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PANCREAS
Dr. Gurudasan
2
INTRODUCTIONThe pancreas is the
largest of the digestive glands and performs a range of both endocrine and exocrine functions.
The pancreas is salmon pink in colour with a firm, lobulated smooth surface.
The main portion is divided into four parts, head, neck, body and tail, purely on the basis of anatomical relations.
A blunt uncinate process arises
from the lower part of head and
turns to the left. This uncinate
process is anatomically and
embryologically distinct.15-05-2014
3
LOCATION In adults the pancreas
measures between 12 and 15 cm long.
It occupies the posterior part of epigastrium and left hypochondrium.
It lies behind the peritoneum on the posterior
Abdominal wall more or less in transpyloric plane.
It extends from the concavity of duodenum to hilum of spleen.
Head & Neck - L1& L2, Body – Transpyloric plane, Tail – T12
Head
Neck
BodyTa
il
Sple
en
Uncinate processDuodenum
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HEAD OF PANCREAS
The head of the pancreas lies to the right of the midline, anterior and to the right side of the vertebral column, within the curve of the duodenum. It is the thickest and broadest part of the pancreas but is still flattened in the anteroposterior plane.
Superior pancreatico-duodenal artery
(Anterior view)(Posterior view)
Common bile duct
Inferior pancreatico-duodenal artery
Superior mesenteric artery
Splenic artery
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NECK OF PANCREAS
It is the slightly constricted part of the gland which connects head with the body.It has anterior and posterior surfaces, upper and lower bordersAnterior surface – pylorusPosterior surface – commencement of portal vein and origin of superior mesentericartery
Pylorus
Superior mesenteric vessels
Portal veinSplenic vein
SuperiorMesentericvein
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BODY OF PANCREAS
It is the elongated part extending from neck to tail. It is triangular in cross-section. And it has 3 surfaces and 3 borders and one process(Tuber omentale). Anterior border – Attachment of transverse colonInferior border – Superior mesenteric vesselsSuperior border – Coeliac artery and its branches.
Tuber omentale
Coeliac artery
Attachment of transverse colonSuperior mesenteric vessels
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Body
7
Relations of Body of pancreas
Body
Duodeno-jejunal flexure
Left gonadalvein
Left colicflexure
Left kidney
Left suprarenal glandSplenic artery
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Relations of Body of pancreas
Coeliac artery
Portal vein
Superior mesenteric veinSuperior mesenteric artery
Splenic vein
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Visceral relations of pancreas
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Tail of pancreasIt is the narrow left
extremity of pancreas.It is present in the
lienorenal ligamentIt has umpteen
number of islets of pancreas.
Relations:It is related to the visceral surface of spleen and is present between gastric and colic impressions.
Lienorenal ligament
Tail
Spleen
Left colic flexure
During splenectomy the tail of pancreas is likely to be injured pancreatic enzymes will leakand destroy surrounding tissues Chemical peritonitis or pancreatic fistula 15-05-2014
11
Ducts of pancreasUsually there are 2I) Main pancreatic ductII) Accessory pancreatic
ductMain pancreatic duct: It runs in the whole
length of the gland. Increases in size as it
gathers more and more tributaries and form “herringbone pattern”
It forms hepato-pancreatic ampulla after joining with CBD and opens into the major duodenal papilla.
Herringbone pattern
Main pancreatic ductMajor duodenalpapillae
Accessory pancreatic duct
Minor duodenal papillae
Accessory pancreatic duct: It begins at the lower part of head and travels upwards crossing main duct and opens at the II part of duodenum at minor duodenal papilla.
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Development of pancreas
Ventral pancreaticbud
Bile duct(Hepaticoutgrowth)
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Arterial supplySplenic artery
Arteria pancreatica magna
Inferior pancreatico-duodenalartery
superior pancreatico-duodenalartery
As pancreas develops at the junction betweenforegut and midgut, it is supplied by the branches of artery of foregut (Coeliactrunk) and artery of midgut(superior mesentericartery )
ArteriaCaudapancreatica
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Venous drainagePortal vein
Superior mesentericvein
Splenic vein
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Nerve supply
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Nerve supply
Coeliac ganglia andplexus
Superior mesentericganglia and plexus
Greater,lesser and leastsplanchnic nerves
Sympathetic
and
parasympathetic
innervation reach
via coeliac and
Superior
mesenteric
plexuses.
Sympathetic:
Vasomotor
Parasympathetic:
Secretomotor
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Intrinsic nerve supply of pancreas
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Lymphatic drainage
Pancreatico-splenicNodes (Main group)
Coeliac nodes
Superior mesenteric nodes
Pyloric nodes
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Clinical Anatomy
Pancreatitis: Inflammation of pancreas. Symptoms: Loss of appetite, nausea, typical pancreatic backache, feverStools : Bulky and fat filledRecurrent pancreatitis predisposes stasis of pancreatic juice leading To calculus formation.
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Typical backpain in pancreatitis
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Pancreatic pseudocystLesser sac is
related anteriorly to the body of pancreas. Therefore inflammatory fluid collects in the omental bursa in pancreatitis.
Such a swelling gives a false impression of a cyst from pancreas, hence the name pancreatic pseudocyst.
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Carcinoma of head of pancreas
It produces symptoms related to compression of the surrounding structures.
CBD – Obstructive jaundice
II part of duodenum – intestinal obstruction
Portal vein – Portal hypertension and ascites
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THANK YOU
15-05-2014