Pancreas

A fish-shaped spongy grayish-pink organ 6 inches (15 cm) long Located at the posterior of the upper abdomen Rest against the curve of the duodenum Tail touches the spleen

Four regions of Pancreas

The Pancreatic head abuts the second part of the duodenum. The pancreatic neck springs from the right upper portion of the front of the head. The Body of the Pancreas lies at the level of L2 on the spine. The tail of the pancreas extends towards the spleen

Pancreatic exocrine cells are arranged in grape-like clusters called acini (a single one is an acinus). The exocrine cells themselves are packed with membrane-bound secretory granules which contain digestive enzymes.

Artery: Inferior pancreaticoduodenal artery Superior pancreaticoduodenal artery Spleenic artery

Veins: Pancreatic veins Pancreaticoduodenal veins Nerves: Pancreatic plexus Celiac ganglia vagus

Pacreatic duct:
Accessory pancreatic duct Hepatopancreatic duct ampulla- ampulla of vater the enlargement formed by the union of the common bile duct with the pacreatic duct where they enter the duodenum.

Endocrine
There are four main types of cells in the islets of Langerhans. Beta cell Insulin and amylin- lower blood sugar Alpha cell glucagon - raise blood sugar Delta cell Somatostatin inhibit endocrine pancreas PP cell Pancreatic polypeptide - inhibit exocrine pancreas

Exocrine
1. Centroacinar cells- bicarbonate ion 2. Basophilic cells

Digestive enzymes Amylase - breakdown of starch and lipase Lipase - fat splitting enzymes

Proteolitic enzymes- breakdown dietary protein Trypsinogen - use to liquify clotted blood, use to facilitate removal of cataract Chymotrypsinogen use in debridement of necrotic tissue

Acute Pancreatitis
Ethiology Gallstone Alcohol Metabolic factor Drugs Viral infection Trauma

Sign & Symptoms: severe epigastric pain Abdominal pain that radiates at the back Abdominal distention Nausea Vomiting Tachycardia Hypotension Cool clammy skin Fever Rapid pulse

Cholelithiasis Ampullary Obstruction Chronic alcoholism Ductal concretions Obstructing lesions

Alcohol Virus Drugs Ischemia Trauma

Alcohol Nutritional deficiency

Ductal Obstruction

Acinar cell Injury

Derange intracellular Transport of Pancreatic Enzymes

Release of intracellular enzymes

Intracellular leak of Enzymes from ductules

Activation of enzymes By lysosomal hydrolase

Activated Enzymes

Interstitial inflammation + Proteolysis + fat necrosis+ hemorrhage

Acute Pancreatitis

Damage to the Pancreatic Cell

Inflammation

Edema of the Pancreas and Pancreatic ducts Obstruction to the flow of pancreatic Enzymes (Activation of Enzymes) Autodigestion of the Pancreas Fatty Necrosis, Ulceration, Hemorrhage, Infection Pancreatitis

Treatment: Pain relief- demerol Restoration of lost plasma volume Antibiotics prophylaxis NPO IVF Drainage

Local complication: Abscess Pseudocyst Ascites Jaundice

Systemic Complication: DM Sepsis Metabolic ARDS Cardiovascular Plueral effusion Hypocalcemia Increase fluid sequestration