Pancreas

Jesse Noel V. Conjares, MD, MOrth

 Pancreas
An accessory digestive
organ with both exocrine
(digestive enzymes) and
endocrine (hormones)
function

Found about the

epigastric and left
hypochondriac areas
along the transpyloric
plane

Exocrine- secretions find their

way outside the body
Endocrine- secretions are
secreted into the bloodstream
 Pancreas
Retroperitoneal in
position, found posterior
to the stomach, forms
part of the stomach bed

A tapered yellowish
organ about 7” long and
1.5” wide

Transversely located
between the duodenum
on the right and spleen
on the left
 Parts of the Pancreas
Head
Uncinate
process tail
body
Neck
neck
Body
head u.p.
Tail
 Parts of the Pancreas
Head
– Lies within the curve
of duodenum

– Posteriorly, the head

rests on the IVC, R
renal vessels, L
renal vein
 Parts of the Pancreas
Uncinate process
– Or “hook”
– Projection from the
inferior part of the
head
– Lies posterior to
the superior
mesenteric artery
and vein hook
 Parts of the Pancreas
Neck
– Connects the head with
the body
– About 2 cm long

– Grooved posteriorly by the

superior mesenteric
vessels

– It is where the splenic vein

joins the superior
mesenteric v to form the
portal vein
 Parts of the Pancreas
Body
– Extends to the left across the
aorta and 2nd lumbar
vertebra
– Triangular in x-sect
– Has 3 surfaces:
anterior: part of stom bed
posterior: in contact with the
aorta, SMA, L adrenal gl, L
kidney and renal vessels
inferior: where the
transverse mesocolon attaches
 Parts of the Pancreas
Tail
– Occupies the narrow
left end
– It is thick, blunted and
may be pointed
superiorly
– It passes between the
2 layers of the spleno-
renal ligament with the
splenic a and v
at the hilum of the
spleen
 Ducts of the Pancreas
Resembles a
“stalk with
bunches of
grapes”
Main
pancreatic duct
Accessory
pancreatic duct
 Ducts of the Pancreas
Main pancreatic duct (duct of Wirsung)
– Begins at the tail and runs thru the substance of the pancreas
– Within the head, comes close to the common bile duct (CBD)
 Ducts of the Pancreas
Main pancreatic duct
– Unites with the common bile duct
to form a short dilated ampulla of
Vater
– The ampulla opens into the 2nd
part of the duodenum obliquely at
the summit of the major
duodenal papilla

Smooth m sphincters are located

at the
– 1] main pancreatic duct:
pancreatic duct sphincter

– 2] amp of Vater: sphincter of

ODI
– 3] common bile duct

– Function: control flow of bile

and pancreatic juice
 Ducts of the Pancreas
Accessory pancreatic duct (duct of Santorini)
– Drains part of head and uncinate process, may be non-functional
– Connects to the duodenum at the minor duodenal papillae
– Variable connections
– Usually connected to the main pancreatic duct
Variations in the ducts of the
pancreas
 Variations in the ducts of the
pancreas

•Larger accessory duct and smaller main duct

Variations in the ducts of the
pancreas
 Blood supply of the pancreas
3 main supplying
arteries
1. Splenic a
Pancreatic a
2. Gastroduodenal a

a Ant superior pd a
b Post superior pd a
1. Superior
Mesenteric a
a Ant inferior pd a
b Post inferior pd a
 Venous drainage of the pancreas
Eventually to the
Hepatic Portal
vein,
from the
pancreatic
branches of the
Superior
Mesenteric v
Splenic v
 Lymphatic drainage
Regional lymph
nodes
– pancreaticosplenic
– pyloric

Central lymph nodes

– celiac
– superior mesenteric
 Innervation
Parasympathetic
(predominates during rest
and sleep, inc peristalsis,
digestion, secretion of
enzymes, blood glucose
regulation)
– Vagus n

Sympathetic
– Thoracic
splancnic nn
from thoracic
portion of the
sympathetic trunk
 Cells of the pancreas
EXOCRINE PORTION-
acinar cells secrete
digestive enzymes and
pancreatic juice into the
ducts which enter the
duodenum and help in
food digestion
Digestive enzymes: trypsin,
chymotrypsin, pancreatic
lipase, and pancreatic
amylase
Pancreatic juice: an alkaline
fluid rich in bicarbonate
and salt
 Cells of the pancreas
ENDOCRINE PORTION- islets of
Langerhans which include:
alpha cells which secrete
glucagon (increases blood
glucose)
beta cells which secrete insulin
(lowers blood glucose)
delta cells which secrete
somatostatin (inhibitory to
release of gastrointestinal and
pancreatic hormones, gastric
emptying, and intestinal blood
flow)

Somatostatin also inhibits growth

hormone and thyroid-stimulating
hormone among others.
 Clinical conditions
(exocrine)
Problems usually
result from blocks
in the flow of
secretions and/or
reflux
Bile duct stones
Tumors of the head
Spasms of the
sphincters
 Clinical conditions
Pancreatitis
– Results in
inflammation of
the pancreas
and severe
abdominal pain
 Clinical conditions
Obstructive
jaundice
(yellowing)
– Results from bile
pigment retention,
gall bladder
distention and
yellowing of the
skin, mucous
membranes and
conjunctiva
 Clinical conditions
Pancreatic trauma
– Severe abdominal pain from
leak of digestive enzymes
into substance of the
pancreas and adjacent
tissues
– After blunt (seatbelt against
vertebral column) or
penetrating trauma to
abdomen
– High index of suspicion: CT
scan and increased blood
levels of serum amylase (a
pancreatic enzyme)
 Clinical conditions
(endocrine)
Type 1 diabetes mellitus
– juvenile-onset dm
– Insulin-dependent dm
– Autoimmune disorder, antibodies vs. beta cells
which produce insulin
– Lack of insulin
– Usually fatal if no intervention
– Symptoms of polyuria, polydipsia, polyphagia,
weight loss
– Present treatment include regular insulin doses
and/or transplanting pancreatic tissue or islet cells.
 End of lecture

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