Gall Bladder & Pancreas.

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1. WELCOME

2. Dewan Institute Of Rehabilitation Sciences Shaheed Benazir Bhutto Dewan University 2

3. 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.

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

5. Fig. Gallbladder Position.

6. STRUCTURE : The gall bladder is a hollow organ. Its shaped is like a tapered sac, with the open end opening into the  biliary tree and the cystic duct.

7. PARTS OF GALL BLADDER : Anatomically, the gallbladder is divided into three sections :

8. Fig. Parts of Gall bladder.

9. Fundus : The  fundus  is a rounded end that faces the front of the body. 2 . Body : The  body  is in contact with the liver, lying in the gallbladder  fossa , a depression at the bottom of the liver.

10. 3. Neck: The  neck  tapers and is continuous with the cystic duct, part of the  biliary tree. The cystic duct unites with the common hepatic duct to become the common bile duct. At the junction of the neck of the gallbladder and the cystic duct.

11. LAYER OF GALL BLADDER: The inner most layer is epithelium. The  submucosa  is a thin layer of loose connective tissue with smaller blood vessels. The muscular layer , formed by  smooth muscular tissue . The  serosa is a thick layer that covers the outer surface of the gallbladder, and is continuous with the peritoneum.

12. Fig. Layers of Gall bladder.

13. FUNCTION OF GALL BLADDER:

14. Lymphatic drainage of GB: 1. Terminate @ celiac nodes 2. Cystic node at neck of GB a. Actually a hepatic node b. Lies at junction of cystic & common hepatic ducts 3. Other lymph vessels also drain into hepatic nodes.

15. Arterial Supply to the Gallbladder Cystic artery Right hepatic artery Proper hepatic artery Common hepatic artery

16. Common Hepatic Artery Proper Hepatic Artery Gastroduodenal Artery Blood 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

17. Nerve supply Sympathetic and parasympathetic from celiac plexus Parasympathetic ---- vagous nerve Hormone  cholecystokini  duodenum

18. Extra hepatic biliary system Rt. hepatic duct + Lt hepatic duct ↓ Common hepatic duct + Cystic duct ↓ Common bile duct 4cm Descend in free edge of lesser omentum Supra duodenal part Retro duodenal part Retro pancreatic part Common bile duct

19. Bile duct……. parts and relations 1 st part Located 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

20. 2 nd part Behind the 1 st part of the duodenum Rt to the gastroduodenal artery. 3 rd part Posterior surface of the head of the pancreas Contact with main pancreatic duct Related with IVC, gastroduodenal artery, portal vein End in the half second part of duodenum at ampulla of Vater

21. Fig. Layers of Gall bladder.

22. Ampulla of Vater with CBD and Pancreatic Duct Ampulla of Vater

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

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

25. 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.

26. 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.

27. REMOVAL OF GALL BLADDER: A  cholecystectomy  is 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 an open procedure, or one conducted by laparoscopy. In the surgery, the gallbladder is removed from the neck to the fundus .

28. Definition:

29. POSITION :

30. 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 main  pancreatic duct , and the accessory  pancreatic duct . These drain enzymes through the ampulla of Vater into the duodenum .

31. PARTS OF PANCREAS: There are four parts of Pancreas. They are: Head. Neck. Body. Tail.

32. Fig. Parts of Pancreas.

33. 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.

34. Fig. Parts of Pancreas.

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

36. Anterior Surface: 1- Covered by peritoneum of post. Wall of lesser sac 2- Tuber omental    : where the ant. surface of pancreas join the neck . b. Posterior Surface: - devoid of peritoneum - in contact with 1- the aorta 2- the splenic vein 3- the left kidney and its vessels 4- the left suprarenal gland 5- the origin of the superior mesenteric artery 

37. c. Inferior Surface: - Narrow on the right but broader on the left Covered 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.

38. Fig. Parts of Pancreas.

39. Fig. Parts of Pancreas.

40. Pancreatic Ducts: The Main Duct: Begins in the tail and runs the length of the gland Receiving 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

41. Fig. Pancreatic Ducts.

42. 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

43. Fig. Pancreatic Ducts.

44. Blood Supply Of Pancreas: Arteries The splenic artery. The superior pancreaticoduodenal artery. Inferior pancreaticoduodenal arteries artery. Veins The corresponding veins drain into the portal system.

45. Fig. Pancreatic Blood Supply.

46. 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.

47. Nerve supply Sympathetic and parasympathetic chain Parasympathetic = vagus nerve

48. Congenital defects of pancreas Annular Pancreas. Ectopic Pancreas.

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

50. Acute Pancreatitis: Common acute abdomen Local inflammatory change in pancreas Life-threatening inflammatory disorder of the pancreas Variable severity and duration

51. Acute Pancreatitis: laboratory test Amylase level in serum and in urine L iver function, PaCO2 ,serum calcium. Diagnostic paracentesis

52. Acute Pancreatitis: Image findings BUS CT ERCP MRCP Abdomen plain film

53. Severe Acute Pancreatitis Severe Acute pancreatitis (SAP) Complicated with MODS(Multiple organ disorder syndrome. Necrosis, abscess, pseudocyst Or both

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