Introduction

The pancreas lies in the upper abdomen behind the stomach. The pancreas is part of the
gastrointestinal system that makes and secretes digestive enzymes into the intestine, and also an
endocrine organ that makes and secretes hormones into the blood to control energy metabolism
and storage throughout the body.

*Exocrine pancreas – The portion of the pancreas that makes and secretes digestive enzymes into
the duodenum. This includes acinar and duct cells with associated connective tissue, vessels, and
nerves. The exocrine components comprise more than 95% of the pancreatic mass.

*Endocrine pancreas - The portions of the pancreas (the islets) that make and secrete insulin,
glucagon, somatostatin and pancreatic polypeptide into the blood. Islets comprise 1-2% of the
pancreatic mass.

Gross Anatomy
The head lies near the duodenum and the tail extends to the hilum of the spleen.

When the terms anterior, posterior, front and back are used, they pertain to relationships in the
human, standing erect. Superior and inferior are used in the same context so that they mean
toward the head and toward the feet, respectively. These usages obviously do not pertain in
quadruped animals where dorsal, ventral, cephalad, and caudad are more useful terms.

These are two normal human pancreases from autopsies of adults. Both pancreases have been
dissected to remove fat and adjacent organs. The two photos illustrate that there is considerable
individual variation in the shape of the pancreas.

(A) This pancreas has a conspicuous uncinate lobe

that curves down and to the left. This is an
unusual configuration since the uncinate process
usually fuses more completely with the dorsal
pancreas adding mass to the head of the pancreas.

(B) In this pancreas the uncinate portion is

fused to the remainder of the head. A probe has
been put into the main pancreatic duct, and a
second probe (vertical) is in the portal-superior
mesenteric vein behind the pancreas. The
diagonal groove in the tip of the tail (image
right) marks the course of a branch of the
splenic artery or vein.

Normal pancreas dissected to reveal the duct system.

The pancreas is viewed from the front and a portion of the parenchyma has been dissected away
to reveal
(1) Main (principal) pancreatic duct (Wirsung’s duct) with multiple branches

(2) Accessory duct (Santorini’s duct) and

(3) Distal common bile duct.

The tail of the pancreas and spleen are in

the left upper quadrant of the abdomen
and the head of the pancreas is in the
right upper quadrant just to the right of
the midline.

The pancreas is about the size of the half

of your hand that includes the index and
third fingers excluding the thumb.

The pancreas weighs about 100 grams

and is 14-23 cm long.

The head of the pancreas lies in the loop of the duodenum as it exits the stomach.

• The tail of the pancreas lies near the hilum of the spleen.

• The body of the pancreas lies posterior to the distal portion of the stomach between the tail and
the neck and is unlabeled in this drawing.

• The portion of the pancreas that lies anterior to the aorta is somewhat thinner than the adjacent
portions of the head and body of the pancreas. This region is sometimes designated as the neck
of the pancreas and marks the junction of the head and body.

• The close proximity of the neck of the pancreas to major blood vessels posteriorly including the
superior mesenteric artery, superior mesenteric-portal vein, inferior vena cava, and aorta limits
the option for a wide surgical margin when pancreatectomy (surgical removal of the pancreas) is
done.

• The common bile duct passes through the head of the pancreas to join the main duct of the
pancreas near the duodenum.The portion nearest the liver lies in a groove on the dorsal aspect of
the head.

• The minor papilla where the accessory pancreatic duct drains into the duodenum and the major
papilla (ampulla of Vater) where the main pancreatic duct enters the duodenum.
 The celiac trunk and the superior mesenteric
artery both arise from the abdominal aorta.
Both have multiple branches that supply
several organs including the pancreas. The
anastomosis of their branches around the
pancreas provides collateral circulation that
generally assures a secure arterial supply to
the pancreas. Most of the arteries are
accompanied by veins that drain into the
portal and splenic veins as they pass behind
the pancreas. The superior mesenteric vein
becomes the portal vein when it joins the
splenic vein.

Lymph nodes draining the pancreas.

This figure indicates the typical location of
lymph nodes surrounding the pancreas. There is
considerable individual variation in the location
of lymph nodes.

The pancreatobiliary anlagen appear at gestation week 5 in the human; fusion of the dorsal and
ventral anlagen occurs during week 7. Full development of acinar tissue extends into the postnatal
period. In mice, pancreatic development begins at embryonic day 8.5 and is largely complete by
day e14.5 .
 (A) The pancreas develops from two outgrowths of
the foregut distal to the stomach. The ventral
diverticulum gives rise to the common bile duct,
gallbladder, liver and the ventral pancreatic anlage
that becomes a portion of the head of the pancreas
with its duct system including the uncinate portion of
the pancreas. The dorsal pancreatic anlage gives rise
to a portion of the head, the body, and tail of the
pancreas including a major duct that is continuous
through the three regions.

The embryonic development of the

pancreas and biliary system in the human.

