Pancreas-Relations-Trauma of the Pancreas-Cancer of the Head of the Pancreas and the Bile Duct-The Pancreatic Tail and Splenectomy-Diagnosis of Pancreatic Disease

Pancreas

The pancreas is both an exocrine and endocrine gland.
 The exocrine portion of the gland function is  producing secretion that contains enzymes capable of hydrolyzing proteins, fats, and carbohydrates. islets of Langerhans  of the gland, the pancreatic islets (The endocrine portion), produces the hormones insulin and glucagon, which play a key role in carbohydrate metabolism.

It is is an elongated structure that lies in the epigastrium and the left upper quadrant. It is soft and lobulated and situated on the posterior abdominal wall behind the peritoneum. It crosses the transpyloric plane. The pancreas is divided into a head, neck, body, and tail.

The head of the pancreas is disc shaped and lies within the concavity of the duodenum. the uncinate process,is  A part of the head extends to the left behind the superior mesenteric vessels .

The neck which connects the head to the body is the constricted portion of the pancreas and. It lies in front of the beginning of the portal vein and the origin of the superior mesenteric artery from the aorta.

The body runs upward and to the left across the midline . It is somewhat triangular in cross section. The tail passes forward in the splenicorenal ligament and comes in contact with the hilum of the spleen

Relations

■■ Anteriorly: From right to left: the transverse colon and the attachment of the transverse mesocolon, the lesser sac, and the stomach

■■ Posteriorly: From right to left: the bile duct, the portal and splenic veins, the inferior vena cava, the aorta, the origin of the superior mesenteric artery, the left psoas muscle, the left suprarenal gland, the left kidney, and the hilum of the spleen

Trauma of the Pancreas

The pancreas is is well protected because it is deeply placed within the abdomen and  protected by the costal margin and the anterior abdominal wall. However, blunt trauma, such as in a sports injury when a sudden blow to the abdomen occurs, can compress and tear the pancreas against the vertebral column. The pancreas is most commonly damaged by gunshot or stab wounds. Damaged pancreatic tissue releases activated pancreatic enzymes that produce the signs and symptoms of acute peritonitis.

Cancer of the Head of the Pancreas and the Bile Duct

cancer of the head of the pancreas often causes obstructive jaundice Because of the close relation of the head of the pancreas to the bile duct,.

The Pancreatic Tail and Splenectomy

The presence of the tail of the pancreas in the splenicorenal ligament sometimes results in its damage during splenectomy. The damaged pancreas releases enzymes that start to digest surrounding tissues, with serious consequences

Diagnosis of Pancreatic Disease

The deep location of the pancreas sometimes gives rise to problems of diagnosis for the following reasons:

■■ Pain from the pancreas is commonly referred to the back.

■■ Because the pancreas lies behind the stomach and transverse colon, disease of the gland can be confused with that of the stomach or transverse colon.

■■ Inflammation of the pancreas can spread to the peritoneum forming the posterior wall of the lesser sac. This in turn can lead to adhesions and the closing off of the lesser sac to form a pseudocyst.

Surface Landmarks of the Abdominal Viscera-Gallbladder-Spleen-Liver-Pancreas-Kidneys-Stomach-Aorta

Surface Landmarks of the Abdominal Viscera

Gallbladder

The gallbladder is a pear-shaped sac,The fundus of the gallbladder lies opposite the tip of the right ninth costal cartilage—that is, where the lateral edge of the right rectus abdominis muscle crosses the costal margin

 

Spleen

It lies in the left upper quadrant and lies under cover of the 9th, 10th, and 11th ribs. Its long axis corresponds to that of the 10th rib, and in the adult it does not normally project forward in front of the midaxillary line. In infants, the lower pole of the spleen may just be felt

Liver

The liver is a large organ that occupies the upper part of the abdominal cavity is covered under  the lower ribs, and most of its bulk lies on the right side.
In infants, until about the end of the third year, the lower margin of the liver extends one or two fingerbreadths below the costal margin. In the adult who is obese or has a welldeveloped right rectus abdominis muscle, the liver is not palpable. In a thin adult, the lower edge of the liver may be felt a fingerbreadth below the costal margin. It is most easily felt when the patient inspires deeply and the diaphragm contracts and pushes down the liver.

 

Pancreas

The pancreas lies across the transpyloric plane. The head lies below and to the right, the neck lies on the plane, and the body and tail lie above and to the left.

 

Kidneys

the left kidney lies at a slightly  higher level than The right kidney (because of the bulk of the right lobe of the liver), and the lower pole can be palpated in the right lumbar region at the end of deep inspiration in a person with poorly developed abdominal muscles. Each kidney moves about 1 in. (2.5 cm) in a vertical direction during full respiratory movement of the diaphragm. The normal left kidney, which is higher than the right kidney, is not palpable. On the anterior abdominal wall, the hilum of each kidney lies on the transpyloric plane, about three fingerbreadths from the midline. On the back, the kidneys extend from the 12th thoracic spine to the 3rd lumbar spine, and the hili are opposite the 1st lumbar vertebra

Stomach

The stomach is a dilated part of the alimentary canal between the esophagus and the small intestine ,The cardioesophageal junction lies about three fingerbreadths below and to the left of the xiphisternal junction (the esophagus pierces the diaphragm at the level of the10th thoracic vertebra).

The pylorus lies on the transpyloric plane just to the right of the midline. The lesser curvature lies on a curved line joining the cardioesophageal junction and the pylorus. The greater curvature has an extremely variable position in the umbilical region or below.

Aorta

The aorta lies in the midline of the abdomen and bifurcates below into the right and left common iliac arteries opposite the 4th lumbar vertebra—that is, on the intercristal plane. The pulsations of the aorta can be easily palpated through the upper part of the anterior abdominal wall just to the left of the midline.