Abdomen_Pancrease & Extrahepatic Biliary System
-
Upload
ewijayapala -
Category
Documents
-
view
94 -
download
8
Transcript of Abdomen_Pancrease & Extrahepatic Biliary System
![Page 1: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/1.jpg)
Pancreas
![Page 2: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/2.jpg)
• A gland – Both exocrine and endocrine
• A retroperitoneal organ
• Like a thick upper end of a walking stick lying horizontally with the hook to the right side.
•At the level of L1 and L2.
•15-20 long•3cm wide•2cm thick
![Page 3: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/3.jpg)
• Entire organ lies posterior to the stomach separated from it by lesser sac
• Divided into head, neck, body and tail.
![Page 4: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/4.jpg)
• Head is moulded in the concavity of the duodenum
• Lies over the inferior vena cava and the, renal veins, right crus of the diaphragm and the bile duct.
• Uncinate process extends to the left and up from the posteroinferior boader of the head between the aorta and superior mesenteric vessles
![Page 5: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/5.jpg)
Root of the transverse mesocolon along the whole length of the gland
Pnacreaticoduodin-al artery
![Page 6: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/6.jpg)
• Neck is a narrow band just in front of the commencement of the portal vein.
• Bhind the pylorus
![Page 7: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/7.jpg)
• Body is triangular in cross section
• Three boarders – Superior, Anterior and Inferior
• Three surfaces – Anterior, Inferior and posterior
• A projection from the superior surface slightly to the left of the neck, is known as the Tuber omentale
![Page 8: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/8.jpg)
• Superior boarder – hepatic, coeliac and splenic arteris.
• Inferior boarder – Superior mesenteric artery
• Post. Surface – aorta with SMA, L.crus, L suprarenal and left kidney with vessels and splenic vein.
• Tail lies in the lienorenal ligament with the splenic vessels.
![Page 9: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/9.jpg)
• Ducts – Main and accessory • Main opens in common with the bile duct at
hepatopancreatic ampulla (of Vater) 8-10 cm distal to the pylorus.
• Accessory opens 2cm proximally.• They communicate each other.
![Page 10: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/10.jpg)
• Lymphatic – pancreaticosplenic, coeliac and superior mesenteric group of lymph nodes.
• Parasympathetic – Vagus - control secretion. (cholecytokinin-pancreozymin also contribute)
• Sympathetic – splanchnic - vasomotor.
![Page 11: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/11.jpg)
• Endocrine – insulin deficiency – Diabetes
• Exocrine deficiency – digestive problems
• Carcinoma of the head common – can obstruct bile duct, portal vein, even pylorus
• Developmental anomalies – Annular pancreas– Accessory pancreatic tissue– Inversion of pancreatic ducts.
![Page 12: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/12.jpg)
![Page 13: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/13.jpg)
Extrahepatic Biliary Apparatus
![Page 14: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/14.jpg)
• Right and left hepatic ducts
• Common hepatic duct
• Gall bladder
• Cystic duct
• Bile duct
![Page 15: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/15.jpg)
• Right and left hepatic ducts arise from the right and left lobes of the liver
• Anterior most structures at the porta hepatis
• Surgically only the junction of the two lies outside the liver.
• Common hepatic duct is located in the free edge of the lesser omentum.
![Page 16: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/16.jpg)
• Common hepatic duct = 3cm
• Joined by the cystic duct to form the bile duct
• Accessory hepatic ducts usually arise from the right lobe of the liver.
![Page 17: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/17.jpg)
• Gall bladder – inferior surface of the liver extending into the anterior boarder
• 7-10cm long and 30-50ml capacity
• Divided into Fundus, body and neck
• Fundus projects between rectus abdominis and 9th costal cartilage
• Posteriorly over the beginning of the transverse colon
![Page 18: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/18.jpg)
• Body lies on the fossa, in the inferior surface of the liver.
• Only the inferior surface is covered with the peritonium
• Mucus membrane of the neck is folded spirally to prevent the block
• Posteromedial wall of neck – Hartmann’s pouch
• Cystic vessels enter via loose areolar tissue in the upper part of the neck
![Page 19: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/19.jpg)
![Page 20: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/20.jpg)
3cm cystic duct
(8 cm)
![Page 21: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/21.jpg)
• Bile duct pathway and relations are important
![Page 22: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/22.jpg)
• Cystic artery – gall bladder and nearby ducts
• Post. Pancreaticoduodenal artery lower part of the bile duct
• Right hepatic artery – middle part of bile duct
• Accessory cystic from common hepatic artery or other branches may arise
![Page 23: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/23.jpg)
• Venous blood from gall bladder– Directly to liver & joins hepatic veins– 1-2 cystic veins
• Constantly present lymph nodes– Cystic node– A node at the anterior border of the epiploic
foramen.
![Page 24: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/24.jpg)
• Left and right vagi, right phrenic and sympathetic (T7-T9)
• As a result referred pain can occur at the stomach, right shoulder, right scapular
![Page 25: Abdomen_Pancrease & Extrahepatic Biliary System](https://reader036.fdocuments.in/reader036/viewer/2022081412/54506fa9b1af9f09098b4ca6/html5/thumbnails/25.jpg)
Clinical relevance
• Murphy’s sign
• Gall bladder investigation
• Cholelithiasis >biliary colic
• Cholecystectomy