14.Pancreas

• Pancreas


  Exocrine & Endocrine gland
• Pancreatic Acinar


  • Exocrine
• Islet of Langerhans


  • Endocrine
• Pancreas


  Elongated accessory digestive gland; lies retroperitoneally and transversely across the posterior abdominal wall
• Normal weight of pancreas - 60 to 100gm
• Relations of pancreas


  1. ANT - from R to L: transverse mesocolon, lesser sac and stomach

  2. POST - from R to L: bile duct, portal and splenic veins, IVC, aorta, SMA, left psoas, left suprarenal, left kidney, spleen
• Head


  • Expanded part
  • Embraced by the C shaped curve of the Duodenum
• Neck


  • Short
  • Overlies the Superior mesenteric vessels
• Body


  • To the left of SMA and SMV
• Tail


  • Closely related to the hilum of spleen and left colic flexure
• Uncinate process


  • Projection from the inferior part of head
  • Extends medially to the left post. to SMA
• Parts of Pancreas


  • Head
  • Neck
  • Body
  • Tail
  • Uncinate process
• Ventral pancreatic bud


  Forms most of the head of the pancreas, including the uncinate process
• Dorsal pancreatic bud


  Forms the remainder of the pancreas - head, body and tail
• Main pancreatic duct


  • Extends through the entire length of pancreas
  • Joins bile duct to form the hepatopancreatic ampulla
  • Empties into duodenum
• Accessory pancreatic duct


  • Lies in head of pancreas
  • Drains into the main duct
• Superior pancreaticoduodenal artery


  From Gastroduodenal (Hepatic - Celiac)
• Inferior pancreaticoduodenal artery


  From SMA
• Pancreatic arteries


  From Splenic
• Pancreatic cancer


  • Cancer involving the pancreatic head accounts for most cases of extrahepatic obstruction of the biliary system
• Pancreatic cancer


  1. Compresses and obstructs the Bile duct

  2. Causes Obstructive jaundice resulting in the retention of bile pigments

  3. Causes enlargement of GB and jaundice
• Pancreatic cancer


  • Cancer of neck and body may cause Portal or IVC obstruction
• Pancreatic veins


  • Tributaries of the Splenic and Superior mesenteric veins
  • Most of them empty into the Splenic vein
• Whipple-Pancreaticoduodenectomy


  Surgical resection done in cases of Pancreatic cancer
• Whipple-Pancreaticoduodenectomy


  • Structures removed: Head of pancreas, Duodenum, CBD, GB, distal part of Stomach