Cme pancreas2

WHY PANCREAS IS SELECTED?Pancreatic cancer is a silent killer- one of the

most difficult tumors to detect and diagnose early.

Its cancer has the lowest survival rate .In most cases, symptoms develop after

metastases. Many organizations across the globe have now

taken initiative to bring awareness in the public regarding the effects of this cancer

Common region – in head of pancreas

CONTENTS:- Introduction Development in detail Location………………………………….…… Relations……………………………………… -Peritoneal -Visceral Morphological Part………………………. -Head -Neck - Body -Tail Secretory Parts………………………………. -Exocrine -Endocrine Pancreatic Duct…………………………….. Applied Aspects………………………………………

:~ PANCREAS ~• PAN – ALL• CREAS ~ FLESH

:~ PANCREAS WAS FIRST DISCOVERED BY

HEROPHILUS

:~ ALSO DISCOVERED LIVER , EYE & MEASURED PULSE . :~ FIRST TO PERFORM PUBLIC DISSECTIONS ON HUMAN CORPSES .

Steve JobsCEO Apple Inc. died with Pancreatic Tumour

Introduction

“Mixed gland”, or compound gland- functions as both -Endocrine gland -Exocrine gland

Yellowish Organ,jshaped or retort shaped

-12 to 15cms long -3 to 4 cms wide Weight : 60-100g (Avg wt: 80g)

M > F

-Ventral bud & Dorsal bud.

~ It arises at the junction of foregut & midgut .

-They develop in relation to the second part of duodneum.

- Ventral bud is in relation to the hepatic bud at the inferior angle.

- Dorsal bud grows into the dorsal mesogastrium.

:~ After rotation of the gut , the ventral bud come s to the right and dorsal bud to the left .

Note------------

:~due to the Differential growth of the developing gut ~ buds come to lie on the same side .

PARTS OF PANCREAS

DUCT SYSTEM OF PANCREAS

1. Annular Pancreas 2. Pancreatic Divisum

3. Anamolies Of The Duct

4. Ectopic Pancreas

1. ANNULAR PANCREAS :

~ A rare condition

--- second part of duodenum is surrounded by a ring of pancreatic tissue continuous with it’s head .

~This portion of pancreas can constrict the duodenum and impairs the flow of food

A) CAUSES:

:~ Bifid ventral bud ~ fusion with dorsal bud ~ pancreatic ring .

:~ Improper rotation of ventral pancreatic bud

O r dorsal bud rotates in the wrong direction

:~ Postnatal diagnostic procedures include

abdominal X-ray ,

ultrasound &

CT scan .

A RARE CASE OF Ampullary carcinoma associated with annular pancreas IS BEING SHOWN

NORMAL POSITION OF PANCREAS

ANNULAR PANCREAS

2. PANCREATIC DIVISUM :

:~ Most common congenital anomaly.

:~ Ventral and Dorsal buds fail to fuse.

:~ The body , tail and part of head of pancreas

drain into the duct of SANTORINI into minor

duodenal papilla .

:~ The rest of the head with uncinate process

drains through the duct of WIRSUNG into the

major dudodenal papilla.

m.r.i. scan showing pancreatic divisum

A) Normal (50%).

B) Absence of communication between normally sited accessory duct and main ducts (10%).

C) Persistance of complete ventral and dorsal ducts with separate drainage (5%).

B and C are both forms of ‘pancreas divisum'.

D)Absence of accessory duct (20%).

E) Conjoined drainage of persistant ventral and dorsal ducts (<5%).

3. ECTOPIC PANCREAS

~ECTOPIC means------ away from normal-

EVIDENCE TO PROOVE It includes all histological elements of both exocrine and endocrine pancreas.

~The ducts of the exocrine pancreas are not arranged in the normal anatomical pattern.

A) CAUSE :

UNKNOWN

:~ Maybe due to hypoplasia of the ventral pancreas which causes rudimentary ventral pancreatic duct.

:~ The pancreatic tissue maybe functionally active and secreting leading to

ulceration of the mucosa ,

Pancreatitis with psuedocyst formation ,

malignant or benign pancreatic tumour .

:~ it can be present

Outside the Gastrointestinal tract in the wall of GALL BLADDER , LIVER ,

hilum of SPleen

Ectopic pancreas in the galbladder

:~

Ectopic pancreatic tissue

can be discovered in stomach , proximal part of jejenum , ileum , duodenum & meckel’s diverticulum .

ECTOPIC PANCREAS SEEN ALONG THE THE GREATER CURVATURE OF THE STOMACH

M.R.I. SCAN

GASTRIC ECTOPIC PANCREAS

C) ECTOPIC PANCREAS IN ILEUM :

PANCREATIC TISSUE

PANCREATIC TISSUE

:~

GROSS ANATOMY

LocationTransversely Across - Posterior abdominal wall

Behind Stomach

From Duodenum to Spleen

Level of L1 & L2

Occupies Epigastric and Hypochondriac regions

Located transversely across the posterior abdominal wall

Location

Location

Behind the Stomach from duodenum toSpleen

Location

Level of L1&L2

Epigastric & hypochondriac regions

RelationsPeritonealRetroperitoneal except for a small part of its tail.

