Anatomy of the Duodenum, Pancreas and Spleen

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PANCREAS

Transcript of Anatomy of the Duodenum, Pancreas and Spleen

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PANCREAS

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OBJECTIVES• Understand the etiology/risk

factors, pathogenesis, morphology, clinical features and outcome of pancreatic inflammations and neoplasms

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Ventral Bud

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Chapter 19

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Posterior view of duodenum/pancreas

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Arterial supply and venous drainage of the pancreas and spleen

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Lymphatic drainage of the distal pancreas and spleen

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Hepaticopancreatic ampulla(Ampulla of Vater)

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L2

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makes HCO3¯

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Pancreatic Enzymes• Amylase• Lipase• DNA-ase• RNA-ase• Zymogens: Trypsinogen

Chymotrypsinogen Procarboxypeptidase A, B

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PANCREAS DISEASES• Congenital

•Inflammatory–Acute–Chronic

• Cysts

•Neoplasms

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Congenital• Agenesis (very rare)

• Pancreas Divisum (failure of 2 ducts to fuse) (common)

• Annular Pancreas (pancreas encircles duodenum) (rare)

• Ectopic Pancreas (very common)

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PANCREATITIS• ACUTE (VERY SERIOUS)

• CHRONIC (Calcifications, Pseudocyst)

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CONSEQUENCES of ACUTE and CHRONIC pancreatitis

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ACUTE PANCREATITIS• ALCOHOLISM• Bile reflux• Medications (thiazides)• Hypertriglyceridemia, hypercalcemia• Acute ischemia• Trauma, blunt, iatrogenic• Genes: PRSS1, SPINK1• Idiopathic, 10-20%

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CLINICAL FEATURES• ABDOMINAL PAIN• EXTREME emergency situation• HIGH mortality

• …but MOST important lab test is……….?????

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AMYLASE

!!!!!!!

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MORPHOLOGY• EDEMA• FAT NECROSIS• ACUTE INFLAMMATORY INFILTRATE• PANCREAS AUTODIGESTION• BLOOD VESSEL DESTRUCTION• “SAPONIFICATION” (stearates, Na+,

Ca++)

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CHRONIC PANCREATITIS• Pancreatic duct obstruction,

LONGSTANDING• Tropical• Hereditary (PRSS1, SPINK1

mutations)• IDIOPATHIC (40%)

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CHRONIC PANCREATITIS

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CLINICAL FEATURES• Abdominal Pain• Vague abdominal symptoms• Nothing

• CT calcifications (why?), amylase elevated, chronic diarrhea if chronic pancreatic insuffiency develops, high likelihood of pseudocysts

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PDEUDOCYSTS• Why “pseudo”?• STRONGLY linked with pancreatitis• Can be as big as a football and often

are.• Can cause obstruction• Can get infected• Do NOT become malignant

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Pancreas Neoplasms• Serous• Mucinous• Cystic• Microcystic• Papillary• Benign• Malignant (dense sclerosis is the

rule)

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SEROUS

CYSTADENOMA

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MUCINOUS

CYSTADENOMA

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INTRADUCTAL

PAPILLARY

MUCINOUS

“NEOPLASM”

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CARCINOGENESISof PANCREATIC

ADENOCARCINOMA

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Pancreatic CA

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Pancreatic

Adenocarcinoma

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FATE:• Regional lymph nodes• Liver• Often L-2 spine• Lungs

Grading (WMP), Staging, TNM

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Final TIP of the day• Painless jaundice in an

elderly person is CARCINOMA of the head of the pancreas until proven otherwise