Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ TEST TAKING TIP ++ Test Taking Tip Neuroendocrine tumors of the pancreas are a favorite. Know the clinical presentation, diagnosis, and medical and surgical treatment particularly in conjunction with multiple endocrine neoplasia (MEN) syndromes. +++ ANATOMY/PHYSIOLOGY +++ What is the duct of Wirsung? ++ Major pancreatic duct that forms in the pancreatic head and descends inferiorly and joins the intrapancreatic portion of the common bile duct to form the common pancreaticobiliary channel proximal to the ampulla of Vater. +++ What is the duct of Santorini? ++ Accessory pancreatic duct that drains the anterior portion of the pancreatic head ++ FIGURE 16-1. Arterial supply to the pancreas. Multiple arcades in the head and body of the pancreas provide a rich blood supply. The head of the pancreas cannot be resected without devascularizing the duodenum unless a rim of pancreas containing the pancreaticoduodenal arcade is preserved. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.) Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ What is the blood supply to the head of the pancreas? ++ Anterior and posterosuperior pancreaticoduodenal arteries from the gastroduodenal artery that form collaterals with branches of the superior mesenteric artery (SMA) (inferoanterior and posterior pancreaticoduodenal arteries) +++ What is the venous drainage? ++ It parallels the arterial supply; drains into the portal system via the superior mesenteric and splenic veins. +++ Which enzyme is responsible for pancreatic necrosis in presence of bile? ++ Phospholipase A +++ What defines a high-output pancreatic fistula? ++ Output in excess of 200 mL/d +++ BENIGN PANCREATIC DISEASES +++ What are the etiologies of acute pancreatitis? ++ Gallstones and alcohol account for >90% of cases. Other causes include hyperlipidemia, hypercalcemia, trauma, pancreatic duct obstruction, ischemia, drugs, familial, and idiopathic. +++ What are some common medications implicated as possible etiologies of pancreatitis? ++ Azathioprine, furosemide, thiazides, sulfonamide, tetracycline, steroids, estrogens, ethacrynic acid, and H2 blockers +++ What metabolic conditions could cause pancreatitis? ++ Hyperlipidemia (types I, IV, and V have been implicated); hypercalcemia, which is most commonly found with hyperparathyroidism that could lead to intraductal precipitation of calcium +++ How is acute pancreatitis diagnosed? ++ The diagnosis of pancreatitis requires 2 of the following 3 features: abdominal pain characteristic of acute pancreatitis, a serum amylase or lipase level at least 3 times the upper limit of normal, and characteristic findings of acute pancreatitis on computed tomography (CT). +++ Which enzyme is implicated ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth