4 page summary of acute pancreatitis (anatomy, physiology, pathophysiology, clinical manifestations and Atlanta classification, investigations, treatment, complications and prognosis)
References used:
Principles in practice of surgery, 9th edition
Case files of surgery, 5th edition
Essentials...
Acute pancreatitis summary
Anatomy: Pancreas lies in the retropeitoneium and the head of the gland lies within the C-
loop of the duodenum. Radiological anatomy: The head of the pancreas lies in front of
L2 vertebra, The body lies in front of L1 vertebra and the tail lies at the level of T12
vertebra.
Ducts of the pancreas:
1. Main pancreatic duct: duct of Wirsung
2. The common bile duct.
Both of these ducts (Wirsung + CBD) unite to form a short dilated ampulla of Vater
which then opens into 2nd part of duodenum at the major duodenal papilla.
Content of the duodenum is prevented from entering the ampulla of vater by The
sphincter of Oddi.
3. Third duct is the accessory pancreatic (also called duct of Santorini): It drains
into the duodenum.
Blood supply of the pancreas:
Arteries: Head: celiac trunk and superior mesenteric arteries
Body and tail: splenic artery.
Veins: most of the pancreatic veins drain into the splenic vein
and then into the portal vein.
Pancreatic lymphatic vessels follow blood vessels. Most of them end in the
pancreaticosplenic nodes that lie along splenic artery, while some drain into pyloric lymph
nodes, superior mesenteric lymph nodes or to the celiac lymph nodes via the hepatic
lymph nodes.
Nerve supply of the pancreas:
Parasympathetic nerve fibers from the posterior vagal trunk via its celiac branch and
Sympathetic supply which comes from T6-T10 via the thoracic splanchnic nerves and
the celiac plexus.
Physiology of the pancreas:
Exocrine produce enzymes that are important to digestion including:
- Trypsin and chymotrypsin which digest proteins
- Amylase which digest carbohydrates
- Lipase which breaks down fats.
Pancreatic secretion is stimulated by eating, when food enters the stomach, these
pancreatic juices are released into a system of ducts that culminate in the main pancreatic
duct.
As for the endocrine: Islets of Langerhans are distributed throughout the pancreas.
Four cell types are recognised: A cells produce glucagon which raise blood sugar, B cells
produce insulin which lower blood sugar, D cells produce somatostatin which inhibits
the secretion of glucagon and insulin and PP cells that produce pancreatic polypeptide.
Pancreatitis: may be acute or chronic
Pancreas usually returns to anatomical and functional normality after an acute
attack, while chronic pancreatitis is associated with a permanent derangement of
structure and function.
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