The pancreas has both exocrine and endocrine functions. Its exocrine role includes secreting digestive enzymes from the ductal cells that help break down carbohydrates, lipids, and proteins. Its endocrine role involves the islets of Langerhans secreting hormones like insulin and glucagon to regulate blood sugar. Pancreatitis refers to inflammation of the pancreas and can be acute, recurrent, or chronic depending on factors like gallstones, alcohol use, metabolic issues, or postoperative complications. Symptoms include abdominal pain, nausea, and high amylase/lipase levels. Treatment involves pain relief, suppressing secretions, antibiotics, and sometimes surgery for complications or underlying issues.

1. Pancreatitis

2. Heterogenic gland
1) EXOCRINE GLAND
 Ductal cells and centro-acinar
cells secrete:
 AMYLASE active form
 LIPASE
 TRYPSIN
 CHYMOTRYPSIN inactive
 CARBOXYPEPTIDASE
2)ENDOCRINE GLAND
Islets of Langerhans secrete
• ALPHA CELLS – GLUCAGON
• BETA CELLS – INSULIN
• DELTA CELLS – SOMATOSTATIN
AND GASTRIN
• PP CELLS – p.polypeptides,
vasoactive intestinal peptides ,
gastro intestinal inhibitor peptides

3. The pancreas is typically divided into five parts;
 Head –
the widest part of the pancreas. It lies within the C-shaped curve created by the
duodenum, and is connected to it by connective tissue.
 Uncinate process –
a projection arising from the lower part of the head and extending medially to lie
beneath the body of the pancreas. It lies posterior to the superior mesenteric vessels.
 Neck –
located between the head and the body of the pancreas. It overlies the superior
mesenteric vessels which form a groove in its posterior aspect.
 Body –
centrally located, crossing the midline of the human body to lie behind the stomach and
to the left of the superior mesenteric vessels.
 Tail –
the left end of the pancreas that lies within close proximity to the hilum of the spleen. It
is contained within the splenorenal ligament with the splenic vessels. This is the only
part of the pancreas that is intraperitoneal.

5. Arterial blood supply
 Splenic artery ( branch of coeliac
artery)
 Superior Pancreaticoduodenal
artery – anterior and
posterior(branches of
the gastroduodenal (from coeliac
trunk)
 Inferior Pancreaticoduodenal
artery – anterior and posterior(
branches of superior mesenteric
arteries)

6. Venous drainage
Portal vein
Splenic veins
Superior mesenteric
veins

7. Lymph nodes
 This figure indicates the typical
location of lymph nodes
surrounding the pancreas.
There is considerable individual
variation in the location of
lymph nodes and an image like
this is idealized. Both A and B
are anterior views. B includes
some nodes that lie posterior to
the pancreas.

8. Nerves supply
 Parasympathetic– Vagus
nerves (secretory in nature)
 Sympathetic- greater , lesser&
least splanchnic nerves (T5 TO
T10) carrying pain fibres

9. Physiology
 Pancreatic secretion = 1500-2000 ml
 1) Bicarbonates secretion
 2) enzymes secretion
 1)secretion of bicarbonates, Cl , Na , P ions is done by secretin
hormone (released from duodenal mucosa ) in the presence of
HCL, proteolytic byproducts, fatty acids and amino acids.
 Vasoactive intestinal peptides stimulates water bicarbonate
secretion
 Insulin necessary for normal release of bicarbonates

10. Digestive Enzymes are synthesized on polysomes attached to
endoplasmic reticulum.
1) Inactive forms of TRYPSIN, CHYMOTRYPSIN A & B ,
CARBOXYPEPTIDASE A&B.
2) Active forms of AMYLASE & LIPASE
TRYPSINOGEN TRYPSIN
CHYMOTRYPSINOGEN
& CARBOXYPEPTIDASE

11. AMYLASE degrades starches to
dissacharides
LIPASE converts glycerol into fatty acids
PANCREATIC PROTEOLYTIC enzymes
converts proteins into peptides and
amino acids

