Pancreas Anatomy Physiology

Send This

Download

Comment

Favourite

more

Rating :

Rate It:

Embed :

chunmin su on Oct 21, 2012 Says :

Great thanks

doaa on Jul 18, 2012 Says :

thanks alot

rehan on May 10, 2011 Says :

nice

mahmoud on Nov 24, 2010 Says :

very very nice preparation thanx a lot

asha on Oct 25, 2009 Says :

thanks....really great work..all the best

ahmad on Aug 08, 2009 Says :

thanks alooooot

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

Notes

Hide Notes

Slide 1 :

Pancreas: Anatomy & Physiology Ajith Uliyargoli 10/30/07

Slide 2 :

Pancreas Gland with both exocrine and endocrine functions 6-10 inch in length 60-100 gram in weight

Slide 3 :

Location: Retro-peritoneum, 2nd lumbar vertebral level Extends in an oblique, transverse position Parts of pancreas: head, neck, body and tail

Slide 4 :

Embryology Endodermal in origin Develops from ventral and dorsal pancreatic buds Ventral bud rotates posteriorly and becomes the uncinate process and inferior head of pancreas Dorsal bud becomes superior head, neck, body and tail Ventral bud duct fuses with dorsal bud duct to become main pancreatic duct (Wirsung)

Slide 5 :

Embryology of Pancreas

Slide 6 :

Slide 7 :

Head of Pancreas Includes uncinate process Flattened structure, 2 – 3 cm thick Attached to the 2nd and 3rd portions of duodenum on the right Merges into neck on the left Border between head & neck is determined by GDA insertion SPDA and IPDA anastamose between the duodenum and the rt. lateral border

Slide 8 :

Neck of Pancreas 2.5 cm in length Straddles SMV and PV Superior border relates to the pylorus Superior mesenteric vessels emerge from the inferior border Posteriorly, SMV and splenic vein confluence to form portal vein Posteriorly, most often no branches to pancreas

Slide 9 :

Pancreas

Slide 10 :

Body of Pancreas Elongated, long structure Anterior surface, separated from stomach by lesser sac Posterior surface, related to aorta, Lt. adrenal gland, Lt. renal vessels and upper 1/3rd of Lt. kidney Splenic vein runs embedded in the post. surface closer to the superior border Inferior surface is covered by transverse mesocolon

Slide 11 :

Tail of Pancreas Narrow, short segment Lies at the level of the 12th thoracic vertebra Ends within the splenic hilum Lies in the splenophrenic ligament Anteriorly, related to splenic flexure of colon May be injured during splenectomy (fistula)

Slide 12 :

Pancreatic Duct Main duct (Wirsung) runs the entire length of pancreas Joins CBD at the ampulla of Vater 2 – 4 mm in diameter, drains up to 20 secondary branches Ductal pressure is 15 – 30 mm Hg (vs. 7 – 17 in CBD) thus preventing reflux and damage to panc. duct Lesser duct (Santorini) drains superior portion of head and empties separately into 2nd portion of duodenum

Slide 13 :

Arterial Supply of Pancreas Variety of major arterial sources (Celiac, SMA and Splenic) Celiac ? Common Hepatic Artery ? Gastroduodenal Artery ? Superior pancreaticoduodenal artery which divides into anterior and posterior branches SMA ? Inferior pancreaticoduodenal artery which divides into anterior and posterior branches

Slide 14 :

Arterial Supply of Pancreas Anterior and posterior collateral arcade between the superior and inferior PDA supply head Body and tail supplied by splenic artery by about 10 branches Three big branches from splenic are Dorsal pancreatic artery Pancreatica Magna (midportion of body) Caudal pancreatic artery (tail)

Slide 15 :

Arterial Supply of Pancreas

Slide 16 :

Approx 25-27% variation in the arterial vascular anatomy

Slide 17 :

Venous Drainage of Pancreas Follows arterial supply Anterior and posterior arcades drain head and the body Splenic vein drains the body and tail Major drainage areas are Suprapancreatic PV Retropancreatic PV Splenic vein Infrapancreatic SMV Ultimately, into portal vein

Slide 18 :

Venous Drainage of Pancreas

Slide 19 :

Lymphatic Drainage Rich periacinar network that drain into 5 nodal groups Superior nodes Anterior nodes Inferior nodes Posterior PD nodes Splenic nodes

Slide 20 :

Innervation of Pancreas Sympathetic fibers from the splanchnic nerves Parasympathetic fibers from the vagus Both give rise to intrapancreatic periacinar plexuses Parasympathetic fibers stimulate both exocrine and endocrine secretion Sympathetic fibers have a predominantly inhibitory effect

