processes. Midgut abnormalities include intestinal atresia and stenosis. Hindgut abnormalities include Hirschsprung's disease and imperforate anus. The development of organs like the stomach, liver, pancreas and derivatives like the duodenum are also described. Common anatomical anomalies associated with their development are discussed.
The document summarizes the anatomy and histology of the pancreas. It describes the pancreas as having both exocrine and endocrine functions. The pancreas has five parts - the head, uncinate process, neck, body, and tail. It is supplied by branches of the splenic artery and drains into the splenic and portal veins. The pancreas contains acini that secrete enzymes into a duct system that empties into the duodenum. Islets of Langerhans contain endocrine cells that secrete hormones like insulin. Common clinical correlates of the pancreas include pancreatitis, which can be caused by factors like gallstones, alcohol use, and genetic mutations.
This document provides information about prolapse of the rectum (rectal prolapse). It discusses the embryology, anatomy, physiology, etiology, clinical features, diagnosis and differential diagnosis of rectal prolapse. Some key points:
- Rectal prolapse is the circumferential descent of the rectum through the anus, either partially (mucosa and submucosa protrude) or completely (full thickness protrusion).
- Risk factors include straining from constipation/diarrhea, pregnancy, prior operations, and neurological/psychiatric conditions.
- Physiologically, it can cause fecal incontinence due to internal sphincter relaxation or damage. Reduction
The document summarizes the development of the pancreas. It notes that the pancreas develops from two buds that arise from the posterior foregut and later fuse. After fusion, the three main cell types of the pancreas - acinar, ductal, and islet cells - differentiate. The development of the ductal system is also described. Key transcription factors involved in pancreatic development like Pdx1 and Hlxb9 are discussed. Some congenital anomalies of the pancreas including annular pancreas and pancreatic divisum are then outlined, describing their presentations, diagnoses, and management approaches.
This document discusses rectal prolapse, including its anatomy, causes, types, clinical features, investigations, and management. It begins with the anatomy of the rectum and its blood supply. It then describes the causes of rectal prolapse as being related to decreased pelvic floor muscle tone. It outlines the types of rectal prolapse as partial, complete, or internal. Management involves dietary changes and injections for partial prolapse or surgery like rectopexy or STARR procedure for complete prolapse.
This document provides an overview of abdominal radiological anatomy. It discusses the anatomy of major abdominal organs including the liver, biliary tract, spleen, pancreas, kidneys, adrenal glands, and gastrointestinal tract. For each organ, it describes key anatomical features visible on imaging modalities like ultrasound, CT, and MRI. It also reviews some common anatomical variants seen in these structures.
The document summarizes normal retroperitoneal and abdominal wall anatomy. It describes the three compartments of the retroperitoneum - the anterior pararenal space, perirenal space, and posterior pararenal space. It also discusses the potential intraperitoneal spaces, including the supramesocolic space (divided into right and left spaces), inframesocolic space, and pelvic spaces. Key organs in the retroperitoneum like the kidneys, adrenal glands, pancreas, and parts of the colon and duodenum are also described.
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
The document provides an overview of abdominal ultrasound anatomy and techniques for examining various abdominal organs. It describes the liver anatomy, including Couinaud's segments. It outlines scanning techniques for the liver, gallbladder, pancreas, spleen, aorta, kidneys, bladder, prostate, uterus, ovaries, appendix, and gastrointestinal tract. For each organ, it describes the normal ultrasound appearance and optimal scanning planes and positions. Key anatomical structures are labeled on ultrasound images.
The pancreas is a retroperitoneal organ approximately 15-20cm long located at the L1 vertebral level. It has both exocrine and endocrine functions. The pancreas is composed of a head, neck, body, and tail. It develops from dorsal and ventral buds originating from the duodenum. The main pancreatic duct drains the pancreas and joins the common bile duct. The pancreas has a blood supply from the coeliac, superior mesenteric, and splenic arteries. Variations include pancreas divisum and annular pancreas.
- Anorectal malformations (ARMs) range from minor defects to complex anomalies associated with other issues. They occur in approximately 1 in 5,000 births.
