gall bladder & pancreas

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WELCOME

Dewan Institute Of Rehabilitation Sciences

Shaheed Benazir BhuttoDewan University2

GALL BLADDER:

It is a small sac-shaped organ beneath the liver, in which bile is stored after secretion by the liver and before release into the intestine.

The gallbladder squeezes stored bile into the small intestine through a series of tubes called ducts.

POSITION:

It lies just beneath the right lobe of theliver. In adults, the gallbladder measures approximately 8 centimetres (3.1in) in length and 4 centimetres (1.6in) in diameter when fully distended. The gallbladder has a capacity of about 100mL.

Fig. Gallbladder Position.

STRUCTURE :

The gall bladder is a hollow organ. Its shaped is like a tapered sac, with the open end opening into thebiliary treeand thecystic duct.

PARTS OF GALL BLADDER :

Anatomically, the gallbladder is divided into three sections:

Fig. Parts of Gall bladder.

Fundus:Thefundusis a rounded end that faces the front of the body.

2. Body:Thebodyis in contact with the liver, lying in the gallbladderfossa, a depression at the bottom of the liver.

3. Neck:Thenecktapers and is continuous with thecystic duct, part of thebiliary tree. The cystic duct unites with the common hepatic ductto become thecommon bile duct. At the junction of the neck of the gallbladder and the cystic duct.

LAYER OF GALL BLADDER:

The inner most layer is epithelium.Thesubmucosais a thin layer of loose connective tissue with smaller blood vessels.The muscular layer, formed bysmooth muscular tissue.Theserosa is a thick layer that covers the outer surface of the gallbladder, and is continuous with theperitoneum.

Fig. Layers of Gall bladder.

FUNCTION OF GALL BLADDER:

Lymphatic drainage of GB:

1. Terminate @ celiac nodes2. Cystic node at neck of GBa. Actually a hepatic nodeb. Lies at junction of cystic & common hepatic ducts3. Other lymph vessels also drain into hepatic nodes.

Arterial Supply to the Gallbladder

Cystic artery

Right hepatic arteryProper hepatic arteryCommon hepatic artery

Common Hepatic Artery

Proper Hepatic Artery

Gastroduodenal ArteryBlood Supply:

- Cystic artery branch of Rt. Hepatic artery

- Cystic vein end in portal vein

- Small branches ( arteries and veins run between liver and gall bladder

Nerve supplySympathetic and parasympathetic from celiac plexusParasympathetic ---- vagous nerveHormone cholecystokini duodenum

Extra hepatic biliary system

Rt. hepatic duct+Lt hepatic ductCommon hepatic duct+Cystic ductCommon bile duct

4cm Descend in free edge of lesser omentum Supra duodenal part Retro duodenal part Retro pancreatic part

Common bile duct

Bile duct. parts and relations1st partLocated in right free margin of lesser omentum in front of the opening into the lesser sac (Epiploic opening) Rt to hepatic artery and portal vein

2nd partBehind the 1st part of the duodenumRt to the gastroduodenal artery.3 rd partPosterior surface of the head of the pancreasContact with main pancreatic ductRelated with IVC, gastroduodenal artery, portal veinEnd in the half second part of duodenum at ampulla of Vater

Fig. Layers of Gall bladder.

Ampulla of Vater with CBD and Pancreatic DuctAmpulla of Vater

Hepaticopancreatic ampulla(Ampulla of Vater)Theampulla of Vater, also known as the hepatopancreaticampulla,or as hepatopancreatic duct, is formed by the union of the pancreatic duct and the common bile duct.

Blood supply of CBD Small arteries supplying CBD a. Arise from cystic artery b. Posterior branch of superior pancreaticoduodenal artery

CLINICAL DISORDERS:GALL STONE: (cholelithiasis)For unclear reasons, substances in bile can crystallize in the gallbladder, forming gallstones. Common and usually harmless, gallstones can sometimes cause pain, nausea, or inflammation.Cholecystitis: Inflammation of the gallbladder, often due to a gallstone in the gallbladder. Cholecystitis causes severe pain and fever, and can require surgery when inflammation continues or recurs.

