Cme pancreas2

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  • Anterior sur rleted peritoneum covering the post wall of the lesser sac n pylorus . Post surface relaated to termination of sup mesentric vein and beginning of portal vein
  • Cme pancreas2

    1. 1. WHY PANCREAS IS SELECTED? Pancreatic cancer is a silent killer- one of the most difficult tumors to detect and diagnose early. Its cancer has the lowest survival rate . In most cases, symptoms develop after metastases. Many organizations across the globe have now taken initiative to bring awareness in the public regarding the effects of this cancer Common region – in head of pancreas
    2. 2. CONTENTS:- Introduction Development in detail Location………………………………….…… Relations……………………………………… -Peritoneal -Visceral Morphological Part………………………. -Head -Neck - Body -Tail Secretory Parts………………………………. -Exocrine -Endocrine Pancreatic Duct…………………………….. Applied Aspects………………………………………
    3. 3. :~ P ANCREAS ~• PAN – ALL• CREAS ~ FLESH:~ PANCREAS WAS FIRST DISCOVERED BYHEROPHILUS :~ ALSO DISCOVERED LIVER , EYE & MEASURED PULSE . :~ FIRST TO PERFORM PUBLIC DISSECTIONS ON HUMAN CORPSES .
    4. 4. Steve JobsCEO Apple Inc. diedwith PancreaticTumour
    5. 5. Introduction “Mixed gland”, or compound gland- functions as both -Endocrine gland -Exocrine gland Yellowish Organ,jshaped or retort shaped -12 to 15cms long -3 to 4 cms wide Weight : 60-100g (Avg wt: 80g) M>F
    6. 6. -Ventral bud & Dorsal bud.~ It arises at the junction of foregut& midgut .-They develop in relation to thesecond part of duodneum.- Ventral bud is in relation to thehepatic bud at the inferior angle.- Dorsal bud grows into the dorsalmesogastrium.
    7. 7. :~ After rotation of the gut , theventral bud come s to the rightand dorsal bud to the left .Note------------:~due to the Differential growth ofthe developing gut ~ buds come tolie on the same side .
    8. 8. PARTS OF PANCREAS
    9. 9. DUCT SYSTEM OFPANCREAS
    10. 10. 1. Annular Pancreas2. Pancreatic Divisum3. Anamolies Of The Duct4. Ectopic Pancreas
    11. 11. 1. ANNULAR PANCREAS :~ A rare condition --- second part of duodenum is surrounded by a ring of pancreatic tissue continuous withit’s head .~This portion of pancreas can constrict theduodenum and impairs the flow of food
    12. 12. A) CAUSES::~ Bifid ventral bud ~ fusion with dorsal bud ~ pancreatic ring .:~ Improper rotation of ventral pancreatic bud O rdorsal bud rotates in the wrong direction
    13. 13. :~ Postnatal diagnostic proceduresinclude abdominal X-ray ,ultrasound &CT scan .A RARE CASE OF AmpullARy CARCinOmAASSOCiAtEd with AnnulAR pAnCREAS iSBEinG ShOwn
    14. 14. NORMAL POSITION OF PANCREAS
    15. 15. ANNULAR PANCREAS
    16. 16. 2. PANCREATIC DIVISUM ::~ Most common congenital anomaly.:~ Ventral and Dorsal buds fail to fuse.:~ The body , tail and part of head ofpancreasdrain into the duct of SANTORINI intominorduodenal papilla .:~ The rest of the head with uncinateprocessdrains through the duct of WIRSUNG into
    17. 17. m.R.i. SCAn ShOwinG pAnCREAtiCdiviSum
    18. 18. A) Normal (50%).B) Absence of communication betweennormally sited accessory duct and mainducts (10%).C) Persistance of complete ventraland dorsal ducts with separatedrainage (5%).B and C are both forms of ‘pancreasdivisum.D)Absence of accessory duct (20%).E) Conjoined drainage of persistantventral and dorsal ducts (<5%).
    19. 19. 3. ECTOPIC PANCREAS~ ECTOPIC means------ away fromnormal-EVIDENCE TO PROOVEIt includes all histological elements ofboth exocrine and endocrinepancreas.~The ducts of the exocrine pancreas are not arranged in the normalanatomical pattern .
    20. 20. A) CAUSE : UNKNOWN:~Maybe due to hypoplasia of the ventral pancreaswhich causes rudimentary ventralpancreatic duct .
    21. 21. :~The pancreatic tissue maybe functionally active and secreting leading toulceration of the mucosa ,Pancreatitis with psuedocyst formation ,malignant or benign pancreatic tumour .
    22. 22. :~it can be presentOutside the Gastrointestinal tractin the wall of GALL BLADDER , LIVER , hilum of SPleen
    23. 23. Ectopic pancreas in the galbladder
    24. 24. :~ Ectopic pancreatic tissuecan be discovered in stomach , proximal part of jejenum , ileum , duodenum & meckel’s diverticulum .
    25. 25. ECTOPIC PANCREAS SEENALONG THETHE GREATER CURVATUREOF THE STOMACH
    26. 26. GAStRiC ECtOpiCpAnCREAS m.R.i. SCAn
    27. 27. C) ECTOPIC PANCREAS IN ILEUM : PANCREATIC TISSUE PANCREATIC TISSUE
    28. 28. :~ GROSS AnAtOmy
    29. 29. Location Transversely Across - Posterior abdominal wall Behind Stomach From Duodenum to Spleen Level of L1 & L2 Occupies Epigastric and Hypochondriac regions
    30. 30. Location Located transversely across the posterior abdominal wall
    31. 31. Location Behind the Stomach from duodenum to Spleen
