Pancreas and pancreatitis

Human body structure and function IV

Pancreas
The pancreas is an accessory organ and exocrine gland of the digestive system, as well
as a hormone producing endocrine gland. It is a retroperitoneal organ consisting of five
parts and an internal system of ducts. The pancreas is supplied by pancreatic arteries
stemming from surrounding vessels and is innervated by the vagus nerve (CN X), celiac
plexus, and superior mesenteric plexus. This organ is incredibly potent; unregulated,
excessive functioning can result in autodigestion, while insufficiency can lead to coma.
Spotting the latter situation typically involves an unconscious (diabetic) person who may
have fruity breath.
Location
The pancreas is an elongated organ (approximately 15 cm) which lies obliquely across
the posterior abdominal wall, at the level of the L1 and L2 vertebral bodies. To put it in a
clinical context, its oblique position makes it impossible to see the entire pancreas in a
single transverse section. The pancreas comes in contact with several neighboring
structures as it traverses the epigastric, left hypochondriac, and a small portion of
the umbilical regions of the abdomen. With the exception of the tail, the pancreas is
situated in the retroperitoneal space of the abdominal cavity, in other words, behind
the peritoneum.

Anatomical relations of the pancreas

Anterior Stomach, lesser sac (omental bursa), transverse mesocolon, superior

mesenteric artery

Posterior Aorta, inferior vena cava, right renal artery, right and left renal veins,
superior mesenteric vessels, splenic vein, hepatic portal vein, left kidney,
left suprarenal gland

Superior Splenic artery

Lateral Spleen

Medial Duodenum (descending and horizontal parts)

Parts

This parenchymatous organ is divided into five anatomical parts; the head, uncinate
process, neck, body and tail.
The head is the expanded medial part of the pancreas. It lies directly against the
descending and horizontal parts of the C-shaped duodenum which wraps around the
pancreatic head. Projecting inferiorly from the head is the uncinate process, which
extends posteriorly towards the superior mesenteric artery. Continuing laterally from the
head is the neck, a short structure of approximately 2 cm that connects the head with the
body. Posterior to the neck are the superior mesenteric artery and vein and the origin of
the hepatic portal vein – formed by the union of the superior mesenteric and splenic
veins. After the neck, the pancreas continues with the body, which consists of two
surfaces (anterior and posterior) and two borders (superior and inferior). It is located
anterior to the L2 vertebra, and also forms the floor of the omental bursa (lesser sac).
The aorta, superior mesenteric artery, left renal vessels, left kidney, and left suprarenal
gland are situated posterior to the pancreatic body. Finally, the intraperitoneal tail is the
last part of the pancreas. It is closely related to the hilum of the spleen and runs with the
splenic vessels in the splenorenal ligament. 

Pancreatic duct

Traveling within the entire pancreatic parenchyma from the tail to the head is the main
pancreatic (Wirsung) duct. It connects with the bile duct in the head of the pancreas to
form the hepatopancreatic duct, otherwise called the ampulla of Vater. This opens into
the descending part of the duodenum at the major duodenal papilla. Flow through the
ampulla of Vater is controlled by a smooth muscle sphincter called the
(hepatopancreatic) sphincter of Oddi. It also prevents reflux of duodenal contents into the
hepatopancreatic duct. The terminal parts of the main pancreatic and bile ducts also have
sphincters, which play an important role in controlling the flow of pancreatic and bile
fluids. 
In addition to the main duct, the pancreas also contains an accessory duct. It
communicates with the main pancreatic duct at the level of the pancreatic neck and
opens into the descending part of the duodenum at the minor duodenal papilla which is
above the major duodenal papilla. This accessory duct has two branches, one branch
arises from main pancreatic duct and the other branch originates from the uncinate
process of the pancreas.
Function

The pancreas is a unique organ because it fulfills both exocrine and endocrine roles.
Its exocrine function includes the synthesis and release of digestive enzymes into the
duodenum of the small intestine. Its endocrine function involves the release of insulin and
glucagon into the bloodstream, two important hormones responsible for regulating
glucose, lipid, and protein metabolism. 

