Gastrointestinal and genitourinary systems
Helen Butler, Neel Sharma, Tiago Villanueva in Student Success in Anatomy - SBAs and EMQs, 2022
17 Which of the following statements is correct with regard to the ampulla of Vater? It is synonymous with the lower oesophageal sphincter.It opens into the third part of the duodenum.It is the point of entry of the accessory pancreatic duct into the duodenum.It is the point of entry of the cystic duct into the second part of the duodenum.It is the point of entry of the pancreatic duct and common bile duct into the duodenum.
Major Digestive and Endocrine Glands
George W. Casarett in Radiation Histopathology: Volume II, 2019
Essentially, the pancreas contains two glands, an exocrine gland and an endocrine gland (Figure 3A). The exocrine component, which is the largest part, is a typical purely serous gland (Figure 3B) that secretes from one type of cell, cytologically, a digestive juice containing several digestive proenzymes which give rise to trypsin, amylase, lipase, and an enzyme like rennin. The secretion of this juice is stimulated by a hormone (secretin) formed in the duodenal mucosa, or it can be induced more directly via the vagus nerve supply. The pancreatic duct system drains into the duodenum via a main excretory duct. The endocrine component consists of diffusely scattered small islands (Islets of Langerhans) of epithelial cells (Figure 3C), an alcoholic extract of which is insulin, a hormone that regulates carbohydrate metabolism.
Cystic Fibrosis and Pancreatic Disease
Praveen S. Goday, Cassandra L. S. Walia in Pediatric Nutrition for Dietitians, 2022
Clinical signs and symptoms result from effects of pancreatic duct obstruction or direct pancreatic acinar cell injury that lead to premature activation of the pancreatic digestive enzymes in the pancreas itself rather than in the intestines. The resulting inflammation leads to symptoms of epigastric pain which may radiate to the back, as well as nausea and vomiting. If due to biliary disease such as gallstones, children may have associated jaundice and scleral icterus. However, in younger children, symptoms can be non-specific and may include non-focal pain or irritability. Thus the diagnosis is made clinically with a combination of two out of three of the following: suggestive abdominal pain or symptoms, levels of serum amylase and/or lipase that are greater than three times the upper limit of normal, and imaging findings such as a diffusely enlarged pancreas and surrounding fluid (Table 19.4).
Heating of metallic biliary stents during magnetic hyperthermia of patients with pancreatic ductal adenocarcinoma: an in silico study
Published in International Journal of Hyperthermia, 2022
Oriano Bottauscio, Irene Rubia-Rodríguez, Alessandro Arduino, Luca Zilberti, Mario Chiampi, Daniel Ortega
The bile duct is a tube that connects the gallbladder and the duodenum in the small intestine to transport there the bile, where it performs essential tasks for food digestion [11]. This tube is part of the biliary tree, which starts in the liver. The part of this tree that comes out from the gallbladder is called cystic duct which is joined along with the common hepatic duct into the common bile duct. This goes through the pancreas and joins with the pancreatic duct, ending up in the ampulla of Vater in the duodenum. It is very common to see that the tumor blocks this path in pancreatic ductal adenocarcinoma (PDAC) patients, avoiding the bile to reach the small intestine [12]. This is clinically shown as jaundice (yellow colored skin) due to the accumulation of bilirubin in the blood, which is a component of the bile.
Clinical case report: endoluminal thermal ablation of main pancreatic duct for patients at high risk of postoperative pancreatic fistula after pancreaticoduodenectomy
Published in International Journal of Hyperthermia, 2021
Benedetto Ielpo, Eva M. Pueyo-Périz, Aleksandar Radosevic, Anna Andaluz, Enrique Berjano, Luis Grande, Patricia Sánchez-Velázquez, Fernando Burdío
A 56-year-old man with a BMI of 30.2 was admitted to our center (Hospital del Mar-IMIM, Barcelona, Spain) with painless jaundice in February 2020. Computerized tomography (CT) showed a 2.7 cm mass in the pancreatic head, considered as resectable. Abdominal magnetic resonance (MR) revealed a main pancreatic duct <2 mm in diameter. A biliary stent was endoscopically placed to reduce jaundice and PD was indicated. During surgery, an important peripancreatic and liver hilum edema component was observed mainly due to the cancer itself and the biliary stent associated with very soft pancreas texture. As the association of a long intervention (almost 5 h), soft pancreas and confirmation of the main pancreatic diameter <2 mm suggested a very high likelihood of developing POPF, we decided to perform ETHA of the main pancreatic duct prior to Blumgart-type pancreatico-jejunal anastomosis with abdominal drainage. The postoperative period was uneventful, with slightly elevated amylase levels (40 IU/L) in the drainage fluid on the 3rd postoperative day, with a mean drainage output of 20 cc per day and a normal CT scan (Figure 2(a)). Drainage was removed on the 10th postoperative day and the patient was discharged 2 days later. Histopathological examination revealed a pT3N1 moderately differentiated adenocarcinoma with all margins being negative. One month after surgery, fecal elastase was 64 m μg/gr, demonstrating exocrine pancreatic insufficiency due to ETHA. To date, the patient has had no further symptoms related to exocrine pancreatic insufficiency such as steatorrhea or the need for substitute pancreatic enzymes.
Progression of pancreatic morphology in chronic pancreatitis is not associated with changes in quality of life and pain
Published in Scandinavian Journal of Gastroenterology, 2020
Emily Steinkohl, Søren Schou Olesen, Asbjørn Mohr Drewes, Jens Brøndum Frøkjaer
We assessed the pancreatic gland volume (reflecting the degree of pancreatic atrophy) by segmentation of the entire gland on the FIESTA images. The gland volume was automatically calculated (by multiplication with slice thickness and summed for all slices). Moreover, the following MRI parameters were measured in the pancreatic apparent diffusion coefficient (ADC) based on DWI (reflecting the degree of tissue fibrosis) and pancreatic fat signal fraction (FSF) obtained using the Dixon images with quantification of the pancreatic fat and water signal according to the formula:SIfat-only/(SIwater-only + SIfat-only).The anterior-posterior (AP) diameter of the main pancreatic duct in the pancreatic head was measured, reflecting ductal changes. All regions of interest for diffusion and the assessment of fat content were the same size and position within each subject. The ROIs were carefully positioned on the slice with the widest diameter of the pancreatic head and effort was made to avoid ducts, vessels and cystic lesions. See Madzak et al. and Steinkohl et al. for a detailed description of the assessment of the imaging parameters [10,15].
Related Knowledge Centers
- Acute Pancreatitis
- Major Duodenal Papilla
- Minor Duodenal Papilla
- Pancreas
- Pancreatic Juice
- Digestion
- Common Bile Duct
- Gallstone
- Ampulla of Vater
- Duodenum