Pancreas

A. General features. The pancreas is a retroperitoneal organ that has five parts.

1. The uncinate process develops embryologically from the ventral pancreatic bud.

2. The head develops embryologically from the ventral pancreatic bud and the dorsal pancreatic bud. It lies in the duodenal C-loop.

3. The neck develops embryologically from the dorsal pancreatic bud. It lies at the confluence of the inferior mesenteric vein and splenic vein.

4. The body develops embryologically from the dorsal pancreatic bud.

5. The tail develops embryologically from the dorsal pancreatic bud. It is related to the spleen.

B. Clinical considerations

1. An annular pancreas occurs when the ventral pancreatic bud fuses with the dorsal pancreatic bud both dorsally and ventrally, forming a ring of pancreatic tissue around the duodenum. It is associated with obstruction of the duodenum shortly after birth.

2. Acute pancreatitis is inflammation of the pancreas that usually is associated with biliary tract disease or alcoholism. Clinical findings include: pain in the epigastric region that radiates to the back, nausea, vomiting, elevated amylase or lipase levels, and retroperitoneal hemorrhage that may lead to flank ecchymosis (Turner sign) or periumbilical ecchymosis (Cullen sign).

3* Pancreatic adenocarcinoma is a very aggressive malignant tumor that usually occurs within the head of the pancreas. It has a poor prognosis and usually has already metastasized at the time of presentation. Clinical findings include: epigastric pain that radiates to the back, weight loss, and obstructive jaundice. Surgical treatment is pancreaticoduodenectomy (Whipple procedure), which removes the head of the pancreas, the duodenum, the distal common bile duct, the gallbladder, and the distal stomach.

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