A 32-year-old man presents to the emergency department with a one-day history of severe abdominal pain along with nausea and vomiting. His pain is constant and radiates to his back. He admits to "drinking a few beers" with some friends a couple days ago. Laboratory studies reveal significantly elevated amylase and lipase. An abdominal CT shows pancreas divisum, a common congenital anomaly that results from failure of the pancreatic ductal systems of the ventral and dorsal pancreatic primordia to fuse during embryogenesis. Which of the following pancreatic structures is derived from the ventral pancreatic primordium?

Question

A 32-year-old man presents to the emergency department with a one-day history of severe abdominal pain along with nausea and vomiting.  His pain is constant and radiates to his back.  He admits to "drinking a few beers" with some friends a couple days ago.  Laboratory studies reveal significantly elevated amylase and lipase.  An abdominal CT shows pancreas divisum, a common congenital anomaly that results from failure of the pancreatic ductal systems of the ventral and dorsal pancreatic primordia to fuse during embryogenesis.  Which of the following pancreatic structures is derived from the ventral pancreatic primordium?

Quizplus · Accepted Answer

11ec160b_373f_76de_9249_2b1e2f8193cb_MD0001_00 Early in fetal life, the duodenal portion of the foregut gives rise to the dorsal and ventral pancreatic buds. The dorsal pancreatic bud forms the pancreatic tail, body, most of the head, and the small accessory pancreatic duct. The smaller ventral bud gives rise to the uncinate process, a portion of the pancreatic head, and the proximal portion of the main pancreatic duct. The dorsal and ventral pancreatic buds then fuse during the eighth week of fetal life. The proximal part of the dorsal (accessory) pancreatic duct often degenerates, although it may persist as a functional lesser pancreatic duct. The remainder of the accessory duct fuses with the ventral duct to form the main pancreatic duct (of Wirsung). Pancreas divisum occurs when the ventral and dorsal pancreatic buds fail to fuse; the pancreatic secretions are instead drained via two separate duct systems. The dominant dorsal duct (of Santorini) opens into the duodenum via the minor papilla, and is responsible for draining the majority of the pancreas. The smaller ventral duct (of Wirsung) opens into the major papilla, and functions to drain the inferior/posterior portion of the head and uncinate process. Pancreas divisum is found in 5% of the population and is usually clinically silent. It is commonly detected as an incidental finding on imaging studies or at autopsy. In some, it may predispose to the development of recurrent pancreatitis. (Choices A, B, C and D) The pancreatic tail, body, superior aspect of the head, and accessory pancreatic duct are derivatives of the dorsal pancreatic bud. Educational objective: The dorsal pancreatic bud forms the majority of pancreatic tissue (body, tail, and most of the head). The ventral pancreatic bud is a precursor of the uncinate process, inferior/posterior portion of the head, and major pancreatic duct (of Wirsung). Failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum. In this condition, the pancreatic ductal systems remain separate, with the accessory duct draining the majority of the pancreas. __________ References: Clinical significance of the accessory pancreatic duct. (http://www.ncbi.nlm.nih.gov/pubmed/14696497)

A 32-Year-Old Man Presents to the Emergency Department with a One-Day