Slide 21 :

Innervation of Pancreas Rich afferent sensory fiber network Ganglionectomy or celiac ganglion blockade interrupt these somatic fibers (pancreatic pain) However the origin of pancreatic pain is difficult to explain anatomically

Slide 22 :

Histology-Exocrine Pancreas 2 major components – Acinar cells and Ducts They constitute 80% to 90% of the pancreatic mass 20 to 40 acinar cells coalesce into a unit called the acinus Acinar cells secrete the digestive enzymes Centroacinar cell (2nd cell type in the acinus) is responsible for fluid and electrolyte secretion by the pancreas

Slide 23 :

Histology-Exocrine Pancreas Ductular system - network of conduits that carry the exocrine secretions into the duodenum Acinus ? small intercalated ducts ? interlobular duct ? pancreatic duct Interlobular ducts contribute to fluid and electrolyte secretion along with the centroacinar cells

Slide 24 :

Histology-Endocrine Pancreas Accounts for only 2% of the pancreatic mass Nests of cells - islets of Langerhans Four major cell types Alpha (A) cells secrete glucagon Beta (B) cells secrete insulin Delta (D) cells secrete somatostatin F cells secrete pancreatic polypeptide

Slide 25 :

Histology-Endocrine Pancreas B cells are centrally located within the islet and constitute 70% of the islet mass PP, A, and D cells are located at the periphery of the islet

Slide 26 :

Physiology – Exocrine Pancreas Secretion of water and electrolytes originates in the centroacinar and intercalated duct cells Pancreatic enzymes originate in the acinar cells Final product is a colorless, odorless, and isosmotic alkaline fluid that contains digestive enzymes (amylase, lipase, and trypsinogen)

Slide 27 :

Physiology – Exocrine Pancreas 500 to 800 ml pancreatic fluid secreted per day Alkaline pH results from secreted bicarbonate which serves to neutralize gastric acid and regulate the pH of the intestine Enzymes digest carbohydrates, proteins, and fats

Slide 28 :

Bicarbonate Secretion Centroacinar cells and ductular epithelium secrete 20 mmol of bicarbonate per liter in the basal state Fluid (pH from 7.6 to 9.0) acts as a vehicle to carry inactive proteolytic enzymes to the duodenal lumen Sodium and potassium concentrations are constant and equal those of plasma Chloride secretion varies inversely with bicarbonate secretion

Slide 29 :

Bicarbonate Secretion Bicarbonate is formed from carbonic acid by the enzyme carbonic anhydrase Major stimulants Secretin, Cholecystokinin, Gastrin, Acetylcholine Major inhibitors Atropine, Somatostatin, Pancreatic polypeptide and Glucagon Secretin - released from the duodenal mucosa in response to a duodenal luminal pH < 3

Slide 30 :

Enzyme Secretion Acinar cells secrete isozymes amylases, lipases, and proteases Major stimulants Cholecystokinin, Acetylcholine, Secretin, VIP Synthesized in the endoplasmic reticulum of the acinar cells and are packaged in the zymogen granules Released from the acinar cells into the lumen of the acinus and then transported into the duodenal lumen, where the enzymes are activated.

Slide 31 :

Enzymes Amylase only digestive enzyme secreted by the pancreas in an active form functions optimally at a pH of 7 hydrolyzes starch and glycogen to glucose, maltose, maltotriose, and dextrins Lipase function optimally at a pH of 7 to 9 emulsify and hydrolyze fat in the presence of bile salts

Slide 32 :

Enzymes of Pancreas Proteases essential for protein digestion secreted as proenzymes and require activation for proteolytic activity duodenal enzyme, enterokinase, converts trypsinogen to trypsin Trypsin, in turn, activates chymotrypsin, elastase, carboxypeptidase, and phospholipase Within the pancreas, enzyme activation is prevented by an antiproteolytic enzyme secreted by the acinar cells

Slide 33 :

Insulin Synthesized in the B cells of the islets of Langerhans 80% of the islet cell mass must be surgically removed before diabetes becomes clinically apparent Proinsulin, is transported from the endoplasmic reticulum to the Golgi complex where it is packaged into granules and cleaved into insulin and a residual connecting peptide, or C peptide

Slide 34 :

Insulin Major stimulants Glucose, amino acids, glucagon, GIP, CCK, sulfonylurea compounds, ß-Sympathetic fibers Major inhibitors somatostatin, amylin, pancreastatin, a-sympathetic fibers

Slide 35 :