The main players responsible for pancreatic function are endocrine and exocrine glands.
The latter synthesize inactive pancreatic digestive enzymes (zymogens), which are
released into the glandular and pancreatic ductal systems. Upon reaching the duodenum,
the zymogens are activated by proteolytic enzymes, becoming active peptidases,
amylases, lipases and nucleases which act to further digest food entering the small
intestine from the stomach. The endocrine function of the pancreas is carried out by
the pancreatic islets of Langerhans. These endocrine glands secrete hormones directly
into the bloodstream and consist of three main cell types (alpha, beta, and delta) which.In
a nutshell, beta cells secrete insulin, alpha cells release glucagon, and delta cells
produce somatostatin. These hormones are crucial in regulating glucose metabolism and
gastrointestinal functions.

Blood vessels

The pancreas receives its blood supply from several sources. The uncinate process and
head are supplied by the superior and inferior pancreaticoduodenal arteries, which are
branches of the gastroduodenal and superior mesenteric arteries respectively. Each
pancreaticoduodenal artery has anterior and posterior branches that project along the
respective faces of the pancreatic neck where they form pancreaticoduodenal arcades
and supply them with arterial blood. 
In turn, the body and tail of the pancreas are supplied by pancreatic arteries that stem
from the splenic, gastroduodenal, and superior mesenteric arteries. The major contributor
is the splenic artery.

Pancreatic veins are responsible for draining deoxygenated blood from the pancreas. The
anterior superior pancreaticoduodenal vein empties into the superior mesenteric vein,
while the posterior variant empties into the hepatic portal vein. Both the anterior and
posterior inferior pancreaticoduodenal veins drain into the superior mesenteric vein, while
the pancreatic veins draining venous blood from the body and tail empty into the splenic
vein.

Innervation

The pancreas receives involuntary innervation via the autonomic nervous system (ANS).
Its parasympathetic innervation originates from the vagus nerve (CN X) and
its sympathetic innervation from the greater and lesser splanchnic nerves (T5-T12). Both
types of autonomic fibers travel until the celiac ganglion and superior mesenteric plexus,
ultimately projecting onto the pancreas. 

Inside the organ, they carry nerve impulses to the acinar cells and the pancreatic islets.
Parasympathetic fibers induce secretion from acinar cells, ultimately resulting in the
release of pancreatic juice, insulin and glucagon. In contrast, sympathetic fibers cause
vasoconstriction and inhibition of exocrine secretion, in other words, inhibition of
pancreatic juice. In relation to hormonal release, sympathetic innervation stimulates the
release of glucagon but inhibits that of insulin. 

Lymphatic

Lymph is drained from the body and tail of the pancreas via lymphatic vessels that empty
into the pancreaticosplenic lymph nodes located along the splenic artery. The vessels
draining the head empty into pyloric lymph nodes. Subsequently, lymph is transported to
the superior mesenteric or celiac lymph nodes.

Pancreatitis

Pancreatitis is an inflammation of the pancreas. Of the many causes of pancreatitis, the

most common are alcohol consumption and gallstones. Pancreatitis can occur as acute
pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can
occur as chronic pancreatitis, which is pancreatitis that occurs over many years. Mild
cases of pancreatitis may go away without treatment, but severe cases can cause life-
threatening complications.

Symptoms
Signs and symptoms of pancreatitis may vary, depending on type of pancreatitis

Acute pancreatitis signs and symptoms include:

  Upper abdominal pain

 Abdominal pain that radiates to back

 Abdominal pain that feels worse after eating

 Fever

 Rapid pulse

 Nausea

 Vomiting

 Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

 Upper abdominal pain

 Losing weight without trying

 Oily, smelly stools (steatorrhea)

Causes

Pancreatitis occurs when digestive enzymes become activated while still in the
pancreas, irritating the cells of pancreas and causing inflammation.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead
to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A
poorly functioning pancreas can cause digestion problems and diabetes.

