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Flashcards in Pancreas Deck (13):
1

Anatomical structure of the pancreas (5)

Head: Lies within C-Shaped curve formed by the duodenum (attaches via connective tissue)
Uncinate process: Lies posterior to the superior mesenteric artery.
Neck: Overlies the superior mesenteric arteries which forms a groove in the neck.
Body: Lies behind the stomach and left to the superior mesenteric artery
Tail: Intraperitoneal. Lies next to hilum of spleen, within the splenorenal ligament with the splenic vessels

2

Duct system of pancreas

Million berry like clusters (acini), connected by short intercalated ducts (centroacinar cells).

Drain into:
Intralobular connecting ducts
Pancreatic duct
Joins Common bile duct (Hepatopancreatic ampulla of Vater)
Duodenum

3

Vasculature of the pancreas

Pancreatic branches of splenic artery

The head also gets supply from superior (gastroduodenal artery from coeliac trunk) and inferior pancreaticoduodenal arteries (Superior mesenteric artery)

Head venous drainage: superior mesenteric branch of hepatic portal vein

Pancreatic veins drain the rest to the splenic vein

4

Lymph drainage

Empty into pancreaticosplenal nodes and pyloric nodes which drain into the superior mesenteric and coeliac lymph nodes.

5

Causes of pancreatitis (I get smashed)

Idiopathic
Gall Stones
Ethanol
Trauma
Steroids
Mumps, Malignancy
Auto-immune
Scorpion sting
Hypertryglyceridaemia, Hypercalcaemia
Endoscopic retrograde cholangiopancreatography (ERCP)
Drugs- Sodium Valproate, Metformin, Azathioprine

6

Signs and symptoms of pancreatitis

Nausea
Vomiting
Anorexia
Mid epigastric pain radiating to back
Tachycardia

Less common:
Grey turner's sign
Cullen's sign
Fox's sign
Chvostek's sign

7

Grey turner's sign

Bilateral flank blue discoloration indicating haemorrhagic pancreatitis

8

Cullen's sign

Peri-umbilical blue discoloration indicating haemorrhagic pancreatitis

9

Fox's sign

Ecchymosis (bruised skin showing blood underneath skin) over the inguinal ligament area

10

Chvostek's sign

Facial muscle spasm when face is tapped on parotid gland region.

11

Investigations to order for pancreatitis

Serum lipase + amylase: 3 times above the normal
FBC: leukocytosis (due to dehydration, raised haematocrit)
CXR. Abdominal ultrasound
(see bmj for more)

12

Treatment for pancreatitis

IV Hydration (Ringer's lactate solution)
Nutrient support (patient nbm)
Analgesia
Antiemetic
Calcium replacement (Calcium gluconate)
Magnesium sulfate (if mg low)

With gall stones (surg, candidate): Cholecystectomy
Non surgical or rapid deterioration after 48hrs treatment: ERCP with sphincterotomy

With alcohol disease: Benzodiazepine (Lorazepam)
Vitamin and mineral replacement

13

ERCP

Endoscopic retrograde cholangiopancreatography
Used to diagnose disease of gall bladder, liver, pancreas
Once problem discovered can be treated by:
sphincterotomy: small incision in opening of bile duct to drain gall stones
Stent Placement or removal of gall stone