[医学保健]胰腺疾病_.pptVIP

Pancreas胰腺疾病 Department of Surgery Ma Qingyong Anatomy The pancreas lies within the retroperitoneum in the upper abdomen, lying in front of the second lumber vertebra and ending in the splenic hilum. The gland can be divided into four portions-head, neck, body, and tail. uncinate process Anatomy The main pancreatic duct (the duct of Wirsung, 2~3 mm in diameter) courses along the gland from the tail to the head and joins the common bile duct just before entering the duodenum at the ampulla of Vater (85%). The accessory pancreatic duct (the duct of Santorini) enters the duodenum 2~2.5 cm proximal to the Vater. Anatomy Blood supply The superior pancreaticoduodenal artery arises from the gastroduedenal artery, runs parallel to the duodenum, and eventually meets the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery, to form an arcade. The splenic artery provides tributaries that supply the body and tail of the pancreas. pancreatic magna A Physiology Exocrine Function The external secretion consists of a clear, alkaline (pH 7.0~8.3) solution of 750~1000 ml/d containing digestive enzymes. Secretion is stimulated by the hormones secretin and cholecystokinin (CCK) and by parasympathetic vagal discharge. Secretin and CCK are synthesized, store, and released from duodenal mucosal cells in response to specific stimuli. Acid in the lumen of the duodenum causes the release of secretin, and luminal digestion products of fat and protein cause the release of CCK. Physiology Exocrine Function enzymes synthesized, stored (as zymogen granules), and released by the acinar cells of the gland, in response to CCK and vagal stinulation. Pancreatic enzymes are proteolytic, lipolytic, and emylolytic. Lipase and amylase are stored and secreted in active forms. The prolytic enzymes are secreted as inactive precursors and activated by the duodenal enzyme enterokinase. Other enzymes include ribonucleases and phospholipase A. Physiology Endocrin