- Evaluation of newborns with ARMs involves examining the anus, genitals, and spine. Imaging studies like ultrasound, MRI and contrast enemas are used to characterize the anatomy and identify any associated anomalies in other organ systems.
- Treatment depends on the specific type of ARM, but may involve procedures like colostomy to allow the distal anatomy to develop before definitive repair. The long-term goals are to establish bowel and urinary continence.
This document discusses several common causes of childhood intestinal obstruction including:
1. Rotation defects that can cause midgut volvulus like malrotation or incomplete rotation.
2. Duodenal atresia which presents with jaundice and bilious vomiting in newborns.
3. Meconium ileus which is thick meconium causing ileal obstruction in cystic fibrosis patients.
4. Congenital hypertrophic pyloric stenosis causing projectile vomiting in infants.
5. Intussusception where one segment of bowel slides into another causing obstruction.
6. Hirschsprung disease where absence of ganglion cells in a segment of colon causes constipation.
The pancreas has four regions - the head, neck, body, and tail. The head is nestled near the duodenum and contains the pancreatic duct which drains into the common bile duct. The neck lies at the level of L1-L2 near the portal vein. The body and tail are located near the spleen. Arterial blood supply comes from branches of the celiac and superior mesenteric arteries, while venous drainage involves the portal vein. The exocrine pancreas secretes enzymes to aid digestion, and the endocrine islets of Langerhans produce hormones like insulin and glucagon to regulate metabolism. Imaging techniques like ultrasound and CT are important for evaluating pancreatic anatomy and function.
The vertebral column consists of 33 vertebrae separated by intervertebral discs. A typical vertebra has a vertebral body and arch enclosing the vertebral foramen through which the spinal cord passes. The spinal cord has 31 pairs of spinal nerves and is composed of gray and white matter. It transmits sensory information up the posterior columns and motor commands down tracts like the corticospinal tract. Injuries can cause syndromes like complete transection with bilateral deficits or Brown-Sequard with unilateral deficits depending on the location and extent of damage.
The document describes the various cerebrospinal fluid (CSF) filled spaces, or cisterns, within the subarachnoid space. It details both supra-tentorial and infra-tentorial cisterns, providing their locations, contents such as vessels and cranial nerves, and anatomical relationships. Key cisterns mentioned include the cistern of the lamina terminalis, chiasmatic cistern, interpeduncular cistern, prepontine cistern, cisterna magna, and cerebellopontine angle cistern. The cisterns form a interconnected network facilitating CSF circulation within the subarachnoid space.
This document provides an overview of the gross anatomy of the brain as seen on MR imaging. It describes the central sulcus, ventricular system, limbic system, and white matter. It then details the axial, sagittal, and coronal views of the brain and lists over 100 structures and their 3D localization within the brain.
CT guided FNAC is a simple and minimally invasive technique for obtaining tissue samples from complex lung lesions for diagnosis. A study of 28 patients found CT guided FNAC to have a sensitivity of 80% and specificity of 100% for diagnosing malignancy. Complications occurred in 3 patients (12.5%) and were minor and self-resolving. CT guided FNAC is shown to be an effective and safe outpatient procedure for evaluating pulmonary nodules and masses.
CT guided FNAC is a simple and effective technique for diagnosing complex pulmonary lesions. In a study of 28 patients, CT guided FNAC had a sensitivity of 80% and specificity of 100% for diagnosing malignancy. CT scanning alone had sensitivity of 75% and specificity of 83.3% for malignancy. Complications occurred in 3 patients (12.5%) and were minor and resolved with conservative treatment. The study concluded that CT guided FNAC is a highly sensitive and specific technique for characterizing pulmonary lesions.
