Chapter 72 The Pancreas

The pancreas is situated in the retroperitoneum. It is divided into a head, which occupies 30% of the gland by mass, and a body and tail, which together constitute 70%. The pancreas weighs approximately 80 g. Of this, 80–90% is composed of exocrine acinar tissue, which is organised into lobules. In response to a meal, the pancreas secretes digestive enzymes in an alkaline bicarbonate-rich fluid. Ultrasonography is the initial investigation of choice in patients with jaundice to determine whether or not the bile duct is dilated, the coexistence of gallstones or gross disease within the liver such as metastases. It may also define the presence or absence of a mass in the pancreas. Most significant pathologies within the pancreas can be diagnosed on high-quality computed tomography scans, with three-dimensional reconstruction if necessary. With magnetic resonance imaging the pancreas can be clearly identified, and the anatomy of the bile duct and the pancreatic duct, together with fluid collections, can be defined.

Multiple Choice Questions
Weblinks

Journal articles

https://www.sciencedirect.com/science/article/abs/pii/S0140673610618521?via%3Dihub/ (paid)

A review article covering all aspects of chronic pancreatitis.

https://www.nejm.org/doi/full/10.1056/NEJMoa1809775/ (free)

A major step forward in defining the new regimens for adjuvant therapy in pancreatic cancer.

https://www.sciencedirect.com/science/article/abs/pii/S0140673620309740?via%3Dihub/ (paid)

Another major step forward in defining the new regimens for adjuvant therapy in pancreatic cancer.

Guidelines

https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0/ (free)

Current guidelines on the management of severe acute pancreatitis.

https://www.nice.org.uk/guidance/ng104/resources/pancreatitis-pdf-66141537952453/ (free)

Guidance from the National Institute for Health and Care Excellence on the management of pancreatitis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890653/ (free)

Current European guidelines on pancreatic cystic neoplasms.

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