12.  Cephalic Phase
vagal stimulation – low volume enzyme rich fluid is
secreted
 Gastric phase
Gastrin stimulates i) enzyme secretion by pancreas
ii) acid secretion by stomach
 Intestinal phase
Acid enters duodenum, secretin stimulates pancreatic
fluid & bicarbonate secretion
 Post cibal phase
Inhibition of pancreatic secretion

13. Types of Pancreatitis
1. Acute
2. Acute relapsing
3. Chronic
4. Chronic relapsing

14. Pathogenesis
1. Gallstones and choledocholithiasis
2. Alcohol drinking
3. Obstruction=Acute pancreatitis may be the first sign
of gallstones. Gallstones can block the pancreatic
duct, which can cause acute pancreatitis.
4. Metabolic factors
 Hyperlipidemia
 Hyper calcemia , hyperparathyroidism
5. Postoperative pancreatitis

17. Symptoms of acute pancreatitis:
 Upper abdominal pain that radiates into the back; it
may be aggravated by eating, especially foods high
in fat.
 Swollen and tender abdomen
 Nausea and vomiting
 Fever
 Increased heart rate (tachycardia)

20. How Is Pancreatitis Diagnosed?
 measure levels in the blood of two digestive enzymes, amylase and lipase. High levels of
these two enzymes strongly suggest acute pancreatitis.
 Pancreatic function test
 Glucose tolerance test to measure damage to the cells in the pancreas that make insulin
 Ultrasound, CT scan, and MRI, which make images of the pancreas so that problems may be
seen
 ERCP to look at the pancreatic and bile ducts using X-rays
 Biopsy, in which a needle is inserted into the pancreas to remove a small tissue sample for
study
 In more advanced stages of the disease, doctors may use blood, urine, and stool tests to
confirm the diagnosis.

25. Complications
 Hemorrhage
 Pseudocyst formation
 Pancreatic abscess formation
 Obstruction of common bile duct or duodenum
 Acute renal failure (I/O chart should be maintained)
 Pancreatic ascites (abd girth is watched for )
 Diabetes mellitus
 Pancreatic insufficiency leading to steatorrhoea,
nutritional deficiency and at times diabetes

26. Conservative Management
1. Management of Shock & Electrolyte imbalance
2. Relief of pain
3. Suppression of Pancreatic Secretions (e.g.octreotide-
inhibit secretion of many hormones, such as gastrin, cholecystokinin, glucagon, growth
hormone, insulin, secretin, pancreatic polypeptide, TSH, and vasoactive intestinal peptide,thus
reduce secretion of fluids by the intestine and pancreas)
4. Anti enzyme preparations- inhibits actions of trypsin & kallikrein e.g.
Trasylol 1 lac units IV *(extracted from bovine parotid gland)
5. Anti-biotics
6. Peritoneal Lavage

27. Indication of Surgical Treatment
 Uncertain diagnosis
 Deterioration of clinical condition
 Correction of associated biliary tract disease
 Secondary pancreatic infection
 Local complication like pseudocyst or abscess

28. Surgery
 Ampullary dilatations / sphincteroplasty of ampulla of vater
 Drainage procedures of the pancreatic duct
i. Duvals pancreatojejunostomy
ii. Peustow’s longitudinal P-jejunostomy
 Excisional procedures
i. Modified whipple operation
ii. Distal subtotal pancreatectomy
iii. Total pancreatectomy

29. Duval’s pancreatico-
jejunostomy

31. Cysts of pancreas
 Pseudocyst (80%) – encapsulation of fluid or blood in the lesser
sac of peritoneum.
 True cyst (20%)
i. Congenital = single or multiple,
simple ,
fibrocystic disease
dermoid cyst
i. Acquired =1. retention cyst, 2. hydatid cyst, 3. neoplastic cyst

33.  Clinical feature
Epigastric swelling, upper abdominal pain, anorexia , vomiting .
 Investigations
Sr.amylase , straight Xray, barium meal xray, USG,
 Complications
1. Infection leading to abscess
2. Rupture
3. Haemorrhage
 Treatment
1. Conservative & 2. Surgical
INTERNAL DRAINAGE = cystojejunostomy, cystogastrostomy, cystoduodenostomy
Excision of pseudocyst
EXTERNAL DRAINAGE

34. Treatment