Dezvoltare Pancreas

7/23/2019 Dezvoltare Pancreas

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ANATOMIA DEZVOLTARIIANATOMIA DEZVOLTARII

PANCREASULUIPANCREASULUI


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5 weeks


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6 WEEKS


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8 WEEKS


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Fascii coalescen pancreasFascii coalescen pancreas


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Fascii posterioare: Treitz RDP dr+stg (cap),Toldt retromezogastric (corp)

Fascii anterioare: Fredet PDP supra si

submezocolice


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Pancreas - anomalii e e!"ol#arePancreas - anomalii e e!"ol#are


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Pancreas i"is$mPancreas i"is$m

- is the most common congenital anomaly ofthe pancreatic ductal system (4%10% of the

population)

- results when the ventral and dorsalpancreatic ducts fail to fuse

- the ventral duct (duct of Wirsung) drainsonly the ventral pancreatic anlage

- the majority of the gland empties into theminor papilla through the dorsal duct (duct of

antorini)


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!ancreas inelar


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"#ial $$& images in a '-year-old man with annular pancreas"#ial $$& image shows pancreatic tissue (white arrow) completely

encircling the second portion of the duodenum (*lac+ arrow)consistent with an annular pancreas


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Pancreas ec#opicPancreas ec#opic

- 0,%1'% of the population- stomach (,%'.% of cases)/

duodenum (.%',%)/ jejunum(1,%)/ ec+el diverticulum/ ileum

- rarely/ it occurs in the colon/esophagus/ gall*ladder/ *ile ducts/

liver/ spleen/ um*ilicus/ mesentery/mesocolon/ omentum

- usually measures 00 cm inits largest dimension (rarely up to

cm) and is located in thesu*mucosa in appro#imately 0%

of cases- ctopic pancreas in the

gastrointestinal tract is usuallyasymptomatic

- complications such as stenosis/ulceration/ *leeding/ and

intussusception may develop

$& scan o*tained in a patient with a*dominal painshows ectopic pancreatic tissue (arrow) within the

small *owel mesentery


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A%ene!ia& 'ipopla!iaA%ene!ia& 'ipopla!ia- Total agenesisof the pancreas is e#tremely rare/ is incompati*le with life and it is associated

with other malformations such as gall*ladder aplasia/ polysplenia/ and fetal growth retardation- Hypoplasia (partial agenesis)result from the a*sence of the ventral or dorsal anlage- Absence o t!e dorsal anlageis visuali2ed as a short or truncated pancreas and can *e

partial or complete 3t may *e seen as a solitary finding or in association with heterota#iasyndromes

- Partial agenesis o t!e dorsal pancreasis relatively more common than agenesis of theventral portion/ *ut complete agenesis o t!e dorsal pancreasis e#tremely rare


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Anomalii con%eni#ale ( c'is#$riAnomalii con%eni#ale ( c'is#$ri- $ongenital pancreatic cysts are e#ceedingly rare

- &hey have a female predilection- &ypically manifest as an asymptomatic palpa*le mass or patients may also presentwith epigastric pain/ jaundice/ and vomiting related to the compression of surroundingstructures- &hese cysts can *e single or multiple and are most commonly located in the tail and*ody of the pancreas- ultiple congenital cysts are associated with other anomalies/ such as von ippel5indau disease and hepatorenal polycystic disease


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"#ial noncontrast $& shows complete fatty replacement of thepancreas in a 4-year-old man with cystic fi*rosis 6o pancreatic

parenchyma is visi*le in its e#pected location (white outline)


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Anatomie descripti"# pancreas


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PANCREASPANCREAS

CEFALICCEFALIC

aspect anterioraspect anterior

1. pancreatico-1. pancreatico-

duodenala dreaptaduodenala dreapta

superiora,superiora,

gastro-epiploicagastro-epiploica

dreapta,dreapta,colica dreaptacolica dreapta

superioarasuperioara

2. fasciile PP Fredet2. fasciile PP Fredet

supra sisupra si

su!"e#ocolice,su!"e#ocolice,"e#ocolonul"e#ocolonul

trans$erstrans$ers


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PANCREAS CEFALICPANCREAS CEFALIC

aspec# pos#erioraspec# pos#erior

1 planarterial(arcadele

duodeno-pancreatice)/plan ductal(coledoc/pancreatic)/plan venos

(7!) fascia89! &reit2dreapta


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aspec# pos#erioraspec# pos#erior

' 7$3/ vasele renale drepte/ pilierii diafragmului/ 5-5'


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- sup: 91 tu*erculii pre si retro9(cel retro9 ; tu*ercul omental/intraperitoneal)

- dr: 9 ductele pancreatice

- inf: 9' proc


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- !ancreatic head and nec+ lo*ulations are defined as outpouchings of the gland morethan 1 cm *eyond the anterior superior pancreaticoduodenal artery- &hese variations are seen in appro#imately '4% of individuals upon close e#amination

