Anatomy and embryology of the pancreas

Question 1

Exocrine pancreas

Answer 1

Amylase, trypsin, chymotrypsin, lipase, nuclease

Question 2

Endocrine pancreas

Answer 2

Insulin, glucagon, somatostatin

Question 3

embryology of pancreas

Answer 3

Pancreas is formed by two buds from endoderm - dorsal and ventral pancreatic bud

As the gut develops, dorsal moves to right and ventral moves dorsally

Ventral fuses with lower part of dorsal bud and lies posterior-inferior to it

Ventral forms ucinate process of pancreas

Dorsal forms rest of pancreas

Pancreatic duct formed by distal part of dorsal duct and entire ventral duct

Question 4

ERCP

Answer 4

endoscope with angled lens to see ampulla and gallstones, knife can perform sphincterotomy to cut sphincter and allow gallstone to fall out

Question 5

sx Meckel’s diverticulum

Answer 5

Appendicitis pain but appendix normal

Question 6

Foregut

Answer 6

from mouth to point where hepatopancreatic ampulla enters duodenum

Question 7

Midgut

Answer 7

point where hepatopancreatic ampulla enters duodenum to junction between proximal 2/3 and distal 1/3 of transverse colon

Question 8

Hindgut

Answer 8

junction between proximal 2/3 and distal 1/3 of transverse colon to anus

Question 9

blood result pancreatitis

Answer 9

Serum amylase high

Question 10

Pancreas blood supply

Answer 10

• Gastroduodenal artery of common hepatic artery → anterior and posterior pancreaticduodenal
• Splenic artery - dorsal and greater pancreatic arteries
• Superior mesenteric vessels - anterior and posterior inferior pancreaticoduodenal vessels

Question 11

Pancreas venous drainage

Answer 11

• Follows arterial veins to drain into splenic, superior mesenteric and hepatic portal veins
• Blood vessels for pancreas and duodenum are same - implications in pancreatic cancer surgery (Whipple’s procedure)

Question 12

Pancreas lymph drainage

Answer 12

• Follows blood vessels and flows to pancreaticosplenic LNs and pyloric LNs
• Then into superior mesenteric LNs and coeliac and hepatic LNs

Question 13

Pancreas nerve supply

Answer 13

• Vagus and abdominopelvic splanchnic nerves
• PS and S pass along arteries from coeliac and superior mesenteric plexus
• PS (secretomotor) and S (vasoconstrictor) fibres supply pancreatic acinar and islets cells
• Pancreatic secretion (exocrine) mediated by secretin and CCK of duodenum

Question 14

Centroacinar cells

Answer 14

Exocrine functions 0 secrete digestive enzymes

Question 15

D cells

Answer 15

Somatostatin

Question 16

Annular pancreas

Answer 16

Improper rotation and migration of parts of the tissues of ventral pancreatic bud with the rotation of the duodenum - may obstruct duodenum and cause obstruction