Endo: Pancreas Flashcards
Weight of pancreas in adult
75-100 grams
Retroperitoneal. Oblique position, sloping upward. Duodenum C-loop to Splenic hilum.
Pancreas
Size of the pancreas in adult
15-20cm long
Pancreas is situated _______ in the abdomen. Sealed in the ________. Poorly localized, ill defined symptoms.
Deeply. Retroperitoneum.
Four regions of the pancreas
Head, Neck, Body & Tail.
Head of the pancreas in nestled in the ______ of the ______. Posterior to the _________.
C-loop. Duodenum. Transverse mesocolon.
Lies behind the head of the pancreas
Both renal veins, Vena cava & Right renal artery “BVR”
Neck of the pancreas lies directly over the ________. Overlies the ___________. At the inferior border, the _____ joins the ______ as the portal vein.
Portal vein. Vertebral body of L1 & L2. SMV & Splenic vein.
The body and tail of the pancreas lie just anterior to the ___________. The _____ runs in the groove on the back, fed by multiple fragile venous branches from the ___________.
Splenic artery and vein. Vein. Pancreatic parenchyma.
Wrap around the right side of the portal vein.
Uncinate process
The uncinate process, end posteriorly near the space between ____ & _____. Venous draining the pancreatic head and uncinate process enter along the right _____ & ______ sides of the portal vein. There are no _________.
SMV & SMA. Lateral & Posterior. Anterior venous tributaries.
Embryology: from the ventral bud connects the bile duct.
Duct of Wirsung
Embryology: from the larger dorsal bud connects to the duodenum
Duct of Santorini
Embryology: with gut rotation, two ducts fuse. Majority drains through the duct of ______ to the major papilla.
Wirsung
Embryology: duct of Santorini persist as a ___________. Or drain through the __________.
Blind accessory duct. Lesser papilla.
Embryology: In a minority, duct remain separated, and the majority of the pancreas drains through the duct of Santorini, a condition referred to as
Pancreas Divisum
Passes behind the neck of pancreas, it gives off the _________. Divides into the ______________ arteries.
SMA. Inferior pancreaticoduodenal artery. Anterior & Posterior inferior pancreaticoduodenal arteries.
_________ in the head and body of the pancreas provide a rich blood supply. The head of the pancreas.
Multiple arcades
From the splenic artery
Dorsal pancreatic artery, Great pancreatic artery & Caudal pancreatic artery “DGC”
Venous drainage of the pancreas, follows the pattern of the arterial supply. ______ usually superficial to the arteries. _______ on the transverse colon can tear fragile branches along the __________ of the pancreas which the retract into the parenchyma of pancreas.
Veins. Anterior traction. Inferior border
Venous branches draining the pancreatic head and uncinate process enter along the right lateral and posterior sides of the
Portal vein
No anterior _________, and a plane can usually be developed between the _________, _______ & ________.
Venous tributaries. Neck of pancreas, Portal vein & SMV
Antero/posterosuperior pancreaticoduodenal vein drains into the
Portal vein
Antero/posteroinferior pancreaticoduodenal vein drains into the
SMV
Venous drainage of the pancreas
Spleenic vein, Inferior mesenteric vein & SMV “SIS”
The SMV joins the splenic vein and continues towards the the porta hepatis as the
Portal vein
The ____ often joins the _______ near its junction with the portal vein, but sometimes joins the SMV; or the three veins merge as a trifurcation to form the portal vein,
IMV & splenic vein
The lymphatic drainage of the pancreas is ______ & _______. High incidence of lymph node metastases and local recurrence of _______.
Diffuse and widespread. Pancreatic cancer
Lymphatics communicate with lymph nodes in the _______ and mesentery of proximal _______.
Transverse mesocolon. Jejunum
________ in the body & tail of the pancreas are often unresectable due to metastasis to these lymph nodes.
Tumors
Innervation of pancreas: rich supply in sensory fibers that travel superiorly to the ________. Interruption of these somatic fibers with a __________ can interfere with transmission of pancreatic pain.
Celiac ganglia. Celiac plexus block.
In ultrasound, pancreas is anterior to the two vessels identified
Portal vein & Spleenic vein
A retroperitoneal structure, note the different organs surrounding it.
CT scan
Cluster of pale staining polyhedral cells. >tail. Fenestrated capillaries automimic innervation.
Islets of Langerhans
Cells found in the pancreas
Alpha, Beta & Delta
10-15% found in the periphery
Alpha & Delta cells
70% found in the center
Beta cells
Beta cells secrete
Insulin
Alpha cells secrete
CCK, Glucagon, ACTH & GIP “CGAG”
Delta cells secrete
Somatostatin & Gastrin”SG”
Control of Endocrine pancreas: parasympathetic increases secretion of
Insulin & Glucagon
Control of endocrine pancreas: sympathetic increases
Glucagon but inhibits Insulin
Exocrine secretion: hormonal in nature
Secretin & CCK
Exocrine secretion: Neuronal. ________ regulation pancreatic blood flow. Parasympathetic _______ & ________.
Sympathetic. Acinar & Centroacinar cells
Exocrine secretion: _____ & _____. Ductal & centroacinar cells. Vagal cholinergic hormonal secretin.
HCO3 @ H20
Exocrine secretion: enzymes acinar cells. Vagal cholinergic hormonal ____.
CCK
Pyramindal, purplish red with basal basophilia, round basal nucleus. Cells outline not clear, lumen distinct, zymogenic granules and myoepithelial cells are prominent.
Serous
Columnar, lightly eosinophilic, flattened peripheral nucleu. Clear, distinct, Mucinogen vesicles and not prominent
Mucous
Apical plasma membrane smooth, intercellular canaliculi rare. Dense large closely packed & Ill defined. >AGAGS
Mucous
Apical microvilli, laterally intercellular canaliculi, junctional complexes, infoldings. Golgi complex, RER. Small discrete granules secretion <AGAGS
Serous