Peritoneal relations

P

P

Visceral relations

Morphological Parts

Head

Neck

Body

Tail

Morphological Parts

HEAD

Thickest & broadestLies in C- shaped curve –

duodenum3 borders – superior,

inferior, rt lateral 2 surfaces – anterior &

posteriorUncinate process

Morphological parts

Neck

Constricted part2 surfaces - anterior and

posterior

Relations Anterior – peritoneum pylorus Posterior – sup mesentric vein portal vein

Portal vein

Sup mesentric vein

Morphological Parts

Body

Elongated part3 borders – anterior,

superior, inferiorPart of superior margin

projects upwards – ‘Tuber omentale’

3 surfaces – Anterior, posterior, inferior

Tail•Narrowest•Between layers of splenorenal ligament Relations•Posteriorly – Splenic artery & vein•At the tip – Splenic hilum

Main Pancreatic Duct

Also called ‘Duct of Wirsung’ and Major Pancreatic Duct Begins in the tail

Runs the length receiving channels – ‘Herring bone pattern’ Pancreatic duct with common bile duct form -----------------

‘Hepatopancreatic Ampulla of Vater’

Herring Bone

Main Pancreatic Duct

Main Pancreatic DuctOpens in 2nd part of duodenum along with bile duct on the

major duodenal papilla

25% - duct opens into duodenum separately

‘Hepatopancreatic sphincter ( of Oddi)’ around the ampulla – smooth muscle controls flow of secretions

Hepatopancreatic ampulla

Accessory Pancreatic Duct

‘Duct of Santorini’

Opens into the duodenum at the summit of the minor duodenal papilla

(60%), the accessory duct communicates with the main pancreatic duct

Note - Some cases, the main pancreatic duct is smaller than the accessory pancreatic duct and the two are not connected

Accessory Pancreatic Duct

DISSECTION

BLOOD SUPPLY OF PANCREAS:

Blood SUPPLY:Celiac Trunk- artery of the foregut.

Superior Mesenteric artery- artery of the midgut.

Arterial supply

is derived from branches of the gastroduodenal artery and inferior

mesenteric artery.These are superior pancreaticoduodenal

artery and inferior pancreaticoduodenal artery respectively.

The gland is mainly supplied by pacreatic branches of the splenic artery.

BLOOD SUPPLY TO PANCREAS

ARTERIAL SUPPLY OF PANCREAS

ARTERIAL SUPPLY OF PANCREAS:

VENOUS DRAINAGE: Drained by the pancreaticoduodenal veins

which end up in the portal vein .

The portal vein is formed by the union of the superior mesenteric vein and splenic vein posterior to the neck of the pancreas.

VENOUS DRAINAGE:VENOUS DRAINAGE: The inferior mesenteric vein joins with the

splenic vein behind the pancreas .

It may also join the superior mesentric vein.

VENOUS DRAINAGE:

NERVE SUPPLY TO PANCREAS

NERVE SUPPLY TO NERVE SUPPLY TO PANCREAS:

NERVE SUPPLY:

Sympathetic nerves are vasomotor .

Parasympathetic nerves controls the pancreatic secretion .

NERVE SUPPLY TO PANCREAS

LYMPHATIC DRAINAGE

A network of lymphatic vessels exists within the pancreas.

The majority of vesselslie in the interlobular septa of connective tissue( that subdivide the pancreas into lobes and

lobules.)

LYMPHATIC DRAINAGE

LYMPHATIC DRAINAGELymphatics follows the arteries Drain into

pancreaticosplenic ,

coeliac

superior mesentric groups of lymph nodes .

LYMPHATIC DRAINAGE

Histology of pancreas:

EXOCRINE HISTOLOGY

H&E StainH&E Stain

Exocrine Pancreas

PANCREATIC ACINIPANCREATIC ACINI

H & E Stain

DUCT SYSTEM OF PANCREASDUCT SYSTEM OF PANCREAS

Duct SystemDuct SystemIntralobular Ducts:Also called as Intercalated Duct.Lined by Squamous or very Low Cuboidal Epithelium.Begins within the Acinus therefore surrounded by Acinar cells.Cells of Intercalated ducts secrete Bicarbonate ions. The Acinar lumen shows pale staining cells of Intercalated Duct called

Centroacinar Cells.

Interlobular Ducts:

Lined by Simple Columnar Epithelium.

These ducts are present in the septa.

Main Duct:

Lined by Tall Columnar Cells with Goblet cells in between.

H & E stain

Endocrine Histology

Islets of Langerhan-Different Cell Islets of Langerhan-Different Cell typestypes

ENDOCRINE HISTOLOGY

Cells Types of islets

THANKS TO MANAGEMENT OF SHADAN MEDICAL COLLEGE.

THANKS TO THE DEPARTMENT OF SURGERYSECIALLY TO CHANDRAMALA MADAM,

RAMESH SIR.THANKS TO THE DEPATMENT OF ANATOMY.THANKS TO THE STUDENTS OF FIRST YEAR

STUDENTS FOR HELPING ME IN THE PREPARATION OF SEMINAR

ACKNOWLEDGEMENTS