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WHY PANCREAS IS SELECTED?Pancreatic cancer is a silent killer- one of the
most difficult tumors to detect and diagnose early.
Its cancer has the lowest survival rate .In most cases, symptoms develop after
metastases. Many organizations across the globe have now
taken initiative to bring awareness in the public regarding the effects of this cancer
Common region – in head of pancreas
CONTENTS:- Introduction Development in detail Location………………………………….…… Relations……………………………………… -Peritoneal -Visceral Morphological Part………………………. -Head -Neck - Body -Tail Secretory Parts………………………………. -Exocrine -Endocrine Pancreatic Duct…………………………….. Applied Aspects………………………………………
:~ PANCREAS ~• PAN – ALL• CREAS ~ FLESH
:~ PANCREAS WAS FIRST DISCOVERED BY
HEROPHILUS
:~ ALSO DISCOVERED LIVER , EYE & MEASURED PULSE . :~ FIRST TO PERFORM PUBLIC DISSECTIONS ON HUMAN CORPSES .
Steve JobsCEO Apple Inc. died with Pancreatic Tumour
Introduction
“Mixed gland”, or compound gland- functions as both -Endocrine gland -Exocrine gland
Yellowish Organ,jshaped or retort shaped
-12 to 15cms long -3 to 4 cms wide Weight : 60-100g (Avg wt: 80g)
M > F
-Ventral bud & Dorsal bud.
~ It arises at the junction of foregut & midgut .
-They develop in relation to the second part of duodneum.
- Ventral bud is in relation to the hepatic bud at the inferior angle.
- Dorsal bud grows into the dorsal mesogastrium.
:~ After rotation of the gut , the ventral bud come s to the right and dorsal bud to the left .
Note------------
:~due to the Differential growth of the developing gut ~ buds come to lie on the same side .
PARTS OF PANCREAS
DUCT SYSTEM OF PANCREAS
1. Annular Pancreas 2. Pancreatic Divisum
3. Anamolies Of The Duct
4. Ectopic Pancreas
1. ANNULAR PANCREAS :
~ A rare condition
--- second part of duodenum is surrounded by a ring of pancreatic tissue continuous with it’s head .
~This portion of pancreas can constrict the duodenum and impairs the flow of food
A) CAUSES:
:~ Bifid ventral bud ~ fusion with dorsal bud ~ pancreatic ring .
:~ Improper rotation of ventral pancreatic bud
O r dorsal bud rotates in the wrong direction
:~ Postnatal diagnostic procedures include
abdominal X-ray ,
ultrasound &
CT scan .
A RARE CASE OF Ampullary carcinoma associated with annular pancreas IS BEING SHOWN
NORMAL POSITION OF PANCREAS
ANNULAR PANCREAS
2. PANCREATIC DIVISUM :
:~ Most common congenital anomaly.
:~ Ventral and Dorsal buds fail to fuse.
:~ The body , tail and part of head of pancreas
drain into the duct of SANTORINI into minor
duodenal papilla .
:~ The rest of the head with uncinate process
drains through the duct of WIRSUNG into the
major dudodenal papilla.
m.r.i. scan showing pancreatic divisum
A) Normal (50%).
B) Absence of communication between normally sited accessory duct and main ducts (10%).
C) Persistance of complete ventral and dorsal ducts with separate drainage (5%).
B and C are both forms of ‘pancreas divisum'.
D)Absence of accessory duct (20%).
E) Conjoined drainage of persistant ventral and dorsal ducts (<5%).
3. ECTOPIC PANCREAS
~ECTOPIC means------ away from normal-
EVIDENCE TO PROOVE It includes all histological elements of both exocrine and endocrine pancreas.
~The ducts of the exocrine pancreas are not arranged in the normal anatomical pattern.
A) CAUSE :
UNKNOWN
:~ Maybe due to hypoplasia of the ventral pancreas which causes rudimentary ventral pancreatic duct.
:~ The pancreatic tissue maybe functionally active and secreting leading to
ulceration of the mucosa ,
Pancreatitis with psuedocyst formation ,
malignant or benign pancreatic tumour .
:~ it can be present
Outside the Gastrointestinal tract in the wall of GALL BLADDER , LIVER ,
hilum of SPleen
Ectopic pancreas in the galbladder
:~
Ectopic pancreatic tissue
can be discovered in stomach , proximal part of jejenum , ileum , duodenum & meckel’s diverticulum .
ECTOPIC PANCREAS SEEN ALONG THE THE GREATER CURVATURE OF THE STOMACH
M.R.I. SCAN
GASTRIC ECTOPIC PANCREAS
C) ECTOPIC PANCREAS IN ILEUM :
PANCREATIC TISSUE
PANCREATIC TISSUE
:~
GROSS ANATOMY
LocationTransversely Across - Posterior abdominal wall
Behind Stomach
From Duodenum to Spleen
Level of L1 & L2
Occupies Epigastric and Hypochondriac regions
Located transversely across the posterior abdominal wall
Location
Location
Behind the Stomach from duodenum toSpleen
Location
Level of L1&L2
Epigastric & hypochondriac regions
RelationsPeritonealRetroperitoneal except for a small part of its tail.
