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