PANCREAS
DEVELOPMENT OF PANCREAS
Frequel ROTATION OF VENTRAL BUD
①
H
Hepatica
D
D
V
32nd
day
Contact : 37th day FUSION : 42 no day
↑ Duct
D
-
Duct
Dorsal Bud Derivative
-
NECK
↑
j
TDih
BODY
Head
Ventral Bud >
-
Derivative
UNCINDST
ACINARCELIS
Accessory
pancreatic)
Duct
: 30 % or
↑
SANTORNI's Duct
4
↑Azur
Pancratic
↓ "Islet cells
- MINOR/BRANCHED
"WIRSUNG"
enter cris
a
Common Bile
duct
-
>
major pancreatic duct
% Ampulla
of water
sphincter of
Oddi
PANCREATIC DIVISUM
#Divided
drainage)
Pathogenesis
* Fusion blu ventral bud and dasal Bud without allishment
results in divided drainage
Dorsal duct
Dorsalduct
opening
↑ ⑳
↑
CBD
-ventral duct
⑪
Clinical features 90% Pt .
Asymptomatic
it
symprematic
persalductstos
Investigations IOC : MRCP - Divided drainage i donsal duct
dilatation
Management -Endoscopic dasal duct Sphincterotary
Dorsal duct starting
- Remove start Looks
after
ANNULAR PANCREAS
Pancreatic tissue around duodenum
* Thick win
of resulting in Gastric outlet obstruction
Pathogenesis
-
~Due to
incomplete
rotation
of ventral
·
V
Bud .
V D
Clinical features
-Sayo
1 MJF ,
# Episodes & vomiting : D2# :
Non-Bilious (M(c)
1
D3# : Bilious
[
Investigation
t ray
E trouble
bubble
sign/
-
Annular
*
p
danc FOC : CSC7 Abdomen
Management
Soeododnostemy
-
-
ACUTE PANCREATITIS
CAUSES
* Gallstones (Mick) >
-
Biliary Pancreatis
* Alcohol (anomic)
* ERCP (IS % PE)
* typer parathyroidism
*
Hyper lipidaema
* Blunt trauma abdomen
* Coxsackie , mumps , schovirus
* DRUGS
TVAminoglucose
T
valparate
veniazide
~
A mino Salisilic acid
PATHOGENESIS
IRRITATION OF ACINAR CELL
-
of lysosomes
colocalisation :
zymogen granule
mogengramea
- Inactive
p
Scarne
.
re
↑ piee
Pancratic Enzyme outHow
Obstruction
>
-
lysosomes migrated
Activations
towards Zymogen Activated
glysosomes
! #zymosmi
granules
Pancratic
pasenchyma
Cathepsin B granule #acinar
-
cell
CLINICAL FEATURES
"
:
adden severe onset of abdominal Pairs
*
- Epigastric Legion -
Radiating to left Back
pain It on
bending/leaning forward
-
* Nauseaa
vomiting
* Non
passage of stools & flates
* periumblical Cullen Sign
Hemarhagic
:
Pancreativis -
L Echinosis
Flank :
Grey turner
EchimosisSign
Investigations
sephinene
-
X ray
I Sentinel loop sign Colon
Cut-off
tang
·
2
2.Color cut
off Sign
3 Renal Halo
Sign
.
4 Ground
glass app
v
IOC CECT ABDOMEN 100 For 0: P2 +
Samylase ↑ base4
+
↓
more specific for
Pancreatitis
PROGNOSTIC CRITERIA IN ACUTE PANCREATITIS
RANSONS CRITERIA
AT PRESENTATION AFTER 48 HOURS OF ADMISSION
~
A Age >55 years - FALL IN HCT >10%
B Blood glucose>200 mg/dL - S.Ca < 8 mg%
cr WBC: >16,000 cells/mm3 v BUN >5 mg/dL
Du LDH: >350 IU/L ~ Fluid requirement >6 L
E Pao2 <60mmHg
-
AST >250 IU/L -
~ BASE DEFICIT > 4mEq/L
⑪ Ranson score ≥3 defines severe pancreatitis
COMPLICATIONS ASSOCIATED WITH ACUTE PANCREATITIS
Local complications Systemic complications
* Acute
collection
Fluid collection
* acte necrotic
* Septic Shock
Pseudocyst # ARDS
# MODS
* WON : Walled off Necrosis
* Splenic vari thrombosis
* splenic
artery pseudo aneurysm
*
panccato - pleural fistula
① sided pleural effusion
⑭ : Conservative My
E . NP 0
. .
. IVF
M .
IV-Analgesia
# .
In-antibiotics-
t panocarc necrosis/
CHORONIC PANCREATITIS
TIGAR -
O
Risk factors
T Toxic@ : -Alcohol (m/c(c)
Tobacco
-
Hyperlipidemia
-
unemia
I Idiopathic
G Generic :
PRSS1/PRSS2/SPINK-1ICFTR
A
Auto-immune
⑪ sausage shaped Sausage ShapedPancreas
=
asIIIi
Pancreas
R
Recurrent Pancreatit's
O OBSTRUCTIVE - * Pancreatic divisure
CAUSE * Annular pancreas
of oddi dystuction
# sphincter
* Malignant Occlusion
Clinical features
Exocrine insufficiency : #acinar cells Endocrine insufficiency :
# islet cells Ductal insufficiency # DUCT
> 90 %
* Pancratic Enzyme * # : Insulin - DM pair
recurrent : Pairi 4 after
eating
-
d/t Ineffective
-malabsorptioa
a -rainage
&p S
.
