Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Pancreas and Portalvin Lecture PPT
PANCREAS
Pancreas ?all flesh
(pan=all and kreas=flesh)
Introduction...
? Soft, lobulated
elongated gland
with both exocrine
and endocrine
functions
? Exocrine ?
pancreatic
juice
? Endocrine-insulin,
Glucogan
Location...
? epigastric & left
hypochondriac
regions.
? behind the
stomach
and lesser sac
? Transversely across
the posterior
abdominal wall at
the level of L1 -
L3
Size and shape..
? J shaped or
retort shaped.
? Length-15-20 cm
? Thickness-
1.2-1.8 cm
? Breadth-2.5 -3.8
cm
? Wt- around 90
gm
PARTS
HEAD
Enlarged part C
shaped, lying within
the concavity of
duodenum, consist of
? 3 borders-superior
,inferior & right lateral
? 2 surfaces-anterior &
Posterior
? uncinate process
HEAD...
? Superior border-
-1st part of duodenum
-Sup. PancreaticodudenalA.
? Inferior border-
-3rd part of duodenum
-Inf. pancreaticodudenal A.
? Rt. lateral border-
-2nd part of duodenum
-Terminal part of bile duct
-Anastomosis betn 2
arteries.
HEAD...
Anterior surface
? 1st part of
duodenum.
? Transverse
colon
? Jejunum
separated by
peritotneum.
HEAD...
Posterior
surface:
? IVC
? Right Renal
veins
? Right crus of
diaphragm
? Bile duct
UNCINATE PROCESS
Triangular projection
which arises from
lower and left part of
the body.
Relations:
? Anterior:
-Superior mesenteric
vessels.
? Posterior
-Aorta
? Above
-Left renal vein
NECK
Relations:
Upper border:
. First part of
Duodenum
Anterior surface
? Peritoneum
covering lesser sac
? Pylorus
NECK..
Posterior surface
is related to
? superior
mesenteric vein
? portal vein
BODY
? Elongated part.
? Extends from neck to
the tail.
? Passes toward the
left with slight upward
and backward
inclination
BODY...
Triangular in cross
section
? 3 borders-
-Anterior
-superior
-Inferior
? Tuber omentale -
small projection
on superior border
little to the left of
the neck
BODY...
Relations...
Borders:
? Anteriorly attach to
root of the tranverse
mesocolon .
? Superior related to
coeliac trunk,
hepatic artery &
splenic artery
? Inferior is related
to
superior mesenteric
artery.
BODY..
Relations...
Surfaces:
? Anterior is convex
covered by the
peritoneum related to
the lesser sac &
stomach.
? Inferior surface covered
by the peritoneum
related the DJ flexure
coils of jejunum & Lt.
colic flexure.
BODY..
? Posterior surface
-Aorta
-Left crus of the
diaphragm
-Left kidney
-Left Suprarenal
gland
-Left renal vessels
-Splenic vein
TAIL
? Left end of the
pancreas
? Lies in the
lienorenal
ligament ,together
with the splenic
vessels
? Related to the
lower part of the
spleen (gastric
surface.
DUCT SYSTEM
Exocrine part
of pancreas is
drained by the
2 ducts
? Main
? Accessory.
Main pancreatic duct of Wirsung
? Lies near posterior
surface ,3 mm in
diam.white in colour
? Begins at the tail, runs
throughout the body
,bends at the neck to
run downwards
backwards in the
head.
? Herring bone pattern
Herring bone pattern
Main pancreatic duct of Wirsung
? In the head of the
pancreas, it is related to
the bile duct(on rt. side)
? Two ducts open in the
wall of the 2nd part of
the duodenum and join
to form
hepatopancreatic
ampulla of vater which
open as major duodenal
papilla,8-10 cm distal to
pylorus.
Accessory duct of Santorini
? Begins in the lower
part of head, crosses
the main duct with
which it communicates
? Opens as minor
duodenal papilla in
the 2nd part of
duodenum (6-8 cm
distal to pylorus)
Arterial supply...
-Splenic A.
-Superior
pancreaticoduodenal
artery
(from coeliac trunk)
-Inferior
pancreaticoduodenal
A.(from
superior mesenteric
Venous drainage
-Splenic vein
-Superior
mesenteric
Vein
-Portal vein
Nerve Supply
? Parasympathetic by
the vagus nerve
controlling secretion .
? Sympathetic from
coeliac & superior
mesenteric plx.
? Secretion is also
controlled by
hormone
secretinpancreozymine
DEVELOPMENT
The pancreas develops in
two parts, both of
which arise from the
endoderm of the
primitive duodenum.
The ventral bud develops
more caudally as a
diverticulum.
DEVELOPMENT
DEVELOPMENT
The dorsal bud is the first to
appear, as a diverticulum from the
dorsal wall of the duodenum. This
eventually forms the whole of the
neck, body and tail of the gland,
together with part of the head.
Between the fourth and eighth
week, the ventral bud rotates
posteriorly in a clockwise fashion to
fuse with the dorsal bud.
DEVELOPMENTAL ANOMALIES
PANCREATIC DIVISUM
Most common congenital anomaly
Results from failure of dorsal and ventral
ducts to fuse
Detected in 5% to 10% of population in
autopsy studies
ANNULAR PANCREAS
Rare congenital anomaly
Ring of pancreatic tissue surrounds the
duodenum
May be partial or complete
1 in every 12 000 to 15 000 live births
DEVELOPMENTAL ANOMALIES
ECTOPIC PANCREAS
Described as pancreatic tissue that lacks anatomic or
vascular continuity with the normal pancreas.
Usually asymptomatic and occurs as incidental
finding.
AGENESIS AND HYPOPLASIA
Total agenesis is extremely rare and incompatible
with life.
Hypoplasia result from absence of ventral or dorsal
pancreatic bud.
DEVELOPMENTAL ANOMALIES
ACCESSORY PANCREATIC LOBE
Extremely rare anomaly
Accessory lobe of pancreatic tissue originating from
main pancreatic gland.
May contain an aberrant duct
ANSA PANCREATICA
Rare anatomical variation.
Communication between main pancreatic and
accessory pancreatic duct.
Predisposing factor in patients with idiopathic acute
pancreatitis.
CLINICAL CORRELATION
1. Carcinoma of the head of pancreas
2. Acute Pancreatitis
PORTAL VEIN
Hepatic Portal Vein
? Origin & end in capillaries /
venous
sinusoids
? Size: 8cm X 1 cm
? Drains
? Abdominal part of alimentary
tract (except lower part of anal
canal)
? Spleen & Pancreas
? Conveys absorbed products of
digested food to liver
? Devoid of valves
? Reservoir of blood : 1200 ml /
min
Formation
? Union of Sup mesenteric & Splenic vein
? Between neck of Pancreas & IVC at level L2
This post was last modified on 30 November 2021