The document discusses various presacral lesions that can be seen on imaging. It describes the anatomy of the presacral space and then covers conditions with osteochondral origin like giant cell tumor and Ewing sarcoma. Neurogenic conditions such as neurofibromas, schwannomas, and perineural cysts are also discussed. Other lesions mentioned include dural ectasia and anterior myelomeningoceles. For each condition, the document provides details on clinical features, imaging appearance on modalities like CT and MRI, and examples of imaging findings.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by non-caseating granulomas. It most commonly affects the lungs, presenting radiographically as bilateral hilar lymphadenopathy in 50% of cases and pulmonary nodules in 30-50% of cases. Other involved organs include the eyes, skin, and heart. On CT, it demonstrates enlarged lymph nodes and pulmonary nodules distributed along the bronchovascular bundles. Late stage disease can develop pulmonary fibrosis. Sarcoidosis can also involve bones, presenting as cystic lesions in the hands. Neurosarcoidosis manifests as leptomeningeal enhancement or intracranial masses.
The document describes various signs seen on imaging of the respiratory system. It defines signs such as the signet ring sign seen on CT scans of the lungs, the finger-in-glove appearance seen in allergic broncho-pulmonary aspergillosis, and the continuous diaphragm sign seen in pneumomediastinum where air outlines the entire diaphragm. It also provides details on other signs like the halo sign associated with hemorrhagic nodules, the reversed halo sign, and tree-in-bud appearance seen in conditions like tuberculosis.
1. The document defines and describes solitary pulmonary nodules, providing details on measurements, characteristics, and imaging features that help determine if a nodule is benign or malignant.
2. Malignant nodules are more likely to be larger in size, irregular or spiculated in shape, located in the upper lobes, and demonstrate rapid growth. Benign nodules often have fat, calcification, or show long-term stability.
3. Guidelines are provided for follow-up of solid versus subsolid nodules based on size, with smaller or stable nodules requiring less frequent follow-up, and suspicious nodules warranting further evaluation including PET scans or biopsy.
Esophageal webs are thin mucosal membranes that project into the esophageal lumen, causing constriction. They more commonly occur in the cervical esophagus near the cricopharyngeus muscle. Associations include Plummer-Vinson syndrome, graft-versus-host disease, and gastroesophageal reflux disease. On barium swallows, esophageal webs appear as smooth tapered concentric narrowing in the cervical esophagus.
The parathyroid glands are located posterior to the thyroid gland in the neck. Parathyroid adenomas, the most common cause of primary hyperparathyroidism, enhance vividly on arterial phase CT then wash out rapidly on delayed phase with low attenuation on non-contrast images. Localizing the adenoma precisely with 4D CT guides focused surgical treatment through a small incision. The characteristic enhancement pattern and morphology help identify ectopic adenomas located during fetal development in the mediastinum.
This document provides an overview of brain anatomy including:
1. It describes the MRI appearance of different brain tissues and structures including white matter, fat, CSF, and gray matter on different sequences.
2. It then covers the sulcal and gyral anatomy of the brain, describing the lobes, major sulci like the central sulcus and sylvian fissure, and how they can be identified.
3. The anatomy of each lobe is then covered in more detail including the surfaces and sulci that make up the frontal, parietal, occipital, and temporal lobes.
Osteomyelitis is an infection of bone that is usually caused by bacteria entering through the bloodstream or direct inoculation via injury. It can be acute, subacute, or chronic. Common symptoms include fever, pain, and swelling near the infected bone. Diagnosis involves blood tests, imaging like x-rays, MRI, and bone scans, and bone/blood cultures. Treatment consists of antibiotics tailored to the identified bacteria as well as possible surgical drainage of abscesses.
This document discusses primary retroperitoneal neoplasms, which arise outside of major retroperitoneal organs. It notes that 70-80% of retroperitoneal masses are malignant in nature. The document then categorizes and describes several specific types of solid neoplastic masses that can occur in the retroperitoneum, including mesodermal neoplasms (such as liposarcomas and leiomyosarcomas), neurogenic tumors, and others. For each type of mass, it provides details on prevalence, appearance on CT and MRI scans, characteristics, associated syndromes, and other relevant clinical information.
1. The goals of first trimester ultrasound include visualization of the gestational sac, identification of embryonic demise, determination of gestational age, and early diagnosis of fetal anomalies.
2. A normal intrauterine gestation will demonstrate a gestational sac, yolk sac, embryo, amnion, and cardiac activity on ultrasound. Measurement of the mean sac diameter, crown-rump length, and biometric measurements can be used to estimate gestational age.
