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Chapter 23: Pancreas

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Which of the following statements regarding pancreatic anatomy is true?

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(A) The majority of the pancreas is drained through the major papilla by the duct of Santorini.

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(B) The minor papilla communicates with the small duct of Wirsung, draining the inferior head and uncinate process.

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(C) Nervous innervation of the pancreas arises in the superior mesenteric ganglion.

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(D) Venous drainage of the pancreas is into the inferior vena cava.

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(E) Arterial supply is from branches of the celiac axis and superior mesenteric artery (SMA).

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(E) The majority of the pancreas is drained through the minor papilla, rather than the major papilla, by the duct of Santorini. The major papilla communicates with the small duct of Wirsung, draining the inferior head and uncinate process. Nervous innervation of the pancreas is both sympathetic from the splanchnic nerves and parasympathetic from the vagus. The main pathways for pain sensation are the sympathetic nerves from the celiac ganglion (Fig. 23-2); therefore, splanchnicectomy targets the sympathetic nerves to alleviate pain from chronic pancreatitis.

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FIGURE 23-2. Pancreatic innervation. Reproduced with permission from Bell RH Jr. Atlas of pancreatic surgery. In: Bell RH Jr, Rikkers LF, Mulholland MW, eds. Digestive Tract Surgery: A Text and Atlas. Philadelphia: Lippincott-Raven; 1996:p 969.

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Arterial supply to the pancreas is from branches of the celiac artery and SMA, which converge via the superior and inferior pancreaticoduodenal arteries. The celiac axis arises from the abdominal aorta and most commonly gives rise to the splenic artery, the left gastric artery, and the common hepatic artery. The splenic artery courses along the posterior surface of the pancreatic body and tail and gives rise to branches that supply the pancreatic body and tail. The gastroduodenal artery (GDA) is the first branch off the common hepatic artery. Distal to the first portion of the duodenum, the GDA becomes the superior pancreaticoduodenal artery, which divides into anterior and posterior branches.

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The SMA gives rise to the inferior pancreaticoduodenal artery, which also divides into anterior and posterior branches. The inferior and superior pancreaticoduodenal arcades form an extensive collateral network with the superior pancreaticoduodenal arcades, supplying both the duodenum and head of the pancreas.

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Venous drainage of the pancreas is into the portal vein (Fig. 23-3). The superior venous arcades drain the pancreatic head either directly into the suprapancreatic portal vein or laterally into the retropancreatic portal vein. The anterior and inferior pancreaticoduodenal arcades drain the pancreatic head directly into the infrapancreatic SMV. The body and tail of the pancreas are drained into the splenic vein, which joins the SMV ...

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