Pancreas Anomalies

Question 1

Where does the splenic vein join the SMV to form the portal vein?

Answer 1

The neck of the pancreas

Question 2

What is the cause of annular pancreas?

Answer 2

Malrotation of the ventral bud in the fifth week

Question 3

What is the vascular supply of the pancreas?

Answer 3

HEAD & NECK

• arterial -> superior & inferior pancreaticoduodenal arteries
• venous -> pancreatic vein -> SMV -> portal vein

BODY & TAIL

• arterial -> splenic artery branches
• venous -> pancreatic vein -> portal vein

Question 4

What is the lymphatic drainage of the pancreas?

Answer 4

Para aortic lymph nodes

Question 5

What is the innervation of the pancreas?

Answer 5

Celiac ganglia

• sympathetic -> T6-T12
• parasympathetic -> vagus nerve

Question 6

What is the cause of cystic fibrosis?

Answer 6

Defective chloride channel that impairs pancreatic water & electrolyte secretion (mutation in CFTR gene on chromosome 7)

• obstruction of ducts
• maldigestion & malabsorption

Question 7

What is cystic fibrosis?

Answer 7

Autosomal recessive condition
Multi system disorder of exocrine glands -> lungs, intestines, pancreas, & liver

• elevated sodium & chloride conc. in sweat

Question 8

How does a patient with cystic fibrosis present?

Answer 8

• child is salty when kissed
• sticky meconium -> meconium ileus
• organ damage -> blockage of narrow passages by thickened secretions
• chronic pulmonary disease -> plugging of bronchi & bronchioles
• later -> Cor pulmonale

Question 9

What is the effect of cystic fibrosis on the pancreas?

Answer 9

1- secretions precipitate in the lumen of the pancreatic duct -> blockage -> duct ectasia & fatty replacement of exocrine acinar tissue
2- pancreatic exocrine insufficiency leads to fat malabsorption -> STEATORRHOEA
- leads to diabetes mellitus

Question 10

What are the general effects of cystic fibrosis?

Answer 10

• diabetes mellitus
• liver cirrhosis due to bile plugging -> portal hypertension
• infertility -> absence of vas deferens or thick cervical mucus
• poor growth
• poor appetite
• abdominal distention
• chronic respiratory disease
• finger clubbing

Question 11

How is cystic fibrosis diagnosed?

Answer 11

• genetic testing OR mother has polyhydraminos

- sweat test -> sodium & chloride level above 90mmol/L

Question 12

How is cystic fibrosis managed?

Answer 12

control of secondary consequences

• pulmonary function -> aggressive physiotherapy & antibiotics
• malabsorption -> oral pancreatic enzyme preparation
• end stage lung disease -> lung transplant

Question 13

What are the congenital abnormalities of the pancreas?

Answer 13

• cystic fibrosis
• pancreas divisum
• annular pancreas
• ectopic pancreas
• congenital cystic disease of the pancreas

Question 14

what embryological disorder occurs when the ventral & dorsal parts of the pancreas fail to fuse?

Answer 14

Pancreas Divisum

• the dorsal pancreatic duct becomes the main one & drains most of the pancreas through
• usually asymptomatic -> doesn’t require intervention

Question 15

What are the symptoms of pancreas divisum?

Answer 15

• recurrent acute pancreatitis
• chronic pancreatitis
• pancreatic pain

due to smaller capacity of minor papilla & probably papillary stenosis -> incomplete drainage -> obstructive pain or pancreatitis

in patients with idiopathic recurrent pancreatitis, pancreas divisum should be excluded

Question 16

How is pancreas divisum diagnosed?

Answer 16

MRCP
ERCP
EUS
injection of secretin

will show obstructive changes or chronic inflammation in the dorsal ductal system

Question 17

How is pancreas divisum treated?

Answer 17

• endoscopic sphincterectomy & stenting of the minor papilla -> relieve symptoms

Surgical

• sphincteroplasty
• pancreatojejunostomy
• resection of pancreatic head

Question 18

failure of complete rotation of the ventral pancreatic bud will lead to?

Answer 18

annular pancreas

• ring of pancreatic tissue surrounding 2nd or 3rd part of duodenum
• more prevalent in Down syndrome (due congenital duodenal stenosis or atresia)

Question 19

How does a patient with annular pancreas persent?

Answer 19

• duodenal obstruction -> vomiting
• intolerance to food
• abdominal distention

in neonates

Question 20

How is annular pancreas treated?

Answer 20

• infancy -> bypass (duodenoduodenostomy)

- later life -> resection of the head of pancreas

Question 21

Von Hippel-Lindau syndrome is associated with which pancreatic disease?

Answer 21

congenital cystic disease of the pancreas