3. Absence of cardiac activity along with signs of bleeding have a high probability of embryonic demise. Criteria such as large sac size without visualizing fetal structures indicate a poor pregnancy outcome.
This document discusses Legg-Calve-Perthes disease, which is avascular necrosis of the femoral head that occurs in children. It begins by describing the etiology as an ischemic episode affecting the capital femoral epiphysis, though the exact cause is unknown. The stages of the disease are then outlined based on radiographic appearance, from initial avascular necrosis to revascularization and bone remodeling. Complications including deformities of the femoral head and neck are also summarized. The document provides detailed information on the radiographic signs and classifications systems used to evaluate the progression and prognosis of Legg-Calve-Perthes disease.
X-ray grids are devices used to remove scattered radiation from radiographic images. They consist of alternating strips of lead and transparent material. Grids work by absorbing most of the multidirectional scattered radiation while allowing the directional primary radiation to pass through. Grid performance is evaluated based on primary transmission, Bucky factor, and contrast improvement factor. Proper grid selection and positioning are important to avoid grid cutoff and increased patient radiation dose. Moving grids eliminate grid line artifacts but have some disadvantages.
This document discusses fluoroscopy, including conventional fluoroscopy units and modern fluoroscopic units. It describes the key components of a fluoroscopic unit, including the image intensifier, vidicon camera, and TV monitor. It also discusses factors that influence fluoroscopic image quality such as radiation dose rates, image resolution both vertically and horizontally, and techniques to reduce image noise like frame averaging.
A fluoroscope uses x-rays and a fluorescent screen to enable direct observation of internal organs. It consists of an x-ray tube, table, and image intensifier. The image intensifier converts x-rays into visible light images and amplifies them for viewing. It works by accelerating photoelectrons emitted from a photocathode onto a phosphor screen, producing light photons and gaining brightness. Newer generations of image intensifiers use additional electron multiplication for higher sensitivity. Fluoroscopy provides real-time moving images for procedures while fluorography captures still diagnostic images.
Diffusion MRI measures the random thermal motion of water molecules in tissues. It provides unique contrast based on differences in water diffusion between normal and abnormal tissues. Diffusion is restricted in cellular tissues and areas of restricted diffusion appear bright on diffusion-weighted images and dark on apparent diffusion coefficient maps. Diffusion MRI is useful for early detection of cerebral ischemia, differentiating between cystic and solid lesions, and evaluating white matter abnormalities and tumors. It has numerous clinical applications including stroke evaluation and characterization of brain lesions.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
PANCREATIC ANOMALY radiology.pptx
1. DR. SABHILASH
SUGATHAN
CONGENITAL ANOMALIES OF
PANCREAS
• Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality
imaging of pancreatic and biliary congenital anomalies.
RadioGraphics 2006;26(3):715–731.
• Anomalies, Anatomic Variants, and Sources of Diagnostic Pitfalls in
Pancreatic Imaging by Peyman Borghei MD , Farnoosh Sokhandon
MD , Ali Shirkhoda MD , Desiree E. Morgan
MD10.1148/radiol.12112469
2. • The pancreas is a retroperitoneal organ that has both endocrine and exocrine functions: it is
involved in the production of hormones (insulin, glucagon, and somatostatin), and also involved in
digestion by its production and secretion of pancreatic enzymes.
• Long (around 15cm ) epigastric structure extending from duodenal loop to splenic hilum
• Comprises the head (including uncinate process), neck, body and tail.
3. GROSS ANATOMY
The pancreas may have the shape of a dumbbell, tadpole, or sausage.
It can be divided into four main parts:
1. HEAD: thickest part; lies to the right of the mesenteric vessels
• uncinate process: extension of the head, posterior to SMV, SMA
• attached to "C" loop of duodenum (D2 and D3)
2. NECK: thinnest part; lies anterior to SMA, SMV
• SMV joins splenic vein behind pancreatic neck to form portal vein
3. BODY: main part; lies to left of SMA, SMV
• splenic vein lies in groove on posterior surface of body
4. TAIL: lies between layers of the splenorenal ligament in the splenic
hilum
4.
