PANCREAS ANATOMY

 PANCREAS

1. ANATOMY

The pancreas extends transversely across the upper abdomen behind

the stomach.

-  The  superior mesenteric vein and artery lie just  behind  the

   neck of the pancreas travelling downward.

-  The weight of the gland is between 75 and 125 gms.

-  The length is 10 to 20 cm.

-  The  main pancreatic duct starts at the tail of  pancreas  and

   extends  right a cross upto its end at the sphincter  of  Oddi

   travelling from left to right (Fig 22.1a).

-  The  duct  lies somewhat closer to the posterior than  to  the

   anterior  surface  of the organ and its tributaries  enter  at

   right angles along its entire course.

-  In the head of the pancreas, the duct turns inferiorly to join

   the common bile duct (Fig. 22.1b).

-  In most cases, the pancreatic duct is 3 to 4 mm in diameter.

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Primary Peritonitis

Primary Peritonitis

There may causes of peritonitis but in cases in children no cause

can  be  found  in  most cases. The child has  fever  and  it  is

suspected that entry of bacteria is through the fallopian  tubes or lymph nodes

and blood sream

The  bacteria  are pneumocacci. The diagnosis  is  by  peritoneal

aspiration and staining.

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T B Peritonitis 1

TUBERCULUS PERITONITIS

This  condition  is not uncommon in our country.  It  is  usually

secondary  to a lesion of the lung or tubercular disease  of  the

gastrointestinal tract.  In some cases it may be met without  any

demonstrable primary disease elsewhere.

In  such  cases  it is possibly due  to  reactivation  of  latent

peritoneal tuberculosis which has been established by spread from

a pulmonary focus in the past.

Clinically,  it is a slowly progressive disease and  may  present

with

*  Low grade fever

*  Anorexia

*  Weight loss and

*  There  may be evidence of free fluid in the peritoneal  cavity

   with dull diffuse abdominal pain

On  examination  there  is  slight  tenderness  of  the   abdomen

classically   described  as  a  "doughy  feel"  in   cases   with

coincidental  tubercular  disease of  the  gastrintestinal  tract

there  may  be  an  evidence  of a  mass  or  signs  of  subacute

obstruction.

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PERITONITIS Treatment

TREATMENT

CAUSE

The treatment for early peritonitis will in most cases be related

to the treatment of the disorder that cuases the peritonitis, for

example,  a  case  of peptic ulcer  when  it  perforates  causing

peritonitis and the case is diagnosed in the first 24 hours,  the

treatment  would be directed towards the closing the  perforation

which causes peritonitis.

-  The  treatment  of  early peritonitis  has  to  be  undertaken

   urgently before the signs of fluid loss and toxaemia set in.

-  The  treatment of an established case of peritonitis going  on

   for  a  few days, has to be, supportive since the  patient  is

   very  ill  and  toxic he requires  a  period  of  conservative

   therapy before surgical intervention can be undertaken.

The measure adopted are:

-  Correction  of fluid and electrolyte balances by  infusion  of

   intravenous fluids.

-  Diminishing the quantity of leak into the peritoneal cavity by

   nasogastric suction

-  Relief of pain by prescribing analgesics

-  Giving  of  antibiotics intravenous, e.g.  chloramphenicol  or

   tetracycline.

This  treatment may have to be continued for some time  till  the

patient's general condition imporves.

SURGERY

In  all the cases, some degree of adhesion between the  loops  of

the  intestines would have already occurred.  This would  present

with  symptoms  of  colic or obstruction.  They  can  be  drained

percutaneously with radiologic control.

ABSCESS

The only other indication for surgical intervention would be  the

closed  drainage  of  localized  intra-abdominal  abscesses,  the

common sites are shown in Fig.21.4.

Open  Surgical  intervention  if  undertaken  at  this  stage  if

patients condition permits can at best be for purposes of closure

of the site of leak and drainage of the peritoneal cavity.

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