PANCREAS

Dr Suresh Bidarkotimath. Professor Anatomy

Texila American University
Introduction
 A. Pancreas is a soft elongated partly exocrine and partly endocrine.
 Located in epigastric & left hypochondriac regions.
 Most of the Pancreas is Retroperitoneal , behind the lesser sac
 Tail of the pancreas lies in the lienorenal ligament
 Exocrine part secreat- pancreatic juce
 Endocrine part secrets- hormone insulin.
 It lies at the level of L1&L2.
 B. Dimensions:
1. 5 - 6” length x
2. 1-1/2” width x
3. 1/2 - 1” thick
 C. Lies transversely,
retroperitoneally at ~T-12/L-1 to L-3
THE PANCREAS:

-Soft lobulated structure

-both exocrine and endocrine gland
-exocrine
enzymes to hydrolyzes
proteins, fats and carbohydrates
-endocrine
islets of Langerhans
insulin and glucagon
 Parts of Pancreas
Head fills concavity
of duodenum
Body crosses left
kidney
Tail reaches hilus of
the spleen
Anteriorly to
transverse
colon
Head of the pancreas
 It is the enlarged disc- shaped
 Lies in the concavity of “C”- shaped
duodenal loop.
 Front of L2 vertebra.
 External features-
 3 Barbers (Sup, Inf, and Rt Lat)
 2Surface (Ant and Post)
 1 process – Uncinate- lower & hook hook-like process at Lt part of
head, behind superior mesenteric vessels.
 Head of the pancreas

Relation
 Superiorly- 1st part of
duodenum, superior-
panceatico-duodenal artery.
 Inferiorly- 3rd part of
duodenum, inferior
panceatico-duodenal artery
 Rt lateral border- 2nd part of
duodenum, terminal part of
bie duct, ant &post
panceatico-duodenal artery
(anastomosis bet panceatico-
duodenal artery )
Head -Anterior surface
transverse colon, root of the transverse
mesocolon, and jejunum.

jejunum

Transverse colon
 Head Posterior surface relation

Right crus of diaphragm, Inferior vena cava

Both renal veins, Middle suprarenal A, Gonadal A
Bile duct, IVC, Uncinate Process- Aorta, superior mesenteric vessels
 Neck : Anterior relations
Peritoneum of lesser sac pylorus,
First part of the duodenum.
 Neck : Posterior relations:

• Superior mesenteric
vein
• Beginning of
PORTAL VEIN
 BODY: BORDERS
It is somewhat triangular in cross section
SUPERIOR BORDER: COELIAC A,
SPLENIC A, COMMON HEPATIC A, TUBER
OMENTALE
INFERIOR BORDER: SUP MESENTERIC
VESSELS
ANTERIOR BORDER: ATTACHMENT OF
ROOT OF TRANSVERSE MESOCOLON

One process: Tuber omentale (a part of the

body proje t just left to the neck. Related to
lesser curvature of the stomach and comes
with the lesser omentum across the lesser sac).
Body: Anterior relations

Postero-inferior surface of the stomach separated by lesser sac.

 BODY : POSTERIOR RELATIONS

NON-PERITONEAL
Abdominal aorta with the origin of sup. mesentric artery Left crus of diaphragm
Left suprarenal gland Left kidney
Left renal vessels & pelvis of left ureter
 BODY : INFERIOR RELATIONS
Peritoneum
Duodenojejunal flexure
Coils of jejunum
Left colic flexure
Tail of pancreas
 It is the narrow left extremity of the
pancreas.
 It lies in the lienorenal ligament along with
splenic vessels.
 It is mobile unlike the other major
retroperitoneal parts of the gland.
 It contains the largest number of islets of
Langerhans
 TAIL: Relations
ANTERIORLY:
 Stomach separated by lesser sac

POSTERIORLY:

 Spleen and splenic vessels

INFERIORLY:

 Left colic flexure

PANCREATIC DUCTS
• main pancreatic duct running down the center of the organ, joins the
CBD to form the AMPULLA OF VATER within the wall of the
duodenum
• accessory duct within uncinate process; lower part of the head

Head of Pancreas Important clinically because:

a. Numerous ducts and vessels traverse it
b. Carcinoma usually located here
PANCREATIC DUCTS: Sphincter
Duct of Wirsung (Main pancreatic duct)
SPHINCTER OF
ODDI:
Encircling the
AMPULLA OF
VATER and terminal
portion of CBD and
Pancreatic duct
 ARTERIAL SUPPLY:

BRANCHES OF:
•Splenic artery, a branch of
coeliac trunk
•Superior
pancreaticoduodenal artery: a
branch of gastroduodenal artery.
•Inferior pancreaticoduodenal
artery: a branch of superior
mesenteric artery.
 VENOUS DRAINAGE:
TRIBUTARIES OF:
The veins of the pancreas drain into (a) portal vein,
(b) superior mesenteric vein, and (c) splenic vein.
 NERVE SUPPLY:

