University:
Texas Lutheran University
Course:
NURS 332 | Fundamental Nursing Concepts & Practice
Academic year:

2020
Views:

338

Pages:

20
Author:

TwoCyber

Pancreas is Retroperitoneal (posterior to stomach, transverse mesocolon, lesser omentum) at level of L2 Head: includes uncinate process & abuts Second part of duodenum. Neck: Portion overlying the Superior mesenteric Vein and splenic vein (Portal Vein) Tail: enter splenorenal ligaments, adjacent to splenic hilum ("Suspected to be injured during Splenectomy)) Ducts: Duct of Wirsung (Main Duct) Q runs entire length of pancreas, Joins CBD and empties into second part of duodenum ad ampulla of Vater Duct of Santorini (small duct) Q accessory duct often joining the duodenum more proximaly than ampulla of Vater. Sphincter of Oddi: Smooth muscle around ampulla of Vater. Blood supply Q Head Pancreatoduodenal Ant (sup, inf) Post (sup, inf) Dorsal pancreatic a. It's branch of Gastroduodenal artery That comes from Celiac trunk Neck, Body, tail: Splenic artery & Branches (Dorsal pancreatic artery) #notes if the head of pancreas is removed, duodenum must be removed because they share Same Blood supply Venous Drain similar routes like artery Nerve Supply: Sympathetic: Via splanchnic nerve Causes pain Celiac plexus block can be done for pain control in pancreatitis disease Parasympathetic: Vagus nerve branches Embryology: Development begins at 4th week of gestation from duodenal endoderm Two buds form, which rotate and fuse by 8th week Ventral pancreatic bud: uncinate process is part of the head Dorsal pancreatic bud: all other parts Portion of dorsal duct between the ampulla and the duodenum regresses; the main duct of the ventral pancreas leading to the duodenum is thus the definitive pancreatic duct Heterotopic pancreas: pancreatic tissue in abnormal location (such as stomach) Pancreas divisum: failure of dorsal and ventral ducts to fuse Majority of pancreatic drainage is accomplished via accessory spill duct of Santorini MC congenital anomaly of pancreas Mostly asymptomatic, rarely causing pain, recurrent pancreatitis May result in inadequate drainage requiring ERCP Annular pancreas: usually in infancy with duodenal obstruction (projectile vomiting) Caused by malrotation of ventral pancreas leading to a ring of pancreatic tissue around the second portion of the duodenum Pancreatitis & peptic ulcer can result Treatment is duodenojejunostomy Pancreas encircling the duodenum Do bypass Physiology Exocrine (85%) Secretion of 1-2 L/day, isosmotic, alkaline pH (7-8.3) fluid Containing Digestive enzymes. (break down carbs - lipid - protein) - Acinar Cells: secrete enzymes (chymotrypsin - trypsin - carboxypeptidase, amylase, lipase) These enzymes are activated in duodenum by enterokinase - Centroacinar and ductal cells: secrete water & electrolytes (Na+, K+, HCO3-) In response to Secretin stimulation Most potent endogenous stimulant Phases of Bicarbonate secretion Cephalic phase: Sight and smell of food activate Vagal fibers. Gastric acid secretion → duodenal acidification → Secretin → Pancreatic HCO3 release Gastric phase: antral distension and ingested protein release of gastrin → gastric acid secretion → duodenal acidification → Secretin → pancreatic HCO3 Intestinal phase: duodenal acid and bile stimulate Secretin. Ingested fat and protein in duodenum stimulate release of CCK → acinar cells release pancreatic enzyme Q Endocrine Islets of Langerhans - 2% of pancreatic wt Insulin: from Beta cells (glucose absorption & use) Anabolic Glucagon: from alpha cells (glycogenolysis and release of glucose) Catabolic Somatostatin: from Delta cells (inhibitory functions of GIT) Also inhibits glucagon and octreotide Gastrin: from G cells (stimulates ↑ acidity of Stomach in Zollinger Ellison syndrome) Acute pancreatitis Inflammation of pancreas due to parenchymal Autodigestion. By proteolytic enzymes *Most common Causes & Gallstones - Alecchal - Idiopathic (401) other causes (I GET SMASHED Thik powde Juice d Inkoputhik Gallstones Ethanol Tromme wading Scorpion bite Mumps (neus) Autoimmune Slecoid Hyper HputernicHypercalcemia ERCP Dragsscnuidqucocartions-Comellisin - Archuudutule - Methyl dors Extragen Diskanosive Valpoonde fleet omiding sul Feramite () Dihicks Tehnagin (1) - nivelutuntein (1) Azathioprin Signs and symplems: Q (immunosuppressive) *Sever Constant epigastric poun Sharf, Stapping Jaundice *Radiale te the back (vchouporitanical organ is is inmovated by colloc plesus) * pain Improve by sitting forward (Tripod position) or standing Vomiting on examination * low grade lever tackeypass, backyardio • upper cabdominad tenderness with guarding but No rebound if complicated and abdominal Destention No Dowed sound dua le udynamic lleus. (dw to destrulyle îmbakace & inflammation) *Sigers of hypotblemic shock dhee to massive rehopenleneal fluids sequestration a dehydratin and systemic, inflammatory response syndrome. *Cullen's sign: Blue discontion of pertumbastions in suver hemenhagic Panesgedetts Grey-Turner's sig of Plunks of inguinal ligamend For's signe *Tefany ( ca due to Fat spermification) Causes of Pancreatitis (Acquired) Gallstones Alcohol abuse Idiopathic Drugs Hyperlipidemia Hypercalcemia Scorpion sting Mumps Autoimmune Trauma ERCP Post-operative Infections Glasgow Imrie Criteria for Acute Pancreatitis 3 or more of the below in first 48hrs indicates a severe attack PaO2 <8kPa Age >55 years Neutrophils >15x10^9/L Calcium <2mmol/L Renal Function Urea >16mmol/L Enzymes LDH >600IU/L, AST >200IU/L Albumin <32g/L Sugar Glucose >10mmol/L

Pancreas Tutorial Notes

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