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Budi Irwan

Division of Digestive Surgery

Department of Surgery

Faculty of Medicine

University of North sumatera

The Pancreas in situ

Right lobe of liver

Falciform ligament

Gallbladder

Pancreas

Duodenum

L-3

Pancreas in situ

Duodenum

Head of Pancreas

Introduction, continued

L. Body related

posteriorly to left

crus, left adrenal, crus, left adrenal,

left renal vein, and

splenic vein

K. Celiac Axis (trunk, artery) lies superior to body

Duct of Wirsung (Main pancreatic duct)

Duct of Santorini

Acute Pancreatitis

1. Diffuse enlargement

2. Less echogenic due

to edema

3. Echogenicity usually >

liver parenchyma

Pancreatic Tumors in the Head

• Tumors in the head

may compress biliary

ducts or pancreatic

ducts

In Tail of

Pancreas: Sx

a. Often silent until local

metastasis occurs

b. May metastasize to:

1. para-aortic lymph

nodes

2. spleen

The Whipple Procedure

Pancreaticoduodenectomy - Whipple

pancreatic head

duodenum

gallbladder

bile duct

+/- gastric antrum

Gall Bladder Disease

Common Symptoms of Gallbladder Disease

• Severe and intermittent pain in the right

upper abdomen. This pain can also spread to

the chest, shoulders or back.the chest, shoulders or back.

• Sometimes this pain may be mistaken for a

heart attack.

• Chronic indigestion and nausea.

Cholecystitis

STONES

• Block

• Traumatize

• Cause Pain• Cause Pain

• May be symptomatic

• Usually made of

cholesterol (80%)

• or Calcium (20%)

RISK FACTORS

The three most important risk factors for

developing gallstone disease are

• Obesity

• Weight loss • Weight loss

• Increasing age and

• Gender

• Geography and ethnicity

Medical Management

• An oral medication such as ursodiol, dissolves

cholesterol gallstones

• Surgery 1) Open & 2) Lap

• Shock wave lithotripsy• Shock wave lithotripsy

OPEN CHOLECYSTECTOMY

• Location of incision / breathing

• Wound care & care of “T” tube if used

• Pre & post op teaching

• Dietary management• Dietary management

Lap Cholecystectomy

Watch for

indications that

there is:

• Infection

• Hemorrhage

• Damage to

adjacent organs