- type 3 (anterior)/ seen in 10% of individuals=- type 33 (posterior)/ seen in 1>%=- type 333 (hori2ontal)/ seen in %- "nother well-recogni2ed pseudomass is a prominence on the anterior surface of thepancreatic *ody to the left of the superior mesenteric vessels that a*uts the posteriorsurface of the lesser omentum &his entity is +nown as tuber omentaleand should *enot misinterpreted as a true pancreatic neoplasm


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- #treme pancreatic lipomatosis can *e seen in cystic fi*rosis and hwachman-9iamondsyndrome/ as well as in dia*etic/ o*ese/ and elderly patients

- type 1a ('% of cases) is characteri2ed *y replacement of the head with sparing of theuncinate process and peri*iliary region=

- type 1* (',%)/ *y replacement of the head/ nec+/ and *ody/ with sparing of the uncinateprocess and peri*iliary region=

- type a (1%)/ *y replacement of the head/ including the uncinate process/ and sparing ofthe peri*iliary region=

- and type * (1.%)/ *y total replacement of the pancreas with sparing of the peri*iliary

region


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)a#$l pancreas$l$i)a#$l pancreas$l$i

*a a an#erioar*a a an#erioar

- intre 1 si $asele "e#enterice superioare- intre 1 si $asele "e#enterice superioare

- fa a anterioar% coresp. Peretelui posterior al &' - raport cu pilorul prin &'- fa a anterioar% coresp. Peretelui posterior al &' - raport cu pilorul prin &'


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- fa a posterioar? raport cu 7 si originea 7! (&reit2 drept- fa a posterioar? raport cu 7 si originea 7! (&reit2 dreptposterior de vase)posterior de vase)

)a#$l pancreas$l$i)a#$l pancreas$l$i

*a a pos#erioar*a a pos#erioar


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Corp$l pancreas$l$i *a a an#erioarCorp$l pancreas$l$i *a a an#erioar

- retroperitoneal- corespundeperetelui posterior al@A


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Corp$l pancreas$l$iCorp$l pancreas$l$i

*a pos#erioar*a pos#erioar

- plan venos: v plenica/ v 3

- fascia &oldt retrome2ogastric

- v renala stanga/ fata ant a rinichiului stang


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Corp$l pancreas$l$iCorp$l pancreas$l$i

- fa a inferioar? me2ocolic? (suprame2ocolic?)- fa a inferioar? me2ocolic? (suprame2ocolic?)

- marginea superioar? trunchi celiac/ ple# solar/ arter? splenic?- marginea superioar? trunchi celiac/ ple# solar/ arter? splenic?


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CoaaCoaa

pancreas$l$ipancreas$l$i


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$oada pancreasului


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!ancreas vasculari2a ie arterial?

1 !9 sup(B9)

!9 inf()

' ! sup(splenica)

4 ! post(splenica)

! inf()


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Pancreas ( "asc$lari!a ie "enoasPancreas ( "asc$lari!a ie "enoas

- !9 sup(B9)

- !9 inf(7)

- vv$orpului(splenicaC

trunchi)


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Pancreas ( lim*a#icePancreas ( lim*a#ice


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Pancreas ( lim*a#icePancreas ( lim*a#ice


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Pancreas ( iner"a iePancreas ( iner"a ie


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%egmentul duodeno&cealic%egmentul duodeno&cealic %egmentul corporeocaudal%egmentul corporeocaudal

- din mugurii pancreatici ventral i- din mugurii pancreatici ventral idorsaldorsal

- din mugurele dorsal/ in grosimea- din mugurele dorsal/ in grosimeame2ogastrului dorsalme2ogastrului dorsal

- fi#at la !!! cu ajutorul fasciilor 89!- fi#at la !!! cu ajutorul fasciilor 89!&reit2&reit2

- corp fi#at la !!! prin &oldt- corp fi#at la !!! prin &oldtretrome2ogastricretrome2ogastric

- coada li*era in epiplonul- coada li*era in epiplonulpancreatico-splenicpancreatico-splenic

- por iuni supra i su*me2ocolica - por iuni supra i su*me2ocolica

- por iunea su*me2ocolica este- por iunea su*me2ocolica esteseparata de inser ia me2enterului Dnseparata de inser ia me2enterului Dnalte por iuni/ dreapta si stangaalte por iuni/ dreapta si stanga

- situat in etjul suprame2ocolic/ la- situat in etjul suprame2ocolic/ lanivelul peretelui posterior al *urseinivelul peretelui posterior al *urseiomentaleomentale

- vasculari2atie hepato-me2enterica- vasculari2atie hepato-me2enterica

superioara (arcadele duodeno-superioara (arcadele duodeno-pancreatice)pancreatice)

- vasculari2atie spleno-me2enterica- vasculari2atie spleno-me2enterica

superioarasuperioara

- e#tirpare in *loc- e#tirpare in *loc(duodenopancreatectomii cefalice)(duodenopancreatectomii cefalice)

- pancreatectomii corporeocaudale- pancreatectomii corporeocaudale(decolare coloepiploica si patrundere(decolare coloepiploica si patrunderein @A)in @A)


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Dezvoltare Pancreas

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