5.
6.
7.
8. MAIN PANCREATIC DUCT
• portion of the dorsal duct proximal to the dorsal-ventral fusion point
• drains at the ampulla of Vater
• connects with the accessory pancreatic duct (of Santorini) (see below)
if present
9. ACCESSORY PANCREATIC DUCT (OF
SANTORINI OR BERNARD)
• portion of the dorsal duct distal to the dorsal-ventral fusion point
• drains anterior and superior portion of the head
• in 70% of individuals drains to the minor papilla
• in 30% of individuals persists as a branch of the main pancreatic duct
10. Pancreatic duct of Wirsung
• distal portion of the main pancreatic duct
• segment of the ventral duct between the dorsal-ventral fusion point and the
major papilla
• continuous with the main pancreatic duct proximally
• joins with the common bile duct at a 60 degree angle at the hepatopancreatic
ampulla.
11. EMBRYOLOGICAL DEVELOPMENT
• By the 4th week of embryologic development, the pancreatic duct develops from
separate ventral and dorsal buds originating from the endodermal lining of the
duodenum.
• The gallbladder, extrahepatic bile ducts, central intrahepatic bile ducts, and
ventral pancreas with its ductal network are derived from the ventral bud or
outpouching.
• The dorsal bud is the precursor to dorsal pancreas and its ductal system.
• The ventral pancreas rotates clockwise posterior to the duodenum and comes into
contact with the dorsal pancreas in the 7th gestational week to develop into the future
pancreatic neck.
• The dorsal and ventral pancreatic buds grow into a pair of branching ,arborizing ductal
systems.
• After fusion, a new duct connects the distal portion of the dorsal pancreatic duct with
the shorter duct of the ventral pancreas to form the main pancreatic duct, also known
as the duct of Wirsung, which empties into the major papilla.
12.
13.
14. Dorsal pancreatic bud
• develops into the anterior part of the head, body, and tail (and a small variable portion of
the uncinate process)
• contains a long duct continuing from the accessory pancreatic papilla to the tail
15. Ventral pancreatic bud
• smaller of the two buds that develops into the posterior part of the pancreatic head and most of the
uncinate process
• contains a short main pancreatic duct which is connected to the common bile duct
• develops just distal to the developing biliary tree
• starts to the right of the duodenum
• rotates to the left underneath the dorsal pancreas
16. VARIANT ANATOMY
• Annular pancreas
• Fishtail pancreas
• Ectopic pancreatic tissue
• Horseshoe pancreas
• pancreatic duct variations
• pancreatic clefts: linear clefts may be seen which contain fat where small
vessels enter the pancreas and are a common mimic of pancreatic laceration.
They are most prominent at the junction of the body and neck
19. Clinical presentation
• annular pancreas in adults are asymptomatic and an incidental finding on
imaging. However, it can cause pancreatitis, duodenal obstruction and
rarely biliary obstruction.
• In children, an annular pancreas may be associated with other congenital
anomalies or cause duodenal obstruction.
20. EMBRYOLOGY
• The pancreas develops from a single dorsal and two ventral buds, which
appear as outgrowths of primitive foregut at 5 weeks of gestation. The ventral
buds fuse rapidly.
• In the 7th week of gestation, the duodenum expands and rotates the ventral
bud from right to left which then fuses with the dorsal bud. The ventral bud
forms the inferior part of uncinate process and inferior head of pancreas while
the dorsal bud gives rise to the tail and body of pancreas.
• Annular pancreas develops due to failure of the ventral bud to rotate with the
duodenum, causing encasement of the duodenum.
21. CLASSIFICATION
• complete annular pancreas: pancreatic parenchyma or an annular duct is
seen to completely surround the 2nd part of duodenum
• incomplete annular pancreas: annulus does not surround the duodenum
completely, giving a 'crocodile jaw' appearance
23. RADIOGRAPHIC FEATURES
CT
• Pancreatic tissue is seen to completely or incompletely surround the 2nd part of the
duodenum. Associated duodenal narrowing and dilatation of the proximal duodenum
may also be seen. In adults, it is frequently associated with pancreatitis.
