Pancreas (Dave's notes)

Question 1

What is the role of the pancreas?

Answer 1

The pancreas is a composite gland of exocrine function to the duodenum and endocrine (islets of langerhans) function

Question 2

What is the size and shape of the pancreas

Answer 2

• approximately 15 cm firm and finely lobulated
• oblong shaped organ
• at the transpyloric plane L1
• retroperitoneal organ (except tail)

Question 3

What are the parts of the pancreas?

Answer 3

Head, neck, body, tail & uncinate process

Question 4

Describe the head of and relations of the head of the pancreas

Answer 4

• The head is the broadest part of the pancreas, moulded into a c-shaped duodenal concavity.
• Lies on the IVC and R and L renal veins (L2).
• The uncinate process is prolonged and wedge shaped, an lies behind the SMA and SMV

Question 5

What is attached to the anterior surface of the pancreas?

Answer 5

• The tansverse colon. The pancreas lies immediately behind the periotoneum in the posterior abdominal wall.

Stomach and pylorus lie anterior (seperated by the lesser sac)

Question 6

Describe the neck of and relations of the neck of the pancreas

Answer 6

• between head and body of pancreas
• superior mesenteric vessels grooves in the posterior aspect

Question 7

What are the relations of the body of the pancreas?

Answer 7

The body passes from the neck of the pancreas to the left, sloping up across the left renal vein, aorta (coeliac trunk origin), L) crus, L) psoas, and lower pole of the left suprarenal cland, and the hilum of the left kidney. The coeliac trunk and then splenic artery passes along the upper border (??). The SMA originates at the lower border. The splenic vein lies closely apposed to the posterior surface

Question 8

What are the relations of the tail of the pancreas?

Answer 8

The tail of the pancreas passes from the anterior surface of the left kidney, through the two layers of the lienorenal ligament to the hilum of the spleen

Question 9

What is the course of the pancreatic duct?

Answer 9

The pancreatic duct passes from tail to head to enter D2, 2cm downstream from the accessory duct draining the uncinate process

Question 10

What is the blood supply of the pancreas?

Answer 10

The blood supply of the pancreas is primarily from the splenic artery. The superior and inferior pancreaticoduodenal arteries supply the head.

Question 11

What is the venous drainage of the pancreas?

Answer 11

The venous drainage of the pancreas is by the splenic vein and the superior pancreaticoduodenal vein, into the portal vein, and the inferior pancreaticoduodenal vain, into the SMV.

Question 12

What is the lymphatic drainage of the pancreas?

Answer 12

The lymphatic drainage of the pancreas mirrors the arterial supply

Question 13

What is the nerve supply of the pancreas?

Answer 13

Parasympathetic and sympathetic

Question 14

Describe the parasympathetic supply of the pancreas

Answer 14

The parasympathetic supply of the pancreas stimulates. It is supplied by a posterior vagal trunk from the coeliac plexus.

Question 15

Describe the sympathetic supply of the pancreas

Answer 15

The sympathetic supply of the pancreas has a vasoconstrictor effect. From T6-10, travelling via splanchnic nerves which also carry fibres for pain.

Question 16

What is the main driver for pancreatic function?

Answer 16

Hormonal

Question 17

The pancreas is a ……… gland of ……. ……… with ……… function. Its cells are similar to those of the ……….. glands.

Answer 17

The pancreas is a lobulated gland of serous acini with exocrine function. Its cells are similar to those of the salivery glands.

Question 18

What hormones affect the pancreas and how?

Answer 18

The pancreas responds to secretin and CCK, by secreting trypsin, lipase et al

Question 19

Describe the development of the pancreas

Answer 19

The pancreas develops as two separate buds as outgrowths. The ventral (from the ventral mesogastrium) is common with the outgrowth of the bile duct and becomes the main pancreatic duct. The dorwal (dorsal mesogastrium) grows indepently and becomes accessory. The duodenum rotates and the two ducts are brought together

Question 20

What manouvre is used to mobilise the pancreatic head?

Answer 20

Kocher’s manouvre

Question 21

How may pseudocysts be drained?

Answer 21

Intragastrically