Conditions that can lead to pancreatitis include:

 Abdominal surgery

 Alcoholism

 Certain medications

 Cystic fibrosis

 Gallstones
  High calcium levels in the blood (hypercalcemia), which may be caused by an
overactive parathyroid gland (hyperparathyroidism)

 High triglyceride levels in the blood (hypertriglyceridemia)

 Infection

 Injury to the abdomen

 Obesity

 Pancreatic cancer

Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat

gallstones, also can lead to pancreatitis.

Sometimes, a cause for pancreatitis is never found.

Risk factors

Factors that increase risk of pancreatitis include:

 Excessive alcohol consumption. Research shows that heavy alcohol users (people

who consume four to five drinks a day) are at increased risk of pancreatitis.

 Cigarette smoking. Smokers are on average three times more likely to develop

chronic pancreatitis, compared with nonsmokers. Quit smoking decreases its risk
up to 50%.

 Obesity.  Family history of pancreatitis. The role of genetics is becoming

increasingly recognized in chronic pancreatitis.

Complications

Pancreatitis can cause serious complications, including:

 Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cystlike

pockets in pancreas. A large pseudocyst that ruptures can cause complications
such as internal bleeding and infection.
  Infection. Acute pancreatitis can make pancreas vulnerable to bacteria and
infection. Pancreatic infections are serious and require intensive treatment, such
as surgery to remove the infected tissue.

 Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated
with dialysis if the kidney failure is severe and persistent.

 Breathing problems. Acute pancreatitis can cause chemical changes in body that

affect lung function, causing the level of oxygen in blood to fall to dangerously low
levels.

 Diabetes. Damage to insulin-producing cells in pancreas from chronic pancreatitis

can lead to diabetes, a disease that affects the way body uses blood sugar.

 Malnutrition. Both acute and chronic pancreatitis can cause pancreas to produce

fewer of the enzymes that are needed to break down and process nutrients from
the food which is eaten. This can lead to malnutrition, diarrhea and weight loss,
even though the patient may be eating the same foods or the same amount of
food.

 Pancreatic cancer. Long-standing inflammation in pancreas caused by chronic

pancreatitis is a risk factor for developing pancreatic cancer.

Diagnosis

There are a number of tests that alone, or in combination, will help establish the
diagnosis of pancreatitis.

Blood tests

Amylase and/or lipase levels are typically elevated in cases of acute pancreatitis. These
blood tests may not be elevated in cases of chronic pancreatitis. These are usually the
first tests performed to establish the diagnosis of pancreatitis, as these results are
generally readily and quickly available. Other blood tests may be ordered, for example:

 Liver and kidney function tests

 Tests for infection
 Tests for anemia
 Pancreatic lipase and amylase

Imaging studies
A CT (computed tomography) scan of the abdomen may be ordered to visualize the
pancreas and to evaluate the extent of inflammation, as well as any of the potential
complications that can arise from pancreatitis, such as bleeding or pseudocyst (a
collection of fluid) formation. The CT scan may also detect gallstones (a major cause of
pancreatitis) and other abnormalities of the biliary system.

Ultrasound imaging can be used to look for gallstones and abnormalities of the biliary
system. Because ultrasound imaging does not emit radiation, this modality is frequently
the initial imaging test obtained in cases of pancreatitis.

Depending on the underlying cause of pancreatitis and the severity of illness, additional
testing may be ordered.

Treatment

Treatment for acute or chronic pancreatitis may include

 a hospital stay to treat dehydration with intravenous (IV) fluids and, if person

can swallow them, fluids by mouth
 pain medicine, and antibiotics by mouth or through an IV if person has an
infection in pancreas
 a low-fat diet, or nutrition by feeding tube or IV if person can’t eat

Doctor may send patient to a gastroenterologist or surgeon for one of the following
treatments, depending on the type of pancreatitis.
References:

https://www.kenhub.com/en/library/anatomy/the-pancreas

https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes/syc-
20360227#:~:text=Pancreatitis%20is%20inflammation%20in%20the,body
%20processes%20sugar%20(glucose).

https://www.news-medical.net/health/What-is-Pancreatitis.aspx

https://www.medicinenet.com/pancreatitis/article.htm

https://teachmeanatomy.info/abdomen/viscera/pancreas/

https://www.ncbi.nlm.nih.gov/books/NBK482468/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511926/