Which of the following parts of the pancreas is intraperitoneal:
The pancreas lies mostly posterior to the stomach. It extends across the posterior abdominal wall from the duodenum on the right, to the spleen on the left. It lies in the epigastric region and left hypochondrium. The pancreas is a retroperitoneal organ (except for a small part of its tail) and consists of a head, uncinate process, neck, body and tail.
Surface Markings of the Pancreas. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Relations of the Pancreas. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
The pancreatic duct begins in the tail of the pancreas and passes to the right, through the body and to the head where it turns inferiorly and joins the bile duct forming the hepatopancreatic ampulla (ampulla of Vater) which enters the second part of the duodenum at the major duodenal papilla. The accessory pancreatic duct empties into the duodenum just above the major duodenal papilla at the minor duodenal papilla.
Pancreatic Duct. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
The arterial supply to the pancreas is primarily derived from the splenic artery from the coeliac trunk, assisted by branches from the gastroduodenal artery (from the common hepatic artery from the coeliac trunk), and from the superior mesenteric artery.
Venous drainage of the head of the pancreas is via pancreaticoduodenal veins into the superior mesenteric vein and portal vein. Venous drainage of the body and tail of the pancreas is via pancreatic veins into the splenic vein.
Lymphatics draining the pancreas empty into the pancreaticosplenic nodes and the pyloric nodes, which in turn drain into the superior mesenteric and celiac pre-aortic lymph nodes.
Visceral afferent fibres travel in the greater and lesser splanchnic nerves. The segmental level of innervation is T6 - T10. Pain typically radiates to the middle of the back due to irritation of the parietal peritoneum covering the pancreas.
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Biochemistry | Normal Value |
---|---|
Sodium | 135 – 145 mmol/l |
Potassium | 3.0 – 4.5 mmol/l |
Urea | 2.5 – 7.5 mmol/l |
Glucose | 3.5 – 5.0 mmol/l |
Creatinine | 35 – 135 μmol/l |
Alanine Aminotransferase (ALT) | 5 – 35 U/l |
Gamma-glutamyl Transferase (GGT) | < 65 U/l |
Alkaline Phosphatase (ALP) | 30 – 135 U/l |
Aspartate Aminotransferase (AST) | < 40 U/l |
Total Protein | 60 – 80 g/l |
Albumin | 35 – 50 g/l |
Globulin | 2.4 – 3.5 g/dl |
Amylase | < 70 U/l |
Total Bilirubin | 3 – 17 μmol/l |
Calcium | 2.1 – 2.5 mmol/l |
Chloride | 95 – 105 mmol/l |
Phosphate | 0.8 – 1.4 mmol/l |
Haematology | Normal Value |
---|---|
Haemoglobin | 11.5 – 16.6 g/dl |
White Blood Cells | 4.0 – 11.0 x 109/l |
Platelets | 150 – 450 x 109/l |
MCV | 80 – 96 fl |
MCHC | 32 – 36 g/dl |
Neutrophils | 2.0 – 7.5 x 109/l |
Lymphocytes | 1.5 – 4.0 x 109/l |
Monocytes | 0.3 – 1.0 x 109/l |
Eosinophils | 0.1 – 0.5 x 109/l |
Basophils | < 0.2 x 109/l |
Reticulocytes | < 2% |
Haematocrit | 0.35 – 0.49 |
Red Cell Distribution Width | 11 – 15% |
Blood Gases | Normal Value |
---|---|
pH | 7.35 – 7.45 |
pO2 | 11 – 14 kPa |
pCO2 | 4.5 – 6.0 kPa |
Base Excess | -2 – +2 mmol/l |
Bicarbonate | 24 – 30 mmol/l |
Lactate | < 2 mmol/l |