Anatomy of the Duodenum, Pancreas and Spleen

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Chapter 19
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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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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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

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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

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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 PANCREATICADENOCARCINOMA
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Pancreatic CA
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Pancreatic Adenocarcinoma
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FATE

• Regional lymph nodes
• Liver
• Often T-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