-statewhea
Investigations
IOC : MRCP + Secretil
Stimulating study
BEST/GOLD STANDARD
ERCP : Chair of lakes
app.
Management : chronic pancreatitis
#
major Pancreatic duct
Diameter
-
Em #
ERCP + Sphincterotony
Drainage election
duct ↓
- pancreatic ↓
Starting * BEGER'S SX
xtDUVALS
-
Pancreat
-
Duodenal Preserving
Pancreatic headsesection
nustay jejinostory
-pancreato
Queston SX
* FREY'S SY
-
longitudinal Pancreato
Duodenal Preserving
zginostay
-
: LPJ Pancreatic head coaring :
L p J
:
.
-
CYSTIC LESION OF PANCREAS
PSEUDOCYST OF PANCREAS SEROUS CYST MUCINOUS CYST INTRADUCTAL PAPILLARY
ADENOMA ADENOMA NEOPLASM
~
mic Cystic lesion of -
Mic Cystic neoplasne
-
Pancreas of pancreas
AGE
40-Goyrs 60-70yrs So-Goyes Go-zoys
GENDER M= F M
F > M F > m =
F
APPEARA
Branch duct IpmN
NCE ↑
↓ Thired [ml T
mcuniduct IPMN
T
"Honey Camb"
- large cyst : anG - -
poorly demarcated lesion
minocyst marocyst F lobulated
-Thick walled : Imm
Fmultiple F
Thick walled F polycystic mass
- mucin
V- > Gwks
of pancreatitis Internal crystalls
v-secrets mucin into the Pancreatic
duct ⑥ duct dilatation
septa ↓ peripheral Egg F Fish mouth Ampulla
r-central shell calcification
Stellate cat
COMMU
NICATION ⑭ : O
WITH Q ⑭ -
DUCT
⑪ :
MOST
COMMO lesser sae Evenly Body/rail Head
N SITE distributed
MUCIN ⑦ ⑦ ⑦ ⑦
STAIN
CEA
⑪ g ↑ ↑
AMYLASE ↑** ⑨ ⑧ ↑4
INVESTIG
CECT Pancratic ERCP
ATION ~ v
protocol
MANAGE < Gwks : Observation Enucleation Distal
MENT Near total
pancreatectory pancreatectory
-WKS -
cystojeunostamy
PERI-AMPULLARY CARCINOMA
* Distal Cholangio Carcinana
* Ampullary. Ca
* Duodenal Ca
i
.
* Pancreatic head Carcinoma
PANCREATIC DUCTAL ADENOCARCINOMA (PDAC)
RISK * Obesity
FACTORS
* DM
* Alcohol
* Genetic : PRSS1 (SPINK-1
* Chronic Pannealih's
4100 times
* Syndromes : -
Peutz-Jegher Syndrome :
mic gene nutation
BRCA2 > BRCA1
fepancreatiaa
-
>
-
HNPCC
# -
FAP
-
Familial Atypical Melanoma Syndrome
CLINICAL -
micIs : Heard
FETAURES Goyrs
Age >
-
-
m > F
* progressive , persistant jaundice
* significant weight loss
⑭
pairobliteration
* Abdominal
Duodenal Compression
* Nausea/vanitiy
Provit's
*
*
Migratory Superficial thrombophlebit's [TROssus SUNDROma]
INVESTIGATIONS
Imp
Double Duct Sign
⑭
2 -
-
Inverted 's' sign
widening o cloop of
duodenum
10C : CECT i Pancreatic Protocol
TM : CA19-9 ↑
MANAGEMENT
RESECTABLE TUMOURS
#
Distalpancake a
:
#anntay/ : t
↓
Whipples SX Poppy Distal
:
Pancreatectomy
CRITERIA FOR UNRESECTABLE TUMOURS
↑ Celiac a > 1800
z .
Common hepatic -
3 .
SMAG
U .
SMV-PV
V. Distant 20
PANCREATO- DUODENECTOMY
, #
: Gastro
gyunostay
Mr Hepatostany : Pancran-justa
m/c complication associated with Whipple surgery: Delayed Gashic Emptying
MANAGEMENT OF UNRESECTABLE TUMOUR
Palliative mx :
Chemo : Gencitabine + cisplatin
jaundice Gashic Outlet 60 0 .
Pour
Obstructions +
I jaundice
↓
↓
ERCP
Feeding
t Coeliac
ganglich
starting Jyeno story Tripple
Block
!
Bypass
Fails SX
# Gastro
/
.
-jeunostay
percutaneous trans
hepatic Biliary Drainage
/
/
I.
Hepato
zeinostay
# .
Jeguno jejenostag
