Download MBBS Surgery Presentations 45 Pancreas Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 45 Pancreas PPT-Powerpoint Presentations and lecture notes


Pancreas:

Anatomy, Physiology,

Investigations

Congenital anomalies

Dept of Surgery

Anatomy

Lies transversely in the retroperitoneal space, between
the duodenum on the right and the spleen on the left

Related anteriorly to the omental bursa above, the
greater sac below, and the transverse mesocolon

Fixed organ


level of the L2 vertebra

From the duodenal C loop
to the hilum of the spleen

Divided into four parts

Cross-sectional relation of the pancreas to other

abdominal structures


Embryology

Pancreatic Ducts

Main pancreatic duct (duct of Wirsung), joins
the CBD to empty into the duodenum at the
ampulla of Vater

Diameter -- 2 to 4 mm

Pressure --15 to 30 mm Hg


Lesser duct (duct of
Santorini)
Drains superior portion
of head of the Pancreas
Empties separately into the
2nd part of duodenum
through the minor papilla

Arterial Supply

Celiac

Superior mesenteric artery

Splenic artery


Venous Drainage

Suprapancreatic portal vein

Retropancreatic portal vein

Splenic veins

Infrapancreatic SMV
Lymphatic Drainage

Drain into five main nodal groups

? Superior nodes drain the upper half of the head of the pancreas


? Anterior lymphatic drain to the prepyloric and infrapyloric nodes

? Inferior group of nodes drain to the superior mesenteric and periaortic nodes

? Posterior pancreaticoduodenal lymph nodes drain into right periaortic nodes


? Splenic group of nodes drain into the interceliomesenteric lymph nodes



The absence of a peritoneal barrier on the posterior
surface of the pancreas results in direct communication
of the intrapancreatic lymphatics with retroperitoneal
tissues, and this contributes to the high incidence of
recurrence after presumably curative resections of
pancreatic cancer


Histology

Exocrine Structure

Acinar cells secrete the enzymes responsible for

digestion

Ductular network carry the exocrine secretions into

the duodenum

Constitute 80% to 90% of the pancreatic mass


Endocrine Structure
Islets of Langerhans responsible for the secretion of

hormones that control glucose homeostasis

Contains

alpha (A)-- glucagon
beta (B)-- insulin
delta (D)-- somatostatin
pancreatic polypeptide (PP) or F cel s? PP

Accounts for 2% of the pancreatic mass

Pancreatic Exocrine Enzymes


Pancreatic Endocrine Enzymes

Investigations

? Serum Markers

Amylase, lipase, trypsinogen, and elastase

CA 19.9 (Tumor Marker)
? Lundh meal test
? Ultrasound
? EUS
? CECT Scan
? MRCP
? ERCP


Ultrasound image of normal pancreas (left) and acute pancreatitis (right).

Evidence of parenchymal edema and peripancreatic fluid accumulation is seen

Non necrotizing acute pancreatitis
Congenital Anomalies


The complex process by which the dorsal and
ventral pancreatic primordia fuse during
pancreatic development gives rise to
congenital variations

Agenesis

Very rarely, the pancreas may be totally absent

The homeodomain transcription factor IPF1

(PDX1) is critical for the development of the

pancreas, and germ line (inherited)

homozygous mutations in the IPF1 gene on

chromosome 13q12.1 have been reported in a

patient with pancreatic agenesis


Pancreas divisum

Most common clinically significant

Incidence of 3% to 10%

Caused by a failure of the fetal duct systems of
the dorsal and ventral pancreatic primordia to
fuse
Cystic fibrosis

vAutosomal recessive

vMore in Caucasians

vIncidence 1 in 2500 live births in U.K.

vDefect is mutation in CFTR gene on Ch 7

vHigh levels of Na2+,Cl2- ions in sweat

Annular pancreas

Develops when one portion of the ventral pancreatic primordium

becomes fixed, while the other portion of this primordium is drawn

around the 2nd or 3rd duodenum

Can be associated with congenital duodenal atresia/ stenosis

Common in children with Down's syndrome

Present with signs and symptoms of duodenal obstruction such as

gastric distention and vomiting

Tx- Duodenoduodenostomy


Ectopic pancreas

Found in about 2% autopsy specimen

Sites for ectopia are stomach and duodenum, followed

by the jejunum, Meckel diverticula, and ileum

May cause pain from localized inflammation, or, rarely,

may incite mucosal bleeding

Approximately 2% of islet cell tumors arise in ectopic

pancreatic tissue.

This post was last modified on 08 April 2022