MRI/MRCP
• Apart from annular pancreas features, pancreatic ductal anatomy can be well assessed
with MR imaging.
24. There is an 'echogenic focus' in short-axis images of the pancreas
head
The structure in the head of the pancreas is the 2nd part of the
duodenum
incomplete annular pancreas
25. Upper gastrointestinal radiograph of annular
pancreas
shows slit-like smooth narrowing of the
second portion of duodenum (arrows).
No gastric distention or mechanical
obstruction is present.
Contrast material flows freely into an
otherwise normal duodenum and proximal
jejunum.
26. Unenhanced axial CT scan of annular
pancreas
in 43-year-old man with history of resected
glucaconoma in the pancreatic tail.
The pancreatic tissue encircles the positive
oral contrastmaterial–filled second portion
of the duodenum(arrows), making the
anomaly easy to recognize even without
intravenous contrast material.
27. Intravenous contrast-enhanced axial CT
scan of annular pancreas
normal enhancing pancreatic tissue (arrows)
surrounding the collapsed duodenum.
The patient received water as a negative oral
contrast agent.
Wirsung duct of the ventral pancreas
(arrowhead) is draining into duodenum.
28. ERCP spot image of annular pancreas in
43-year-old man shows mild diffuse
acinarization of the pancreas (solid arrows).
The pancreatic tissue and pancreatic duct
(arrowhead) are to the right of the second
portion of the duodenum, consistent with
annular pancreas.
Focal dilatation of the main pancreatic
duct (dashed arrow) with pooling of contrast
material in the dependent portion is also
present.
29. Treatment and prognosis
• In symptomatic cases of annular pancreas, surgical management is
the treatment of choice.
• Bypass surgeries such as duodeno-jejunostomy or gastro-
jejunostomy are the mainstay of surgical management 3.
30. FISHTAIL PANCREAS
• Fishtail pancreas (also known as pancreas bifidum or bifid tail of the
pancreas) is a rare anatomical variant of the pancreas produced by a
branching anomaly during its development.
• It is named as such due to the fishtail-like appearance of the pancreas.
31. • Fishtail pancreas is thought to be caused by the failure of part of the ventral
pancreatic anlage to regress. The ventral pancreatic anlage develops into the majority of the
into the majority of the pancreatic gland.
• During pancreatic development, the ventral anlage initially has two lobes with two primitive
ducts .
• One lobe tends to dominate and persists to become the head of the pancreas, while the
other regresses and becomes the uncinate process of the pancreas.
• Fishtail pancreas is caused by failure of one of these lobes to regress producing duplication
32.
33. RADIOGRAPHIC FEATURES
MRCP
• Fishtail pancreas may be visible as a duplication of the major duct in the body of
the pancreas and the presence of two pancreatic tails .
ERCP
• Like MRCP, on ERCP it also shows duplication of the major pancreatic duct
34. ECTOPIC PANCREATIC TISSUE
• Ectopic pancreatic tissue, aka heterotopic pancreatic tissue, refers to the
presence of pancreatic tissue in the submucosal, muscularis or subserosal layers
of the luminal gastrointestinal tract outside the normal confines of
the pancreas and lacking any anatomic or vascular connection with the pancreas
proper.
36. Radiographic features
• On upper gastrointestinal examination, an ectopic pancreas appears as an
extra- mucosal, smooth, broad-based lesion either along the greater
curvature of the gastric antrum or in the proximal duodenum.
1. Fluoroscopy
2. Upper GI barium study
• In 45% of the cases of ectopic pancreas discovered on upper gastrointestinal
fluoroscopic examination, the ectopic pancreatic tissue contained a central
small collection of barium, i.e. a central niche or umbilication, indicative of the
rudimentary duct’s draining orifice. It is this finding that is diagnostic of
ectopic pancreatic tissue.
38. Ectopic pancreatic tissue ( green arrows )
similar to attenuation of the pancreas ( red
arrow ) in all 3 phases.
3. CT
Contrast enhanced CT may show a homogeneously enhancing tissue (similar to normal pancreas) or
cystic area (acinar component or pseudocyst).
