Pancreas (Anatomy)

The pancreas is an abdominal glandular organ with both digestive (exocrine)

and hormonal (endocrine) functions.

In this article, we shall look at the anatomy of the pancreas – its structure, anatomical position
and neurovascular supply.
Anatomical Position
The pancreas is an oblong-shaped organ positioned at the level of the transpyloric plane.  With
the exception of the tail of the pancreas, it is a retroperitoneal organ, located deep within the
upper abdomen in the epigastrium and left hypochodrium regions.

Within the abdomen, the pancreas has direct anatomical relations to several structures

Organs:

 Stomach – Separated from the pancreas by the lesser sac, the stomach and pylorus lie
anterior and to the pancreas.
 Duodenum – The “C” shaped duodenum curves around and outlines the head of the
pancreas. The first part of the duodenum lies anteriorly whereas the second part of the
duodenum including the ampulla of Vater lies laterally to the right of the pancreatic head
 Transverse mesocolon – Attaches to the anterior surface of the pancreas
 Common bile duct – Descends behind the head of the pancreas before opening into
the second part of the duodenum alongside the major pancreatic duct through the major
duodenal papilla
 Spleen – located posteriorly and laterally. The lienorenal ligament is formed from
peritoneum and connects the spleen to the tail of the pancreas.

Vessels

The pancreas lies near several major vessels and significant landmarks in vascular anatomy:

 The aorta and inferior vena cava pass posteriorly to the head of the pancreas.
 The superior mesenteric artery lies behind the neck of the pancreas and anterior to the
uncinate process.
 Posterior to the neck of the pancreas, the splenic and superior mesenteric veins unite to
form the hepatic portal vein.
 As it journeys from its origin at the celiac plexus to the splenic hilum, the splenic artery
traverses the superior border of the pancreas.

 By TeachMeSeries Ltd (2020)
 Fig 1 – Anterior view of the abdomen. The stomach, transverse colon, and the majority of the
small intestine have been removed to expose the underlying pancreas
Anatomical Structure
The pancreas is typically divided into five parts;

 Head – the widest part of the pancreas. It lies within the C-shaped curve created by the
duodenum, and is connected to it by connective tissue.
 Uncinate process – a projection arising from the lower part of the head and extending
medially to lie beneath the body of the pancreas. It lies posterior to the superior mesenteric
vessels.
 Neck – located between the head and the body of the pancreas. It overlies the superior
mesenteric vessels which form a groove in its posterior aspect.
 Body – centrally located, crossing the midline of the human body to lie behind the
stomach and to the left of the superior mesenteric vessels.
 Tail – the left end of the pancreas that lies within close proximity to the hilum of the
spleen. It is contained within the splenorenal ligament with the splenic vessels. This is the only
part of the pancreas that is intraperitoneal.

 By TeachMeSeries Ltd (2020)

Fig 2 – The parts of the pancreas

The Duct System
 By TeachMeSeries Ltd (2020)
Fig 3 – The exocrine pancreas, secreting into the duodenum
The exocrine pancreas is classified as a lobulated, serous gland which produces digestive
enzyme precursors. It is composed of approximately one million ‘berry-like’ clusters of cells
called acini, connected by short intercalated ducts.

The intercalated ducts unite with those draining adjacent lobules  and drain into a network
of intralobular collecting ducts, which in turn drain into the main pancreatic duct.

The pancreatic duct runs the length of the pancreas and unites with the common bile duct,
forming the hepatopancreatic ampulla of Vater. This structure then opens into the duodenum
via the major duodenal papilla.

Secretions into the duodenum are controlled by a muscular valve – the sphincter of

Oddi. It surrounds the ampulla of Vater, acting as a valve.
Vasculature
The pancreas is supplied by the pancreatic branches of the splenic artery. The head is
additionally supplied by the superior and inferior pancreaticoduodenal arteries which are
branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries,
respectively.

Venous drainage of the head of the pancreas is into the superior mesenteric branches of
the hepatic portal vein. The pancreatic veins draining the rest of the pancreas do so via
the splenic vein.

 By TeachMeSeries Ltd (2020)
Fig 4 – The arterial supply and venous drainage of the pancreas
Lymphatics
The pancreas is drained by lymphatic vessels that follow the arterial supply. They empty into
the pancreaticosplenal nodes and the pyloric nodes, which in turn drain into the superior
mesenteric and coeliac lymph nodes.

Embryology of pancreas

At the foregut/midgut junction the septum transversum generates 2 pancreatic buds (dorsal and
ventral endoderm) which will fuse to form the pancreas. The dorsal bud arises first and
generates most of the pancreas. The ventral bud arises beside the bile duct and forms only part
of the head and uncinate process of the pancreas.

