Pancreas
LEARNING OBJECTIVES
To understand
:
•The anatomy and physiology of the pancreas
•Investigations of the pancreas
•Congenital abnormalities of the pancreas
•Assessment and management of pancreatitis
•Diagnosis and treatment of pancreatic cancer
External injury to the pancreas
Pancreatic injuries may range from a contusion or laceration of
the parenchyma without duct disruption to major parenchymal
with duct disruption (sometimes complete transection) and,
rarely, massive destruction of the pancreatic head
.
CT and ERCP are the most useful tests
The most important factor that determines treatment
Surgery
is whether the pancreatic duct has been
disrupted or not
.
Iatrogenic injury
This can occur in several ways:
•Injury to the tail of the pancreas during splenectomy, resulting in
a pancreatic fistula.
•Injury to the accessory pancreatic duct (Santorini), which is the
main duct in 7 per cent of patients, during Billroth II gastrectomy .
•Enucleation of islet cell tumours of the pancreas can result in
fistulae.
•Duodenal or ampullary bleeding following sphincterotomy .
Pancreatitis is inflammation of the
gland parenchyma of the pancreas
.
For clinical purposes, it is useful to divide
pancreatitis into :
•Acute, which presents as an emergency, and
• Chronic, which is a prolonged and frequently
lifelong disorder resulting from the development of
fibrosis within the pancreas.