    32. 32. Location Level of L1&L2
    33. 33. Epigastric & hypochondriac regions
    34. 34. RelationsPeritonealRetroperitoneal except for a small part of its tail.
    35. 35. Peritoneal relations P P
    36. 36. Visceral relations
    37. 37. Morphological Parts Head Neck Body Tail
    38. 38. Morphological Parts HEAD  Thickest & broadest  Lies in C- shaped curve – duodenum  3 borders – superior, inferior, rt lateral  2 surfaces – anterior & posterior  Uncinate process
    39. 39. Morphological parts Neck Portal vein  Constricted part  2 surfaces - anterior and posterior  RelationsSup mesentric Anterior – peritoneumvein pylorus Posterior – sup mesentric vein portal vein
    40. 40. Morphological Parts Body  Elongated part  3 borders – anterior, superior, inferior  Part of superior margin projects upwards – ‘Tuber omentale’  3 surfaces – Anterior, posterior, inferior
    41. 41. Tail•Narrowest•Between layers of splenorenalligamentRelations•Posteriorly – Splenic artery & vein•At the tip – Splenic hilum
    42. 42. Main Pancreatic Duct Also called ‘Duct of Wirsung’ and Major Pancreatic Duct Begins in the tail Runs the length receiving channels – ‘Herring bone pattern’ Pancreatic duct with common bile duct form -----------------Hepatopancreatic Ampulla of Vater’‘
    43. 43. Herring Bone
    44. 44. Main Pancreatic Duct
    45. 45. Main Pancreatic Duct Opens in 2nd part of duodenum along with bile duct on the major duodenal papilla 25% - duct opens into duodenum separately ‘Hepatopancreatic sphincter ( of Oddi)’ around the ampulla – smooth muscle controls flow of secretions
    46. 46. Hepatopancreatic ampulla
    47. 47. Accessory Pancreatic Duct ‘Duct of Santorini’ Opens into the duodenum at the summit of the minor duodenal papilla (60%), the accessory duct communicates with the main pancreatic duct Note - Some cases, the main pancreatic duct is smaller than the accessory pancreatic duct and the two are not connected
    48. 48. Accessory Pancreatic Duct
    49. 49. DISSECTION
    50. 50. BlOOd Supply OF pAnCREAS:
    51. 51. BlOOd Supply:Celiac Trunk- artery of the foregut.Superior Mesenteric artery- artery of the midgut.
    52. 52. ARtERiAl Supply is derived from branches of the gastroduodenal artery and inferior mesenteric artery. These are superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery respectively. The gland is mainly supplied by pacreatic branches of the splenic artery.
    53. 53. BLOOD SUPPLY TO PANCREAS
    54. 54. ARTERIAL SUPPLY OFPANCREAS
    55. 55. ARTERIAL SUPPLY OFPANCREAS:
    56. 56. VENOUS DRAINAGE:Drained by the pancreaticoduodenal veins which end up in the portal vein . The portal vein is formed by the union of thesuperior mesenteric vein and splenic vein posterior to the neck of the pancreas.
    57. 57. VENOUS DRAINAGE: The inferior mesenteric vein joins with the splenic vein behind the pancreas . It may also join the superior mesentric vein.
    58. 58. VENOUS DRAINAGE:
    59. 59. nERvE Supply tO pAnCREAS
    60. 60. NERVE SUPPLY TO PANCREAS:
    61. 61. nERvE Supply: Sympathetic nerves are vasomotor . Parasympathetic nerves controls the pancreatic secretion .
    62. 62. nERvE Supply tO pAnCREAS
    63. 63. LYMPHATIC DRAINAGE A network of lymphatic vessels exists within the pancreas. The majority of vesselslie in the interlobular septa of connective tissue( that subdivide the pancreas into lobes and lobules.)
    64. 64. lymphAtiC dRAinAGE
    65. 65. lymphAtiC dRAinAGE Lymphatics follows the arteries Drain into pancreaticosplenic , coeliac superior mesentric groups of lymph nodes .
    66. 66. lymphAtiC dRAinAGE
    67. 67. hiStOlOGy OF pAnCREAS:
    68. 68. EXOCRinE hiStOlOGy
    69. 69. H&E Stain
    70. 70. Exocrine Pancreas
    71. 71. PANCREATIC ACINI
    72. 72. H & E Stain
    73. 73. DUCT SYSTEM OF PANCREAS
    74. 74. Duct SystemIntralobular Ducts:Also called as Intercalated Duct.Lined by Squamous or very Low CuboidalEpithelium.Begins within the Acinus therefore surrounded byAcinar cells.Cells of Intercalated ducts secrete Bicarbonate ions. The Acinar lumen shows pale staining cells ofIntercalated Duct called Centroacinar Cells.
    75. 75. Interlobular Ducts:Lined by Simple Columnar Epithelium.These ducts are present in the septa.Main Duct:Lined by Tall Columnar Cells with Goblet cells inbetween.
    76. 76. H & E stain
    77. 77. Endocrine Histology
    78. 78. Islets of Langerhan-Different Celltypes
    79. 79. EndOCRinEhiStOlOGy
    80. 80. Cells Types of islets
    81. 81. ACKNOWLEDGEMENTS THANKS TO MANAGEMENT OF SHADAN MEDICAL COLLEGE. THANKS TO THE DEPARTMENT OF SURGERY SECIALLY TO CHANDRAMALA MADAM, RAMESH SIR. THANKS TO THE DEPATMENT OF ANATOMY. THANKS TO THE STUDENTS OF FIRST YEAR STUDENTS FOR HELPING ME IN THE PREPARATION OF SEMINAR

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