Pancreatic Diseases

Published on 16/04/2015 by admin

Filed under Surgery

Last modified 16/04/2015

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14 Pancreatic Diseases

Anatomy of the Pancreas

image

Pancreas in Situ

Parts and Landmarks

• Head (includes uncinate process), neck, body, tail
• Uncinate process lies behind superior mesenteric artery and anterior to aorta.
• Neck overlies superior mesenteric artery and vein and portal vein.
• Development

image Two endodermal gland buds of caudal foregut merge to form pancreas.
image Buds rotate with foregut.
image Dorsal bud forms body and tail.
image Ventral bud makes head; uncinate process rotates behind superior mesenteric artery.
image Original mesentery fuses with posterior peritoneum, and pancreas becomes retroperitoneal.

Location and Locale of the Pancreas

• Retroperitoneal and posterior to stomach: typically nonpalpable on physical examination
• Neck of pancreas overlies L1 and L2 vertebral bodies in the transpyloric plane.
• Head is to the right of and inferior to transpyloric plane.
• Body and tail are to the left and above transpyloric plane.

Duct System

Main Pancreatic Duct

• Begins in tail, runs medially into head
• Turns inferiorly, closely related to bile duct
• Ducts unite to form hepatopancreatic ampulla (of Vater).
• Ampulla empties into descending duodenum at the major duodenal papilla.
• Smooth muscle sphincter of pancreatic duct around terminal portion
• Smooth muscle sphincter lies around terminal bile duct.
• Hepatopancreatic sphincter (of Oddi) around hepatopancreatic ampulla

Accessory Pancreatic Duct (Variable)

• Can open into duodenum at minor duodenal papilla
• Accessory duct more often joins main duct (~60%).
• If main duct is small, and there is no juncture, accessory duct can carry majority of secretion.

Functional Anatomy

• Tubuloacinar gland structure with a variety of cell types, including intermingled islets of Langerhans
• Parasympathetic and sympathetic nerves are distributed to islets and acini.
• Cells’ secretions are controlled by endocrine and autonomic nervous activities.

Exocrine Functions

• Mediated by secretin and cholecystokinin formed by duodenal and jejunal epithelium
• Acinar cells secrete amylase, lipase, trypsinogen, chymotrypsinogen, carboxypeptidase, and Cl−.
• Ductal cells secrete HCO3−.
• Some secretomotor input comes from vagal parasympathetic fibers.

Endocrine Functions

• Alpha cells secrete glucagon.
• Beta cells

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