In the fetal period islet cell clusters (icc) differentiate from pancreatic bud endoderm. These cell
clusters form acini and ducts (exocrine). On the edge of these cell clusters pancreatic islets
(endocrine) also form. Pancreatic hormonal function is mainly to secrete insulin and glucagon
that together regulate blood glucose levels. Pancreatic progenitor cells give rise to five
endocrine cell types secreting: insulin, glucagon, somatostatin, pancreatic polypeptide and
ghrelin. Furthermore gastrin, secreted by stomach G-cells, is also embryonically expressed in
the pancreas but disappears after birth.

The pancreas exocrine function begins after birth, while the endocrine function (hormone
release) can be measured from 10 to 15 weeks onward. At this stage, it is not clear what the
exact roles of these hormones are in regulating fetal growth.
Epidemiology and prevention of diabetes mellitus .

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough
insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that
regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of
uncontrolled diabetes and over time leads to serious damage to many of the body’s systems,
especially the nerves and blood vessels.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct
cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million
deaths.

Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes. In
high-income countries the premature mortality rate due to diabetes decreased from 2000 to
2010 but then increased in 2010-2016. In lower-middle-income countries, the premature
mortality rate due to diabetes increased across both periods.

By contrast, the probability of dying from any one of the four main noncommunicable diseases
(cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between the ages of
30 and 70 decreased by 18% globally between 2000 and 2016.

Type 2 diabetes

Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s
ineffective use of insulin. The majority of people with diabetes have type 2 diabetes. This type of
diabetes is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result,
the disease may be diagnosed several years after onset, after complications have already
arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring
increasingly frequently in children.

Type 1 diabetes

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is

characterized by deficient insulin production and requires daily administration of insulin. Neither
the cause of Type 1 diabetes nor the means to prevent it are known.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger,
weight loss, vision changes, and fatigue. These symptoms may occur suddenly.

Gestational diabetes
Gestational diabetes is hyperglycaemia with blood glucose values above normal but below
those diagnostic of diabetes. Gestational diabetes occurs during pregnancy

Women with gestational diabetes are at an increased risk of complications during pregnancy
and at delivery. These women and possibly their children are also at increased risk of type 2
diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than through reported
symptoms.

Impaired glucose tolerance and impaired fasting glycaemia

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate
conditions in the transition between normality and diabetes. People with IGT or IFG are at high
risk of progressing to type 2 diabetes, although this is not inevitable.

Health impact

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes(1).

Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the
chance of foot ulcers, infection and eventual need for limb amputation.

Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term

accumulated damage to the small blood vessels in the retina. Diabetes is the cause of 2.6% of
global blindness(2).

Diabetes is among the leading causes of kidney failure(3).

Prevention

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset
of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

Achieve and maintain a healthy body weight;

Be physically active – doing at least 30 minutes of regular, moderate-intensity activity on most
days. More activity is required for weight control;

Eat a healthy diet, avoiding sugar and saturated fats; and

Avoid tobacco use – smoking increases the risk of diabetes and cardiovascular disease.

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.

Treatment of diabetes involves diet and physical activity along with lowering of blood glucose
and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is
also important to avoid complications.

Interventions that are both cost-saving and feasible in low- and middle-income countries
include:

Blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require
insulin, people with type 2 diabetes can be treated with oral medication, but may also require
insulin;

Blood pressure control; and

Foot care (patient self-care by maintaining foot hygiene; wearing appropriate footwear; seeking
professional care for ulcer management; and regular examination of feet by health
professionals).
Metabolic syndrome

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart
disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high
blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

Symptoms

Most of the disorders associated with metabolic syndrome don’t have obvious signs or
symptoms. One sign that is visible is a large waist circumference. And if your blood sugar is
high, you might notice the signs and symptoms of diabetes — such as increased thirst and
urination, fatigue, and blurred vision.

Causes

Metabolic syndrome is closely linked to overweight or obesity and inactivity.

It’s also linked to a condition called insulin resistance.

Risk factors

The following factors increase your chances of having metabolic syndrome:

Age. Your risk of metabolic syndrome increases with age.

Ethnicity. In the United States, Hispanics— especially Hispanic women — appear to be at the
greatest risk of developing metabolic syndrome.

Obesity. Carrying too much weight, especially in your abdomen, increases your risk of
metabolic syndrome.

Endocrine Function:

The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that
create and release important hormones directly into the bloodstream. Two of the main
pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to
raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key
organs including the brain, liver, and kidneys.

Diabetes and slow healing wounds

High levels of blood glucose caused by diabetes can, over time, affect the nerves (neuropathy)
and lead to poor blood circulation, making it hard for blood – needed for skin repair – to reach
areas of the body affected by sores or wounds.

This can cause them to remain open and unhealed for months, increasing the risk of:

Fungal infections
Bacterial infections

Gangrene.

According to the World Health

Organization (WHO), a healthy WHR is:
0.9 or less in men. 0.85 or less for
women.
Pharmacology
FBS
Normal 70-100 mg/dl
Pre diabetic 100-125mg/dl
Diabetic is above 125mg/dl

RBS
Normal 70-140 mg/dl
Pre diabetic 140-200 mg/dl
Diabetic >200 mg/dl
Reference
Teachmeana
Katzung
WHO website.