PARASYMPATH
ETIC:
VAGUS N.
SYMPATHETIC:T5
-T10
SEGMENTS OF SPINAL
CORD
 LYMPHATIC DRAINAGE:

 Pancreaticosplenic nodes
 Pancreaticoduodenal
nodes celiac nodes
 Superior mesenteric
nodes
ACUTE PANCREATITIS
 It occurs due to obstruction of pancreatic duct, ingestion of alcohol, viral
infections (mumps), or trauma.
 It is serious condition because activated pancreatic enzymes leak into the
substance of pancreas and initiates the autodigestion of the gland. Clinically, it
presents as very severe pain in the epigastric region radiating to the back,
fever, nausea, and vomiting. The serum amylase, level is raised four times.
 CHRONIC PANCREATITIS:

Chronic pancreatitis is a chronic

inflammatory disease in which there is
irreversible morphological change typically
causing pain & permanent loss of function.
Symptoms: pain, weight loss, steatorrhoea &
diabetes mellitus
OTHER CLINICAL CONDITIONS RELATED
TO PANCREAS

 Cancer of Head of Pancreas: Due to close proximity can spread to or

compress Common Bile Duct and lead to Obstruction of bile flow. This in
turn lead to Obstructive Jaundice.
 Gall stone stuck at ampulla of Vater may lead to pancreatitis &/or
obstructive jaundice.
 Trauma of the Pancreas
 Sudden blow to the abdomen occurs, can compress and tear the
pancreas against the vertebral column or may damage during
splenectomy
 Damaged pancreatic tissue releases activated pancreatic enzymes
that produce the signs and symptoms of acute peritonitis.
 Questions
A 45-year-old bank manager presents to the emergency department with a 2-
week history of abdominal pain. The patient’s clinical manifestations include
emesis and hematemesis during the last 1 hour. His pain was mild initially but
is currently severe in intensity (rated 8 on a scale of 10), stabbing, and
relentless. Ingestion of food and consumption of milk attenuates pain
symptoms. The patient’s heart rate is 115/min. His blood pressure is 85/66 mm
Hg standing, and 96/83 mm Hg lying down. He appears pale and feels dizzy.
An intravenous line is started, and a bolus of fluids is administered to improve
his vital signs. After stabilization, gastroduodenoscopy (EGD) is performed. A
fair amount of blood is detected in the stomach; however, after it is washed out,
no abnormalities occur. A bleeding duodenal ulcer is seen located on the
posteromedial wall of the duodenal bulb. Which artery is at risk in this ulcer?

a. Right gastroepiploic artery

b. Gastroduodenal artery
c. Dorsal pancreatic artery
d. Inferior pancreaticoduodenal artery
e. Superior pancreaticoduodenal artery
 Q2
 A 30-year old man is admitted to the hospital by severe
abdominal pain with nausea and vomiting for 24-hour
duration. He states the pain radiates straight to the
back. The serum amylase and lipase levels are
markedly elevated and this case was diagnosed as
acute pancreatitis.
1-Tail
 1- Which part of the pancreas that is not 2-Common hepatic A
retroperitoneal? 3-Splenic – left renal
4-Superior & inferior
 2- What is the origin of the artery that lies anterior to pancreaticoduodenal –
the neck of pancreas? numerous branches from
splenic A
 3- Mention 2 veins related to the posterior surface of 5-From the head: pyloric &
the body of pancreas? superior mesenteric L.N –
from the body:
 4- Enumerate the arterial supply of pancreas? pancreaticosplenic L.N.
 5- Mention its lymphatic drainage? finally, all these nodes
drain to the celiac L.N.
 A 65-year-old male patient was admitted in the hospital with the following complaints:
progressive jaundice, pale greasy stools, itching of skin, loss of appetite and weight, and
back pain. On examination the doctors found palpable gallbladder and ascites. After
thorough investigations he was diagnosed as a case of “carcinoma of the head of
pancreas.”
 Questions
 1. What is the anatomical basis of jaundice in carcinoma of the head of pancreas?
 2. What is Courvoisier’s law?
 3. What are the important posterior relations of the head of pancreas?
 4. Give the source of development of common bile duct and main pancreatic duct (of
Wirsung).
Ans
 1. This is due to obstruction of CBD. The CBD being embedded in the
head of pancreas on its posterior surface is blocked by cancer
infiltration. This leads to stasis of bile in the biliary tree. The bile
escapes through ruptured bile canaliculi into blood. As a result, the
patient develops jaundice. This type of jaundice is called
obstructivejaundice.
 2. The obstructive jaundice with palpable gallbladder indicates
carcinoma of the head of pancreas whereas obstructive jaundice
without palpable gallbladder indicates obstruction of bile duct due
to gallstone.
 3. (a) Bile duct and (b) IVC.
 4. (a) The CBD develops from the hepatic bud. (b) The small proximal
part of the main pancreatic duct develops from the duct of ventral
pancreatic and larger distal part of main pancreatic duct part
develops from the duct of dorsal pancreatic bud.