CLINICAL DISORDERS:

Gallbladder cancer: Although rare, cancer can affect the gallbladder. It is difficult to diagnose and usually found at late stages when symptoms appear. Symptoms may resemble those of gallstones.Gallstone pancreatitis: An impacted gallstone blocks the ducts that drain the pancreas. Inflammation of the pancreas results, a serious condition.

REMOVAL OF GALL BLADDER:Acholecystectomyis a procedure in which the gallbladder is removed. It may be removed because of recurrent gallstones, and is considered an elective procedure. A cholecystectomy may be anopenprocedure, or one conducted bylaparoscopy. In the surgery, the gallbladder is removed from the neck to the fundus.

Definition:

POSITION:

STRUCTURE: The pancreas is a secretory structure with an internal hormonal role (endocrine) and an external digestive role (exocrine). It has two main ducts, the mainpancreatic duct, and the accessorypancreatic duct. These drain enzymes through the ampulla of Vater into the duodenum.

PARTS OF PANCREAS:

There are four parts of Pancreas. They are:

Head.Neck.Body.Tail.

Fig. Parts of Pancreas.

Head:It is disc shaped lies within the concavity of the duodenum A part of the head extends to the left behind the superior mesenteric vessels and is called the Uncinate process.

Neck: It is the constricted portion of the pancreas connects the head to the body. It lies in front of the beginning of the portal vein.

Fig. Parts of Pancreas.

3. Body:Runs upward and to the left across the midline It is somewhat triangular in cross section.Three surfaces: AnteriorPosteriorinferior.

Anterior Surface:1- Covered by peritoneum of post. Wall of lesser sac2- Tuber omental: where the ant. surface of pancreas join the neck.

b. Posterior Surface:- devoid of peritoneum - in contact with 1- the aorta2- the splenic vein3- the left kidney and its vessels4- the left suprarenal gland5- the origin of the superior mesenteric artery

c. Inferior Surface:

- Narrow on the right but broader on the leftCovered by peritoneum of greater omentum lies upon the duodenojejunal flexure - Some coils of the jejunum- its left extremity rests on the left colic flexure.4. Tail:- Anatomically left with the hilum of the spleen.

Fig. Parts of Pancreas.

Fig. Parts of Pancreas.

Pancreatic Ducts:The Main Duct:

Begins in the tail and runs the length of the glandReceiving numerous tributaries on the way . It opens into the second part of the duodenum at about its middle with the bile duct on the major duodenal papilla

Fig. Pancreatic Ducts.

Pancreatic Ducts:The Accessory Duct:

- When present, drains the upper part of the head Then opens into the duodenum a short distance above the main duct on the minor duodenal papilla . The accessory duct frequently communicates with the main duct

Fig. Pancreatic Ducts.

Blood Supply Of Pancreas:ArteriesThe splenic artery. The superior pancreaticoduodenal artery. Inferior pancreaticoduodenal arteries artery.

VeinsThe corresponding veins drain into the portal system.

Fig. Pancreatic Blood Supply.

Lymphatic Drainage

Lymph nodes are situated along the arteries that supply the gland. The efferent vessels ultimately drain into the celiac and superior mesenteric lymph nodes.

Nerve supplySympathetic and parasympathetic chainParasympathetic = vagus nerve

Congenital defects of pancreas

Annular Pancreas.Ectopic Pancreas.

Annular Pancreas:Pancreas encircle Duodenum.It is a rare type.Ectopic Pancreas.Outside the Gastrointestinal Tract.It is the most common type.

Acute Pancreatitis:

Common acute abdomenLocal inflammatory change in pancreasLife-threatening inflammatory disorder of the pancreasVariable severity and duration

Acute Pancreatitis:

laboratory test Amylase level in serum and in urineLiver function, PaCO2 ,serum calcium.Diagnostic paracentesis

Acute Pancreatitis:

Image findingsBUSCT ERCPMRCPAbdomen plain film

Severe Acute PancreatitisSevere Acute pancreatitis (SAP)Complicated with MODS(Multiple organ disorder syndrome.Necrosis, abscess, pseudocystOr both

Q?U?E?S?T?I?O?N?S?

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