Glucagon Secreted by the A cells of the islet Glucagon elevates blood glucose levels through the stimulation of glycogenolysis and gluconeogenesis Major stimulants Aminoacids, Cholinergic fibers, ß-Sympathetic fibers Major inhibitors Glucose, insulin, somatostatin, a-sympathetic fibers

Slide 36 :

Somatostatin Secreted by the D cells of the islet Inhibits the release of growth hormone Inhibits the release of almost all peptide hormones Inhibits gastric, pancreatic, and biliary secretion Used to treat both endocrine and exocrine disorders

Slide 37 :

Pancreatic function tests

Slide 38 :

Exocrine function Secretin test Overnight fast Double lumen tube Basal secretion 2u/kg of Secretin Four 20 min collections of secretions Test for volume, bicarbonate, amylase

Slide 39 :

Slide 40 :

Fecal fat test Distinguish between pancreatic dysfunction and intestinal malabsorption In Pancreatic disease when lipase secretion is reduced by 90%- 24-hour fecal fat content is elevated to more than 20 g. Intestinal dysfunction - Steatorrhea with low levels of fecal fat Use- Efficacy of pancreatic enzyme replacement

Slide 41 :

The dimethadione (DMO) test Pancreas degrades Trimethadione (anticonvulsant), and secretes its metabolite, DMO. Trimethadione - 0.45 g Po TID for 3 days. Secretin test is performed. The duodenal output of DMO measured Impaired in exocrine insufficiency

Slide 42 :

The Lundh test Based on endogenous secretion of secretin and CCK in addition to pancreatic secretion Overnight fast Basal collection of duodenal fluid Meal of 18 g of corn oil, 15 g of casein, and 40 g of glucose in 300 mL of water. Thirty-minute collections - for 2 hours Analyzed for trypsin, amylase, and lipase Abnormal in patients with chronic pancreatitis Limitations - Need for duodenal intubation Abnormal - Dis. involving the GI mucosa

Slide 43 :

Triolein breath test Noninvasive test of exocrine insufficiency 25 grams of corn oil containing 5 mCi of [14C]triolein is given orally 4 hours later - metabolite 14C-carbon dioxide measured in breath In fat digestion or malabsorption less than 3% of the [14C]triolein dose per hour measured. Test repeated after oral pancreatic enzyme replacement. In exocrine insufficiency achieve a normal rate of excretion of 14C–carbon dioxide, whereas patients with enteric disorders show no improvement

Slide 44 :

Paraaminobenzoic(PABA) acid test Noninvasive test of pancreatic insufficiency N-benzoyl-l-tyrosyl-PABA is cleaved by chymotrypsin to form PABA. PABA is absorbed from the small intestine excreted in the urine One gram of BT-PABA in 300 mL of water is given orally, and urine collections are obtained for 6 hours. Patients with chronic pancreatitis excrete less than 60% of the ingested dose of BT-PABA.

Slide 45 :

Islet hormone - PP levels Basal and meal stimulated levels of plasma PP measured Overnight fast- Test meal consisting of 20% protein, 40% fat, and 40% carbohydrate is given Basal levels Normal- 100 to 250 pg/mL) Less than 50 pg/mL in severe chronic pancreatitis After meal PP -Normally rise to 700 to 1,000 pg/mL Reduced to 250 pg/mL in severe disease. Limitations Depends on intact pancreatic innervation, depressed in cases of diabetic autonomic neuropathy, after truncal vagotomy and antrectomy

Slide 46 :

DIFFERENTIAL DIAGNOSIS OF INTESTINAL AND PANCREATIC STEATORRHEA

Slide 47 :

Endocrine function Oral GTT Confirm the diagnosis of diabetes. Indirect assessment of the insulin response to an oral glucose load. Overnight fastlng 2 basal blood samples for Blood sugar Oral glucose load of 40 g/m2 is given over 10 minutes. Blood samples are drawn every 30 minutes for 2 hours

Slide 48 :

INTERPRETATION OF ORAL GLUCOSE TOLERANCE TEST RESULTS

Slide 49 :

Intravenous glucose tolerance test Eliminates the GI influences on glucose metabolism that affects the oral GTT IV bolus of 0.5 g of glucose per kg over 2 to 5 minutes. Blood samples - every 10 minutes for 1 hour. The decline in glucose concentration (percentage of disappearance per minute) is called the K value. A K value of 1.5 or higher is normal.

