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1、CHAPTER56EXOCRINEPANCREASEricH.Jensen,DanielBorja-Cacho,WaddahB.Al-Refaie,andSelwynM.VickerspancreaticoduodenalveinenterstheSMVlaterallyatthesupe-anatomyriorborderoftheneckofthepancreas.Theanterosuperiorembryologypancreaticoduodenalveinenterstherightgastroepipl
2、oicveinphysiologyjustpriortoitsconfluencewiththeSMVattheinferiorborderacutepancreatitisofthepancreas.Theanteriorandposteroinferiorpancreatico-chronicpancreatitisduodenalveinsentertheSMValongtheinferiorborderofthecysticneoplasmsofthepancreasuncinateprocess.There
3、mainingbodyandtailaredrainedviaadenocarcinomaoftheexocrinepancreasthesplenicvenoussystem.pancreatictraumaEMBRYOLOGYTheexocrinepancreasbeginsdevelopmentduringthefourthweekofgestation.PluripotentpancreaticepithelialstemcellsANATOMYgiverisetoexocrineandendocrinece
4、lllines,aswellastheTheaveragepancreasweighsbetween75and125gandmea-intricatepancreaticductalnetwork.Initially,dorsalandventralsures10to20cm.Itliesintheretroperitoneumjustanteriortobudsappearfromtheprimitiveduodenalendoderm(Fig.thefirstlumbarvertebraeandisanatomi
5、callydividedintofour56-2A).Thedorsalbudtypicallyappearsfirstandultimatelyportions,thehead,neck,bodyandtail.Theheadliestotherightdevelopsintothesuperiorhead,neck,body,andtailoftheofmidlinewithintheCloopoftheduodenum,immediatelymaturepancreas.Theventralbuddevelop
6、saspartofthehepaticanteriortothevenacavaattheconfluenceoftherenalveins.diverticulumandmaintainscommunicationwiththebiliarytreeTheuncinateprocessextendsfromtheheadofthepancreasthroughoutdevelopment.Theventralbudwillbecometheinfe-behindthesuperiormesentericvein(S
7、MV)andterminatesadja-riorpartoftheheadanduncinateprocessofthegland.Betweencenttothesuperiormesentericartery(SMA).Theneckisthethefourthandeighthweek,theventralbudrotatesposteriorlyshortsegmentofpancreasthatimmediatelyoverliestheSMV.inaclockwisefashiontofusewitht
8、hedorsalbud(seeFig.Thebodyandtailofthepancreasthenextendacrossthemidline,56-2B).Atapproximately8weeks’gestation,thedorsalandanteriortoGerota’sfasciaandslightlycephalad,termi