(B) The caudal portion of the head of the

pancreas (uncinate) and the major papilla
(ampulla of Vater) are derived from the ventral
anlage. The minor papilla that drains the duct of
Santorini is derived from the dorsal anlage.

Anatomic variations in the pancreatic and common bile duct systems.

The anatomic variations depicted provide

additional examples of individual differences in
pancreatic anatomy seen in adults. It becomes
apparent that the duct of Santorini is derived
from the dorsal anlage, whereas the duct of
Wirsung (the main duct of the pancreas) is
derived from the fusion of duct systems of
both dorsal and ventral anlagen and drains
into the duodenum at the ampulla of Vater.
The connection of the duct of Santorini to the
duodenum may regress. The duct systems of
the two anlagen may fail to fuse giving rise to
“pancreas divisum”. Rarely the duct systems
may fuse but lose their connection to the
ampulla. Pancreatic secretions then reach the duodenum through the duct of Santorini and the
minor papilla.
 Anatomic variations in the union of
the common bile duct and the main
pancreatic duct at the major papilla
(ampulla of Vater).

“Common channel” refers to the fused

portion of the bile and pancreatic ducts
proximal to entry into the duodenum. The
common channel may be long. Less often,
there is no common channel because the
ducts open separately into the duodenum.
The common channel has received much
attention because stones in the biliary tract (gallstones) may lodge in the common channel
causing obstruction of both pancreatic and biliary duct systems. Such an obstruction is frequently
regarded as the cause of acute pancreatitis

Histology of the Pancreas

1. Cellular Composition
The cellular composition of the pancreas is diverse, reflecting its dual role as an endocrine and
exocrine organ. The pancreas is composed of different cell types, each with specific functions. The
two primary cellular components are the endocrine cells, found in clusters known as the Islets of
Langerhans, and the exocrine cells, primarily forming the acini.
1. Endocrine Cells - Islets of Langerhans:
• Beta Cells: These cells are responsible for producing and secreting insulin. Insulin plays a
crucial role in regulating blood glucose levels by promoting the uptake of glucose by cells.
• Alpha Cells: Alpha cells produce and
release glucagon, a hormone that
elevates blood glucose levels by
stimulating the liver to convert stored
glycogen into glucose.
• Delta Cells: Delta cells secrete
somatostatin, a hormone that regulates
the release of both insulin and
glucagon, acting as a modulator of
pancreatic hormone activity.
• Epsilon Cells: Epsilon cells produce ghrelin, a hormone that stimulates hunger and
regulates energy balance.
The coordinated release of hormones from these endocrine cells ensures the precise regulation of
blood glucose levels and metabolic processes.
2. Exocrine Cells - Acinar Cells:
• Acinar Cells: These cells constitute the exocrine portion of the pancreas and are arranged
in clusters called acini. Acinar cells produce and secrete digestive enzymes that play a
 crucial role in breaking down food in the digestive tract. The main enzymes produced
include:
• Amylase: Breaks down carbohydrates (starches) into smaller sugar molecules.
• Lipase: Breaks down fats (lipids) into fatty acids and glycerol.
• Protease: Breaks down proteins into amino acids.
• Ductal Cells: Ductal cells are responsible for producing and secreting bicarbonate ions,
which contribute to the alkaline nature of pancreatic juice. Bicarbonate helps neutralize the
acidic chyme from the stomach, creating a favorable environment for enzyme activity in the
small intestine.
3. Other Cells:
• Stellate Cells: Also known as pancreatic stellate cells, these are specialized cells found in
the connective tissue of the pancreas. They play a role in maintaining the organ's structure
and are involved in tissue repair and fibrosis.

2. Ductal System
The ductal system of the pancreas is a network of ducts that plays a crucial role in transporting
pancreatic juice from the pancreas to the duodenum, the first part of the small intestine.
Pancreatic juice is essential for digestion as it contains enzymes that break down carbohydrates,
fats, and proteins, as well as bicarbonate ions that neutralize the acidic chyme coming from the
stomach.
Here's a detailed overview of the ductal system of the pancreas:
1. Main Pancreatic Duct:
• The main pancreatic duct, also known as
the duct of Wirsung, runs the length of the
pancreas.
• It typically joins the common bile duct, a
duct that carries bile from the liver and
gallbladder, forming the hepatopancreatic
ampulla (also known as the ampulla of
Vater).
• The hepatopancreatic sphincter (sphincter
of Oddi) surrounds the ampulla and
regulates the release of pancreatic juice
and bile into the duodenum.
2. Accessory Pancreatic Duct:
• Some individuals have an additional duct called the accessory pancreatic duct (duct of
Santorini), which also connects to the duodenum.
• The presence and size of the accessory duct can vary among individuals.
• It provides an alternative route for pancreatic juice to enter the duodenum.
3. Ductal Cells:
• The walls of the pancreatic ducts are lined with specialized ductal cells.
• These cells play a role in the secretion of bicarbonate ions, which neutralize the acidic
chyme from the stomach.
• The neutralization of acidity creates an optimal environment for the activity of pancreatic
enzymes.
4. Bicarbonate Secretion:
• The pancreas secretes a bicarbonate-rich fluid in response to hormonal signals, particularly
stimulated by the hormone secretin.
• Bicarbonate ions help neutralize the acidic chyme, preventing damage to the delicate lining
of the small intestine and providing an alkaline environment for enzyme activity.
5. Transport of Pancreatic Juice:
• Pancreatic juice, once produced by acinar cells and ductal cells, flows through the ductal
system toward the duodenum.
• The release of pancreatic juice is regulated by the sphincter of Oddi, which opens in
response to specific stimuli, including the presence of food in the duodenum.
6. Role in Digestion:
• Pancreatic juice contains various enzymes crucial for the digestion of nutrients:
• Amylase: Breaks down carbohydrates (starches) into smaller sugar molecules.
• Lipase: Breaks down fats (lipids) into fatty acids and glycerol.
• Protease: Breaks down proteins into amino acids.