Slide 50 :

Intravenous arginine test Arginine stimulates the secretion of islet hormones Diagnosis of hormone-secreting tumors Overnight fast, and given a 30-minute infusion of 0.5 g of arginine per kilogram. Blood samples are taken every 10 minutes Radioimmunoassays are performed for the specific hormones in question. This test is particularly useful for the diagnosis of glucagon-secreting tumors Elevations of plasma glucagon to above 400 pg/mL usually indicate a glucagonoma

Slide 51 :

Tolbutamide response test Useful in detecting hormone-secreting tumors. Sulfonylurea stimulates insulin secretion. Overnight fasting, basal blood samples are drawn. One gram of sodium tolbutamide is given intravenously Blood glucose level is monitored for 1 hour. Blood samples for radioimmunoassay of insulin or other suspected hormones, such as somatostatin obtained. In normal patients, the blood glucose level falls to 50% of basal values after 30 minutes. Sustained hypoglycemia with hypersecretion of insulin is consistent with an insulinoma. In the case of a somatostatinoma, somatostatin levels are more than twice as high as the prevailing normal values for the particular somatostatin radioimmunoassay

Slide 52 :

Acute pancreatitis Blood Investigations – CBC,LFT, serum calcium, serum amylase and lipase, ABG Chest Xray (for exclusion of perforated viscus) Abdominal Xrays (for detection of "sentinel loop", gallstones which are radioopaque in 10%) CT abdomen U/S abdomen MRI/MRA

Slide 53 :

Chr. Pancreatitis Study of exocrine pancreatic function CT- size, duct, stone, mass lesions ERCP-Duct size, stenosis, obstruction, stones, therapeutic stenting

Slide 54 :

Pancreatic neoplasm's CBC, LFT, Amylase, Lipase Ca-19-9- 80% accurate, prognosis and f/u Genetic testing- Genetic syndrome associated with hereditary pancreatic cancer-(Peutz-Jeghers, Hereditary pancreatitis, FAMMM, HNPCC) Genetic Mutations-DPC4 gene(18Q)-missing in 90% of pancreatic cancers. K-ras mutations common. Also changes in p53 and p16 tumor suppressor genes.

Slide 55 :

CAT scan - Spiral CT- Cuts taken through pancreas both in a arterial phase and a portal venous phase Local disease and metastatic disease MRCP-Non invasive, assess biliary tract in a jaundiced pt ERCP-90% accurate, in pts whom no mass is seen, brushings for biopsy U/S EUS- Detect early lesions <2cm, L.N assessment, vascular involvement, FNAC

Slide 56 :

Cystic neoplasms CT scan Serous –mutilocular ,central calcification, Mucinous- more common in body and tail, 30% malignant potential, needs to be resected ERCP- IPMN, common in the head and mucin secreted from the ducts

Slide 57 :

Functional endocrine neoplasms Insulinomas Monitored fast test Insulin to glucose ratio >0.4 (N <0.3) Elevated C-peptide and pro-insulin levels CT, EUS STS (Somatostatin receptor scintigraphy- Octreotide scan)- Local tumors-75%, metastatic-65%, significant false negatives Visceral angiography- not performed anymore Selective arterial calcium stimulation test(GDA, splenic, Inferior Panc. Duo. Art) Intraop ultrasound

Slide 58 :

Gastrinoma Serum gastrin- Fasting gastrin>200pgm/ml >1000pgm.ml pathgnomonic Gastric acid analysis-Basal Acid Output>15mEq/hr (Non-ulcerogenic causes - Atrophic gastritis, Pernicious anemia, Vagotomy) Secretin Stimulation test- Increase by 200 pgm/ml above the basal level CT, EUS SRS- more sensitive than in Insulinoma Selective arterial secretin stimulation test Intra-op ultrasound

Slide 59 :

VIPOMA BMP- Hypokalemia, Metabolic acidosis Elevated VIP levels- repeated testing required Gastric acid levels- Achlorohydria CT, EUS

Slide 60 :

Glucagonoma Hyperglycemia Hypoproteniemia Glucagon levels CT, EUS

Slide 61 :

Somatostatinoma Hyperglycemia Hypocholorohydria Somatostatin level>100pgm/ml diagnostic

Anatomy and Physiology

Heart Anatomy (PPT) ...

Physiology curricula...

Heterotopic pancreas...

cardio vascular phys...

Free Powerpoint Templates

	SlidesOnline 4 Years ago.



12322 Views, 1 favourite
Variety of major arterial sources (Celiac, SMA and Splenic)Rich afferent sensory fiber network; Gan more Variety of major arterial sources (Celiac, SMA and Splenic)Rich afferent sensory fiber network; Ganglionectomy or celiac ganglion blockade interrupt ... less
More By User Flag as inappropriate Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details. Cancel