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 Neck Body Tail

tail body neck head u.p.

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 splenorenal 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 PORTIONacinar 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
10-item quiz now. Pls get ¼ yellow pad. 10-questions in the long exam

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