Peritoneal relations
P
P
Visceral relations
Morphological Parts
Head
Neck
Body
Tail
Morphological Parts
HEAD
Thickest & broadestLies in C- shaped curve –
duodenum3 borders – superior,
inferior, rt lateral 2 surfaces – anterior &
posteriorUncinate process
Morphological parts
Neck
Constricted part2 surfaces - anterior and
posterior
Relations Anterior – peritoneum pylorus Posterior – sup mesentric vein portal vein
Portal vein
Sup mesentric vein
Morphological Parts
Body
Elongated part3 borders – anterior,
superior, inferiorPart of superior margin
projects upwards – ‘Tuber omentale’
3 surfaces – Anterior, posterior, inferior
Tail•Narrowest•Between layers of splenorenal ligament Relations•Posteriorly – Splenic artery & vein•At the tip – Splenic hilum
Main Pancreatic Duct
Also called ‘Duct of Wirsung’ and Major Pancreatic Duct Begins in the tail
Runs the length receiving channels – ‘Herring bone pattern’ Pancreatic duct with common bile duct form -----------------
‘Hepatopancreatic Ampulla of Vater’
Herring Bone
Main Pancreatic Duct
Main Pancreatic DuctOpens in 2nd part of duodenum along with bile duct on the
major duodenal papilla
25% - duct opens into duodenum separately
‘Hepatopancreatic sphincter ( of Oddi)’ around the ampulla – smooth muscle controls flow of secretions
Hepatopancreatic ampulla
Accessory Pancreatic Duct
‘Duct of Santorini’
Opens into the duodenum at the summit of the minor duodenal papilla
(60%), the accessory duct communicates with the main pancreatic duct
Note - Some cases, the main pancreatic duct is smaller than the accessory pancreatic duct and the two are not connected
Accessory Pancreatic Duct
DISSECTION
BLOOD SUPPLY OF PANCREAS:
Blood SUPPLY:Celiac Trunk- artery of the foregut.
Superior Mesenteric artery- artery of the midgut.
Arterial supply
is derived from branches of the gastroduodenal artery and inferior
mesenteric artery.These are superior pancreaticoduodenal
artery and inferior pancreaticoduodenal artery respectively.
The gland is mainly supplied by pacreatic branches of the splenic artery.
BLOOD SUPPLY TO PANCREAS
ARTERIAL SUPPLY OF PANCREAS
ARTERIAL SUPPLY OF PANCREAS:
VENOUS DRAINAGE: Drained by the pancreaticoduodenal veins
which end up in the portal vein .
The portal vein is formed by the union of the superior mesenteric vein and splenic vein posterior to the neck of the pancreas.
VENOUS DRAINAGE:VENOUS DRAINAGE: The inferior mesenteric vein joins with the
splenic vein behind the pancreas .
It may also join the superior mesentric vein.
VENOUS DRAINAGE:
NERVE SUPPLY TO PANCREAS
NERVE SUPPLY TO NERVE SUPPLY TO PANCREAS:
NERVE SUPPLY:
Sympathetic nerves are vasomotor .
Parasympathetic nerves controls the pancreatic secretion .
NERVE SUPPLY TO PANCREAS
LYMPHATIC DRAINAGE
A network of lymphatic vessels exists within the pancreas.
The majority of vesselslie in the interlobular septa of connective tissue( that subdivide the pancreas into lobes and
lobules.)
LYMPHATIC DRAINAGE
LYMPHATIC DRAINAGELymphatics follows the arteries Drain into
pancreaticosplenic ,
coeliac
superior mesentric groups of lymph nodes .
LYMPHATIC DRAINAGE
Histology of pancreas:
EXOCRINE HISTOLOGY
H&E StainH&E Stain
Exocrine Pancreas
PANCREATIC ACINIPANCREATIC ACINI
H & E Stain
DUCT SYSTEM OF PANCREASDUCT SYSTEM OF PANCREAS
Duct SystemDuct SystemIntralobular Ducts:Also called as Intercalated Duct.Lined by Squamous or very Low Cuboidal Epithelium.Begins within the Acinus therefore surrounded by Acinar cells.Cells of Intercalated ducts secrete Bicarbonate ions. The Acinar lumen shows pale staining cells of Intercalated Duct called
Centroacinar Cells.
Interlobular Ducts:
Lined by Simple Columnar Epithelium.
These ducts are present in the septa.
Main Duct:
Lined by Tall Columnar Cells with Goblet cells in between.
H & E stain
Endocrine Histology
Islets of Langerhan-Different Cell Islets of Langerhan-Different Cell typestypes
ENDOCRINE HISTOLOGY
Cells Types of islets
THANKS TO MANAGEMENT OF SHADAN MEDICAL COLLEGE.
THANKS TO THE DEPARTMENT OF SURGERYSECIALLY TO CHANDRAMALA MADAM,
RAMESH SIR.THANKS TO THE DEPATMENT OF ANATOMY.THANKS TO THE STUDENTS OF FIRST YEAR
STUDENTS FOR HELPING ME IN THE PREPARATION OF SEMINAR
ACKNOWLEDGEMENTS