Download MBBS Pancreas and Portalvin Lecture PPT

PANCREAS

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Pancreas ?all flesh

(pan=all and kreas=flesh)

Introduction...

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? Soft, lobulated

elongated gland

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with both exocrine

and endocrine

functions

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? Exocrine ?

pancreatic

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juice

? Endocrine-insulin,

Glucogan

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Location...

? epigastric & left

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hypochondriac

regions.

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? behind the

stomach

and lesser sac

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? Transversely across

the posterior

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abdominal wall at

the level of L1 -

L3

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Size and shape..

? J shaped or

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retort shaped.

? Length-15-20 cm

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? Thickness-

1.2-1.8 cm

? Breadth-2.5 -3.8

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cm

? Wt- around 90

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gm


PARTS

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HEAD

Enlarged part C

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shaped, lying within

the concavity of

duodenum, consist of

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? 3 borders-superior

,inferior & right lateral

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? 2 surfaces-anterior &

Posterior

? uncinate process

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HEAD...

? Superior border-

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-1st part of duodenum

-Sup. PancreaticodudenalA.

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? Inferior border-

-3rd part of duodenum

-Inf. pancreaticodudenal A.

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? Rt. lateral border-

-2nd part of duodenum

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-Terminal part of bile duct

-Anastomosis betn 2

arteries.

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HEAD...

Anterior surface

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? 1st part of

duodenum.

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? Transverse

colon

? Jejunum

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separated by

peritotneum.

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HEAD...

Posterior

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surface:

? IVC

? Right Renal

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veins

? Right crus of

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diaphragm

? Bile duct

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UNCINATE PROCESS

Triangular projection

which arises from

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lower and left part of

the body.

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Relations:

? Anterior:

-Superior mesenteric

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vessels.

? Posterior

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-Aorta

? Above

-Left renal vein

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NECK

Relations:

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Upper border:

. First part of

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Duodenum

Anterior surface

? Peritoneum

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covering lesser sac

? Pylorus

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NECK..

Posterior surface

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is related to

? superior

mesenteric vein

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? portal vein


BODY

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? Elongated part.

? Extends from neck to

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the tail.

? Passes toward the

left with slight upward

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and backward

inclination
BODY...

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Triangular in cross

section

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? 3 borders-

-Anterior

-superior

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-Inferior

? Tuber omentale -

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small projection

on superior border

little to the left of

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the neck


BODY...

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Relations...

Borders:

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? Anteriorly attach to

root of the tranverse

mesocolon .

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? Superior related to

coeliac trunk,

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hepatic artery &

splenic artery

? Inferior is related

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to

superior mesenteric

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artery.


BODY..

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Relations...

Surfaces:

? Anterior is convex

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covered by the

peritoneum related to

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the lesser sac &

stomach.

? Inferior surface covered

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by the peritoneum

related the DJ flexure

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coils of jejunum & Lt.

colic flexure.

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BODY..

? Posterior surface

-Aorta

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-Left crus of the

diaphragm

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-Left kidney

-Left Suprarenal

gland

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-Left renal vessels

-Splenic vein
TAIL

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? Left end of the

pancreas

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? Lies in the

lienorenal

ligament ,together

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with the splenic

vessels

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? Related to the

lower part of the

spleen (gastric

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surface.


DUCT SYSTEM

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Exocrine part

of pancreas is

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drained by the

2 ducts

? Main

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? Accessory.


Main pancreatic duct of Wirsung

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? Lies near posterior

surface ,3 mm in

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diam.white in colour

? Begins at the tail, runs

throughout the body

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,bends at the neck to

run downwards

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backwards in the

head.

? Herring bone pattern

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Herring bone pattern

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Main pancreatic duct of Wirsung

? In the head of the

pancreas, it is related to

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the bile duct(on rt. side)

? Two ducts open in the

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wall of the 2nd part of

the duodenum and join

to form

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hepatopancreatic

ampulla of vater which

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open as major duodenal

papilla,8-10 cm distal to

pylorus.

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Accessory duct of Santorini

? Begins in the lower

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part of head, crosses

the main duct with

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which it communicates

? Opens as minor

duodenal papilla in

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the 2nd part of

duodenum (6-8 cm

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distal to pylorus)


Arterial supply...

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-Splenic A.

-Superior

pancreaticoduodenal

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artery

(from coeliac trunk)

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-Inferior

pancreaticoduodenal

A.(from

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superior mesenteric


Venous drainage

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-Splenic vein

-Superior

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mesenteric

Vein

-Portal vein

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Nerve Supply

? Parasympathetic by

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the vagus nerve

controlling secretion .

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? Sympathetic from

coeliac & superior

mesenteric plx.

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? Secretion is also

controlled by

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hormone

secretinpancreozymine

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DEVELOPMENT

The pancreas develops in

two parts, both of

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which arise from the

endoderm of the

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primitive duodenum.

The ventral bud develops

more caudally as a

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diverticulum.


DEVELOPMENT

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DEVELOPMENT

The dorsal bud is the first to

appear, as a diverticulum from the

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dorsal wall of the duodenum. This

eventually forms the whole of the

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neck, body and tail of the gland,

together with part of the head.
Between the fourth and eighth

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week, the ventral bud rotates

posteriorly in a clockwise fashion to

fuse with the dorsal bud.

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DEVELOPMENTAL ANOMALIES

PANCREATIC DIVISUM

Most common congenital anomaly

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Results from failure of dorsal and ventral

ducts to fuse

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Detected in 5% to 10% of population in

autopsy studies

ANNULAR PANCREAS

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Rare congenital anomaly

Ring of pancreatic tissue surrounds the

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duodenum

May be partial or complete

1 in every 12 000 to 15 000 live births

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DEVELOPMENTAL ANOMALIES

ECTOPIC PANCREAS

Described as pancreatic tissue that lacks anatomic or

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vascular continuity with the normal pancreas.

Usually asymptomatic and occurs as incidental

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finding.

AGENESIS AND HYPOPLASIA

Total agenesis is extremely rare and incompatible

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with life.

Hypoplasia result from absence of ventral or dorsal

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pancreatic bud.
DEVELOPMENTAL ANOMALIES

ACCESSORY PANCREATIC LOBE

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Extremely rare anomaly

Accessory lobe of pancreatic tissue originating from

main pancreatic gland.

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May contain an aberrant duct

ANSA PANCREATICA

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Rare anatomical variation.

Communication between main pancreatic and

accessory pancreatic duct.

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Predisposing factor in patients with idiopathic acute

pancreatitis.
CLINICAL CORRELATION

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1. Carcinoma of the head of pancreas
2. Acute Pancreatitis
PORTAL VEIN

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Hepatic Portal Vein

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? Origin & end in capillaries /

venous

sinusoids

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? Size: 8cm X 1 cm

? Drains

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? Abdominal part of alimentary

tract (except lower part of anal

canal)

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? Spleen & Pancreas

? Conveys absorbed products of

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digested food to liver

? Devoid of valves

? Reservoir of blood : 1200 ml /

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min


Formation

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? Union of Sup mesenteric & Splenic vein

? Between neck of Pancreas & IVC at level L2

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