39. HORSESHOE PANCREAS
• A rare anatomic variant of the pancreas in which the uncinate
process is unusually elongated such that it extends along the
whole 3rd part of the duodenum to mirror the tail superiorly
forming a horseshoe-shaped gland.
40. The uncinate process of the pancreas extends
along the entire aspect of the third part of the
duodenum. Normal anatomic variant of horseshoe
of horseshoe pancreas.
41. PANCREAS DIVISUM
• Pancreas divisum represents a variation in pancreatic ductal anatomy
• that can be associated with abdominal pain and idiopathic pancreatitis.
• It is characterized, in the majority of cases, by the main pancreatic
duct directly entering the minor papilla with no communication with the
ventral duct the major papilla.
• It results from failure of fusion of dorsal and ventral pancreatic anlages. As
a result, the dorsal pancreatic duct drains most of the pancreatic glandular
parenchyma via the minor papilla. Although controversial, this variant is
considered a cause of pancreatitis.
42. Three subtypes are known:
• TYPE 1 (CLASSIC): no connection at all; occurs in the majority of cases; 70%
cases; 70%
• TYPE 2 (ABSENT VENTRAL DUCT): minor papilla drains all of pancreas while major
pancreas while major papilla drains bile duct; 20-25%
• TYPE 3 (FUNCTIONAL): filamentous or inadequate connection between dorsal and
between dorsal and ventral ducts; 5-6%
Anomalies, Anatomic Variants, and Sources of Diagnostic Pitfalls in Pancreatic Imaging by Peyman Borghei MD , Farnoosh
Sokhandon MD , Ali Shirkhoda MD , Desiree E. Morgan MD10.1148/radiol.12112469
43. •TYPE 1 (CLASSIC): no connection at all; occurs in the majority of cases;
70%
44. •TYPE 2 (ABSENT VENTRAL
DUCT): minor papilla drains all
of pancreas while major papilla
duct; 20-25%
46. RADIOGRAPHIC FEATURES
1. Fluoroscopy
2. ERCP
• This was the traditional method of diagnosis where a pancreas divisum was
suspected when there was no contrast extending towards the pancreatic tail
when administered through the ampulla of Vater.
3. MRI
• MRI is the current gold standard method of evaluation. The key imaging
features:
• the dorsal pancreatic duct is in direct continuity with the duct of Santorini,
which drains into the minor papilla
• the ventral pancreatic duct (duct of Wirsung) does not communicate with the
dorsal pancreatic duct but joins with the distal common bile duct to enter the
major papilla
48. MRCP image of pancreas divisum
the main pancreatic duct (dorsal
Santorini
duct, straight solid arrow) draining
separately into the minor papilla (dashed
arrow).
The common bile duct (arrowheads)
joins the smaller ventral pancreaticduct
(curved arrow) at a more inferior
leveland drains into the duodenum
through the major
papilla.
Figure 3
49. ERCP images of pancreas divisum.
(a) The main pancreatic duct
(arrows) drains through the minor
papilla, consistent with pancreas
divisum.
(b) The short, terminally arborizing
duct of Wirsung (arrow) is depicted
by means of contrast material
injection of the major papilla, with
the common bile duct (arrowhead)
also filling.
50. • Reverse pancreas divisum : has been described where the main duct
fuses with the ventral duct and a small residual dorsal duct does not
duct and drains separately into the minor papilla.
51. TREATMENT AND PROGNOSIS
• A diagnosis of pancreas divisum does not routinely warrant treatment,
especially when incidental and asymptomatic. In symptomatic patients (e.g.
recurrent pancreatitis), management options may include:
• conservative, non-operative treatment +/- pancreatic enzyme supplements
• minor papillotomy
• minor papilla stenting
• balloon dilatation of any associated stricture
53. ANOMALOUS PANCREATICOBILIARY
JUNCTION
• An anomalous pancreaticobiliary junction, also known
as pancreaticobiliary maljunction, describes the abnormal junction of
the pancreatic duct and common bile duct that occurs outside
the duodenal wall to form a long common channel (>15 mm) .
