25

CASE 25


A 55-year-old man with a history of alcohol abuse presents to the emergency department with chronic epigastric pain radiating to the back and jaundice. He comments that the pain is aggravated after eating and after an evening of alcohol consumption, and he also complains of nausea and vomiting and feeling full after consuming small amounts of food (early satiety). An abdominal CT scan revealed a dilated main pancreatic duct and several pseudocysts of the pancreas. Ultimately, a diagnosis of chronic pancreatitis was made.



WHAT ARE THE PARTS OF THE PANCREAS?


The pancreas, which resembles a sea horse lying transversely, has the following parts (Fig. 3-40):


• Head. The hooklike prolongation of the head is called the uncinate process.

• Neck

• Body

• Tail

image

FIGURE 3-40 Pancreas.


(Drake R, Vogl W and Mitchell A: Gray’s Anatomy for Students. Churchill Livingstone, 2004. Fig. 4-87.)



WHAT ARE THE ANATOMICAL RELATIONSHIPS OF THE PANCREAS?


The pancreas has the following anatomical relationships (Fig. 3-41):


• Rests in the epigastric and left hypochondriac regions along the posterior abdominal wall

• Lies across the vertebral bodies of L1-L3

• Lies posterior to the stomach

• Transverse colon attaches to its anterior border

image

FIGURE 3-41 Abdominal CT scan showing the anatomical relationships of the pancreas.


(Drake R, Vogl W and Mitchell A: Gray’s Anatomy for Students. Churchill Livingstone, 2004. Fig. 4-88.)


The four regions of the pancreas have the following anatomical relationships:


• Head. The head fits into the C-shaped curve of the duodenum. Its posterior surface lies on the inferior vena cava, right renal vessels, and the left renal vein as it empties into the inferior vena cava. The uncinate process hooks around the superior mesenteric vessels to assume its position posterior to these vessels. The common bile duct passes in a groove along the posterosuperior surface of the head and may be embedded in it.

• Neck. The superior mesenteric vessels groove its posterior surface and the superior mesenteric and splenic veins converge to form the portal vein posterior to the neck. The neck lies next to the pylorus of the stomach, and its anterior surface is covered by peritoneum.

• Body. The peritoneum lines its anterior surface. Its posterior surface contacts the aorta, superior mesenteric artery, left adrenal gland, left kidney, and the left renal vessels. The splenic vein also is in contact with its posterior surface and may even penetrate the gland.

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 25

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