The pancreas is a narrow, flat organ about six inches long, with a head, middle, and tail section. It is located below the liver, between the stomach and the spine, and its head section connects to the duodenum. Inside the pancreas, small ducts (tubes) feed fluids produced by the pancreas into the pancreatic duct.
This larger duct carries the fluids down the length of the pancreas, from the tail to the head, and into the duodenum. The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gall bladder into the small intestine. The bile duct and the pancreatic duct usually join just before entering the duodenum and so have a common opening into the small intestine.
The pancreas consists of two kinds of tissues : -
Exocrine :- which make powerful enzymes to digest fats, proteins, and carbohydrates. The enzymes normally are created and carried to the duodenum in an inactive form, then activated as needed. Exocrine tissue also makes bicarbonates that work to neutralize stomach acids.
Endocrine : - which produce the hormones insulin and glucagon and release them into the blood stream. These hormones regulate glucose transport into the body's cells and are crucial for energy production.
Parts of the Pancreas
There are 5 parts to the pancreas : -
uncinate process : - The part of the gland that bends backwards and underneath the body of the pancreas. Two very important blood vessels, the superior mesenteric artery and vein cross in front of the uncinate process.
head : - The widest part of the gland. It is found in the right part of abdomen, nestled in the curve of the duodenum which forms an impression in the side of the gland.
neck : - The thin section between the head and the body of the gland.
body : - The middle part of gland between the neck and the tail. The superior mesenteric blood vessels run behind this part of the gland.
tail : -The thin tip of gland in the left part of abdomen in close proximity with the spleen.
Pancreatic Diseases
The pancreas is a gland behind your stomach and in front of your spine. It produces juices that help break down food and hormones that help control blood sugar levels. Problems with the pancreas can lead to many health problems.
These include : -
Pancreatitis, or inflammation of the pancreas: This happens when digestive enzymes start digesting the pancreas itself
Pancreatic cancer
Cystic fibrosis, a genetic disorder in which thick, sticky mucus can also block tubes in your pancreas
Solid tumors of the pancreas
Adenocarcinoma : - an aggressive cancer that arises from the exocrine glands. (The exocrine glands produce pancreatic "juice," which contains enzymes that digest fats, proteins and carbohydrates in food. More than 95 percent of the cells in the pancreas are exocrine glands and ducts). Adenocarcinomas usually begin in the ducts of the pancreas, and 85 percent to 90 percent of all cancerous tumors of the pancreas are this type of tumor.
Neuroendocrine tumors : - A hormone-producing tumor (islet cell tumor) in the pancreas. One of the most common types of neuroendocrine tumors is a carcinoid tumor.
Cystic tumors of the pancreas
Many types of cysts can be found in the pancreas. Cysts can be benign, pre-malignant or malignant. Treatment depends upon the type of cyst. Cysts are often found during a CT scan or MRI scan done for other purposes.
Serous cystic neoplasm (SCN) : - a spongy, localized cyst in the pancreas that is usually benign. These cysts may be located anywhere in the pancreas. They may be removed surgically if they cause symptoms or if a diagnosis cannot be firmly defined by standard imaging and biopsies/fine needle aspiration.
Mucinous cystic neoplasm (MCN) : - 30 percent of cysts in the pancreas are this type, which ranges from benign to malignant. It is made up of cells that produce mucin, a component of mucus. About 70 percent to 90 percent of these cysts are found in the body or tail of the pancreas, and one-third are associated with invasive cancer of the pancreas.
Intraductal papillary mucinous neoplasms (IPMN) : - cysts consisting of mucin-producing tumors. They involve the main pancreatic duct or major side branches. These cysts are usually found in the head and neck of the pancreas or uncinate process of the pancreas (part of the head of the pancreas). IPMNs have a high potential for progressing from benign growths to invasive cancer.
Treatments
Surgery to Remove Tumors : -
The best chance for cure of pancreatic cancer is an early diagnosis and surgical removal of the cancer. Some patients with pancreatic cancer are candidates for surgery. All or part of the pancreas may be removed, depending on the location and size of the tumor, the stage of the disease and the patient's overall health. (If the cancer has spread beyond the pancreas, surgical removal will not cure this type of cancer.)
Pancreaticoduodenectomy (also called the Whipple procedure) : - surgery to remove a tumor in the head of the pancreas. The procedure involves removing the head of the pancreas, the duodenum (first part of the small intestine), gallbladder, part of the common bile duct and lymph nodes near the pancreas. Froedtert & The Medical College have performed many of these procedures and many patients from throughout the region are referred here for this surgery.
Pancreatectomy : - surgical removal of all or part of the pancreas. In a total pancreatectomy, the entire pancreas is removed, usually along with the spleen, gallbladder, common bile duct and portions of the small intestine and stomach.
In a distal pancreatectomy, only the body and tail of the pancreas are removed, leaving the head of the pancreas. After a total pancreatectomy, the body loses the ability to secrete insulin, enzymes and other substances. These conditions are treated with pancreatic enzyme replacement therapy, which supplies digestive enzymes, and with insulin injections.
Ampullectomy : - removal of tumors of the ampulla of Vater (the junction of the ducts from the liver and pancreas at the point where they enter the small intestine)
Enucleation : - removal of just the tumor in the pancreas without removing surrounding pancreas.
Other Pancreatic Surgery
Pancreaticojejunostomy (Puestow procedure) : - drainage of the pancreatic duct into the small intestine to relieve the pain of chronic pancreatitis due to obstruction of the duct.
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