YOHANANTH SIVANANTHAN

ROLL NO-10132

NEPALGUNJ MEDICAL COLLEGE

NEPAL

Pancreas derived from greek Pan=All kreas=flesh

Means the organ contain neither cartilage nor bone

Pancreas is an elongated retroperitoneal organ lies more or less transversely across the posterior abdominal wall at the level of first(L1) , second lumbar vertebra(L2)

It lies posterior to stomach seperated by lesser sac and also posterior to lesser omentum.

It is a J shaped or retort shaped, set obliquely.

I5-20cm long,

2.5-3.8cm broad

1.2-1.8cm thick

And weighs about 80 grams

Parts

Head

Neck

Body

Tail

Head lies in the

concavity of

duodenum and

tail reaches the

hilum of spleen

Exocrine pancreas

drained by twoducts

Main duct of pancreas

(duct of wirsung)

Accesory duct of

pancreas(duct of Santorini)

Duct of wir sung Begins at tail runs on

the post surface of the body and head of pancreas.

Crosses the vertebral column Between at the level of T12 ,L2

Receives numerous tributaries at right angle along its length (hearring bone pattern)

Joins the bile duct in the wall of second part of duodenum to form hepato pancreatic ampullavater.

Opens at the summit of major duodenal papilla 8 to 10 cm from pylorus

Acessory pancreatic duct:

Begins at the lower part of head and opens into

duodenum at minor duodenal papilla (6-8

cm)from pylorus, 2 Cm slightly ant to major

papilla

Mainly by pancreatic branches of splenic artery

Superior pancreatico duodenal artery

Inferior pancreatico duodenal artery

Lympatics

Follow the arteries and drain in to the

Major drainage of head and uncinate process to

subpyloric ,portal,mesentric,mesocolic and aortacavalnodes

Body and tail-

coeliac Aortacaval,mesentric,mesocolic and aortacavalnodes,nodes through the splenic hilum

Nerve supply

Vagus or parasympathetic and splanchnic sympathetic nerves supply the pancreas through the plexuses and around its arteries.

Sympathetic –vasomotor

Parasympathetic control pancreatic secretion

EXOCRINE

Secreates pancreaticjuice which contain many

digestive enzymes

Trypsin-breakdown protein to lower peptide

Amylase-hydrolises starch and glycogen to disaccarides

Lipase-fat in to fatty acid and glycerol

ENDOCRINE

Isets or Langerhans

Beta cells - Insulin

Alpha cells – Glucagon

Delta cells - Somatostatin

Clear,bicarbonate rich fluid contain 15g protein total,2.5 litres/day, Ph-7.8-8.4

Ductal cells-Electrolytes

Na,k,ca,Mg,Zn cations

Bicarbonate,chlorate,traces of biphospate,sulphateanions

Acinar cells-protein

Pancreatic alpa amylase,lipase,esteraseprophosphatase A2

Pancreatic proteolytic enzymes

Typsinogen,chymotrypsinogen,procarboxypeptidaseA,B,Ribonuclease,deoxyribonuclease,proelastase

Acute inflammation of the gland parenchyma of the pancreas.

It is an acute condition presenting with abdominal pain and is usually associated with raised pancreatic enzyme levels in the blood or in urine a result of pancreatic inflammation

Incidence – increasing from past 20 years

300,000 hospital admitions in U.S annualy.

3% of all causes of abdominal pain among patients admitted in U.K

World wide annual incidence is 5-50/100000

It may be categorised Mild Acute pancreatitis

Severe Acute pancreatitis

Mild acute pancreatitis Characterised by

interstitial odeama and

minimal organ dysfunction

80 percent of patients have mild acute type

Mortality is about 1%

Severe acute pancreatitis Characterised by

pancreatic necrosis,

a severe systemic inflammatory response and often mutiorgan failure

Mortality varies 20%-50%

Bimodal distribution

About 1/3 of deaths occur at the early phase(first 2week) of attack from multiorganfailure and aftr the 2week known as late period and mortalidty due to septic complications