54. • The origin of a long common channel might be formed embryologically with adhesion of the ventral
pancreatic duct and the terminal portion of the bile duct .
• It is divided into anomalous pancreaticobiliary junction with biliary dilatation (77%) and without biliary
dilatation (23%) .
• The anomalous pancreaticobiliary junction makes biliary drainage not under the control of sphincter of
Oddi, resulting in pancreatic juice reflux into the biliary tract that injures the biliary epithelium .
55. CLASSIFICATION
• The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) proposed
the following classification in 2015:
• TYPE A (STENOTIC TYPE): dilatation of the common bile duct upstream of a
stenotic segment of the distal common bile duct, which joins the common
channel
56. •TYPE B (NON‐STENOTIC TYPE): nonstenotic distal common bile duct
smoothly joins the common channel; no localized dilatation of the
57. •TYPE C (DILATED CHANNEL TYPE): narrow distal common bile
duct joins dilated common channel
58. •TYPE D (COMPLEX TYPE): complex maljunction associated
with annular pancreas, pancreas divisum, or other complicated duct
61. RADIOGRAPHIC FEATURES
ERCP
• An intrabiliary amylase level more than 8000 UI/L within the bile duct and
gallbladder obtained endoscopically (ERCP) or percutaneously suggests reflux
of pancreatic juice through an anomalous pancreaticobiliary junction and
shows a positive predictive value and a specificity of more than 90 % .
• In patients with a short common channel, direct cholangiography
(e.g. ERCP) can be effective in the assessment of pancreaticobiliary junction
incompetence.
62. Ultrasound
• It has a limited role in diagnosis, but is a useful noninvasive tool for
screening. Careful measurement of the common bile duct and comparison
with the normal limits for age helps in early detection. Detection of a
dilated common bile duct may be the first clue to suspect
pancreaticobiliary maljunction with biliary dilatation. In this case,
further MRCP is recommended for biliary junction anatomy. It is also
associated with gallbladder wall thickening. However, it is non-specific.
• The visualization of pancreaticobiliary junction outside the duodenal wall
can be detected at endoscopic ultrasound. It is also helpful in screening
and surveillance of biliary cancer after diagnosis of pancreaticobiliary
maljunction
63. CT/MRI
• a common channel length of >8 mm
• an abnormal union between the pancreatic and bile ducts
• pancreaticobiliary junction outside the duodenal wall
• common bile duct dilatation is suggestive of pancreaticobiliary
maljunction with biliary dilatation
• MRCP is the gold standard of diagnosis and is superior to ERCP in
depicting biliary anatomy, including the intrahepatic bile duct.
64. ANSA PANCREATICA
• It is a communication between the main pancreatic duct (of Wirsung)
and the accessory pancreatic duct (of Santorini).
• Recently, the ansa pancreatica has been considered as a predisposing
factor in patients with idiopathic acute pancreatitis .
• The ansa pancreatica arises as a branch duct from the main pancreatic
duct. It descends down initially, it then ascends upward forming a loop
finally terminating at the minor papilla.
• This type of pancreatic ductal variation can be identified
on ERCP or MRCP studies.
65.
66. ERCP image of ansa pancreatica
Dashed line represents dorsal main
pancreatic duct (technically underfilled).
There is obliteration of the proximal dorsal
pancreatic duct(solid arrow).
The proximal dorsal duct connects with
an inferior branch of the ventral duct
(arrowhead) through S-shaped collateral
(dashed arrow).
67. PANCREATIC CYSTS
• A congenital true pancreatic cyst is a very rare entity, mostly seen in children
younger than 2 years of age
• These cysts develop as a result of sequestration of primitive pancreatic
ducts and are lined by cuboidal epithelium
• Congenital pancreatic cysts are generally asymptomatic, although abdominal
distention, vomiting, jaundice, or pancreatitis can be observed
• At imaging, this condition manifests as a uniform thin-walled cyst usually in
the region of the pancreatic body and tail
• Congenital true pancreatic cysts may be idiopathic or may be observed in
association with other systemic diseases such as Von Hippel– Lindau disease
, Beckwith- Wiedeman syndrome, or polycystic disease of the pancreas
and kidneys