Vi Poma

2. Neck of PancreasNeck of Pancreas

4. •ตับอ่อน มีหน้าที่สำาคัญ 2 ประการ คือ
1.ต่อมมีท่อ(Exocrine) : มีหน้าท่ีสร้างน้้าย่อยท่ี

เรียกว่า
“น้้ำย่อยของตับอ่อน” (Pancreatic juice)

ประกอบด้วยเอ็นไซม์
(enzymes)
หลายชนิดซ่ึง
มีหน้าท่ี
ช่วยในการย่อยอาหารจ้าพวกแป้งโปรตีน

ไขมันให้มีขนาดเล็กลงจนสามารถซึมผ่านผนัง
ของล้าไส้เข้าส่่ร่างกายได้
2.ต่อมไร้ท่อ(Endocrine gland):
สร้างฮอร์โมน

หลายชนิดซ่ึงจะส่งเข้ากระแสเลือดโดยตรง

ฮอร์โมนท่ีส้าคัญได้แก่
Insulin , Glucagon ,
Somatostatin , Pancreatic polypeptide

5. •Non-Endocrine
origin
- Non functional pancreatic
endocrine neoplasms
typically present later in the
couse of their disease,when
their tumors being to cause
symptoms related to a mass
effect.
- No associated evevation in
plasma hormone level
•Endocrine origin
- Most pancreatic endocrine
neoplasms discovered
clinically are functional
- Tumors secrete one or
more hormonal product into
the blood, which leads to a
recognizable clinical
syndrome
- Pancreatic polypeptide (PP)
is a product that appears to
be a marker for pancreatic
endocrine tumors

6. Exocrine TumorExocrine Tumor
•Benign
- Serous cystadenoma
- Mucinous cystadenoma
- Intraductal papillary-mucinous
adenoma
- Mature teratomaBorderline tumors
(uncertain malignant potential)
- Mucinous cystic tumor with
moderate dysplasia
- Intraductal papillary-mucinous
tumor with moderate dysplasia
- Solid-pseudopapillary tumor
•Malignant
- Severe ductal dysplasia-carcinoma in
situ
- Ductal adenocarcinoma:
* Mucinous noncystic carcinoma
* Signet ring cell carcinoma
* Adenosquamous carcinoma
* Undifferentiated (anaplastic)
carcinoma
* Mixed ductal-endocrine carcinom
a
- Osteoclast-like giant cell tumor
- Serous cystadenocarcinoma
- Mucinous cystadenocarcinoma:
* Noninvasive
* Invasive
- Intraductal papillary-mucinous
carcinoma:
* Noninvasive
* Invasive (papillary-mucinous carc
inoma)
- Acinar cell carcinoma:
* Acinar cell cystadenocarcinoma
* Mixed acinar-endocrine
carcinoma
- Pancreatoblastoma
- Solid-pseudopapillary carcinoma
- Miscellaneous carcinomas

7. Clinical presentations of Clinical presentations of
pancreatic endocrine tumorpancreatic endocrine tumor
Name (synonym) Hormone
responsible
Clinical
symptoms
Principle of
Medical
Treatment
Insulinoma
(insulin-
producing tumor)
or Beta cell
tumor
Insulin Whipple triad
- Mental confuse,
weakness,fatigue
and convulsion ,
palpitation
- Fasting
hypoglycemia
- Relief of
hypoglycemic
symptoms after
glucose
administation
May require
immediate
potassium
replasement and
glucose
administration

8. Clinical presentations of Clinical presentations of
pancreatic endocrine tumorpancreatic endocrine tumor
Name
(synonym)
Hormone
responsible
Clinical symptoms Principle of Medical
Treatment
Gastrinoma
(gastrin-
producing
tumor;
ulcerogenic
tumor) or G-cell
tumors
Gastrin Zollinger-Ellison
syndrome
* Severe
gastrointestinal
ulcerative disease
* Gastric acid
hypersecretion
* Steatorrhea (fatty
diarrhea)

1. Stabilize
hemodynamic and
control bleeding from
gastrointestinal ulcers
2. Establish a
nonacidic gastric pH
with the use of proton
pump inhibitors, eg,
omeprazole
3. Administration of
the somatostatin
analogue octreotide or
chemotherapeutic
agent

9. Clinical presentations of Clinical presentations of
pancreatic endocrine tumorpancreatic endocrine tumor
Name
(synonym)
Hormone
responsible
Clinical symptoms Principle of Medical
Treatment
Glucagonoma
(glucagon-
producing
tumor) or Alpha
cell tumors
Glucagon Glucagonoma
syndrome
•Abnormal glucose
tolerance test
•Normochromic
normocytic anemia
•Skin rash จากการ
หลั่งฮอร์โมนกลูคากอ
นมากเกินไป

Generally have
nutritional depletion
and often require
blood transfusions,
total parenteral
nutrition, and
preoperative control
of hyperglycemia

10. Clinical presentations of Clinical presentations of
pancreatic endocrine tumorpancreatic endocrine tumor
Name (synonym) Hormone
responsible
Clinical
symptoms
Principle of
Medical
Treatment
VIPoma (vasoactive
intestinal
polypeptide) (VIP-
producing tumor;
diarrheogenic
tumor; Verner-
Morrison
syndrome;
pancreatic cholera)
VIP WDHA
syndrome
•Watery
diarrhea
• Hypokalemia
• Achlorhydria
Primary initial
concern in the
treatment of a
patient who
presents first with
VIPoma-associated
diarrhea is the
replacement of
volume losses and
the correction of
acid-base and
electrolyte
abnormalities

11. Clinical presentations of Clinical presentations of
pancreatic endocrine tumorpancreatic endocrine tumor
Name
(synonym)
Hormone
responsible
Clinical symptoms Principle of Medical
Treatment
Somatostatinoma
(somatostatin-
producing tumor)
or Delta cell
tumors
Somatostatin Somatostatinoma
syndrome
•Diabetes mellitus
•Steatorrhea
•Cholelithiasis
•gastric
hyposecretion
Nutritional repletion
and control of
hyperglycemia are
important aspects of
good medical care in
patients

12. Diagnosis of pancreatic tumors :
need imaging studies e.g.
ultrasound ,
CT scan , MRI

13. •Tumors deep in the substance of the pancreatic gland, and
therefore close to the main duct, have ill-defined capsules,
and tumors larger than 2 cm in diameter should be treated
with regional pancreatectomy.
•Tumors in the body or tail of the pancreas can be managed
with distal pancreatectomy
•Tumors in the neck of the pancreas can now be managed
with middle-segment pancreatectomy by oversewing the
proximal pancreatic stump and draining the distal
pancreatic duct via a pancreaticogastrostomy or
pancreaticojejunostomy
•Lesions in the head or uncinate process of the pancreas can
be resected with pancreaticoduodenectomy