Physiology of the Pancreas

1. Endocrine Function
The pancreas contains clusters of cells known as the Islets of Langerhans, which house different
types of endocrine cells. These cells release hormones into the bloodstream, playing a crucial role
in maintaining glucose homeostasis. The key hormones involved in the endocrine function of the
pancreas are insulin, glucagon, somatostatin, and ghrelin.
1. Insulin:
• Produced by: Beta cells in the Islets of Langerhans.
• Function: Insulin is released in response to elevated blood glucose levels, such as
after a meal. It facilitates the uptake of glucose by cells, promoting the conversion of
glucose into glycogen in the liver and muscle cells for energy storage. Insulin also
inhibits the breakdown of stored glycogen and the production of glucose by the liver.
2. Glucagon:
• Produced by: Alpha cells in the Islets of Langerhans.
 • Function: Glucagon is released when blood glucose levels are low, typically between
meals or during fasting. It stimulates the liver to convert stored glycogen into
glucose, releasing it into the bloodstream. This process helps raise blood glucose
levels and provides a constant supply of energy for the body.
3. Somatostatin:
• Produced by: Delta cells in the Islets of Langerhans.
• Function: Somatostatin acts as a modulator of the endocrine functions of the
pancreas. It inhibits the release of both insulin and glucagon, helping to maintain
balanced blood glucose levels. Somatostatin also regulates the release of other
hormones within the digestive system.
4. Ghrelin:
• Produced by: Epsilon cells in the Islets of Langerhans.
• Function: Ghrelin is primarily associated with the regulation of appetite and energy
balance. It stimulates hunger and promotes the intake of food. Ghrelin levels
typically increase before meals and decrease after eating.

2. Exocrine Function
The majority of the pancreas is dedicated to its exocrine function, and this involves the production
and delivery of pancreatic juice that contains enzymes crucial for breaking down carbohydrates,
fats, and proteins. Here are the key aspects of the exocrine function of the pancreas:
1. Acinar Cells:
• Location: The exocrine portion of the pancreas is mainly composed of acinar cells.
• Function: Acinar cells are responsible
for producing and secreting digestive
enzymes.
2. Digestive Enzymes:
• Amylase: Breaks down
carbohydrates (starches) into smaller
sugar molecules.
• Lipase: Breaks down fats (lipids) into
fatty acids and glycerol.
• Protease: Breaks down proteins into amino acids.
3. Ductal Cells:
• Location: Ductal cells line the pancreatic ducts.
• Function: Ductal cells secrete a bicarbonate-rich fluid into the pancreatic juice.
4. Bicarbonate Secretion:
• Function: The bicarbonate ions released by ductal cells serve to neutralize the acidic chyme
from the stomach as it enters the duodenum.
5. Pancreatic Juice:
• Formation: Pancreatic juice is formed by the combination of digestive enzymes from acinar
cells and bicarbonate from ductal cells.
• Composition: The pancreatic juice is alkaline due to the presence of bicarbonate, which
helps neutralize the acidic environment created by stomach acid.
6. Release into Duodenum:
• Regulation: The release of pancreatic juice into the duodenum is controlled by the
sphincter of Oddi, a muscular valve that surrounds the junction of the common bile duct
and the pancreatic duct.
• Stimulus: The presence of food in the duodenum, particularly acidic chyme from the
stomach, stimulates the release of pancreatic juice.
7. Role in Digestion:
• Carbohydrate Digestion: Amylase breaks down complex carbohydrates into simpler sugars,
facilitating their absorption in the small intestine.
• Fat Digestion: Lipase breaks down fats into fatty acids and glycerol, aiding in fat
absorption.
• Protein Digestion: Protease breaks down proteins into amino acids, allowing for their
absorption.

Pancreatic Diseases
1. Diabetes Mellitus
Diabetes mellitus, a group of metabolic disorders, is a primary concern associated with the
pancreas. In Type 1 diabetes, the immune system attacks and destroys insulin-producing beta
cells, leading to insulin deficiency. Type 2 diabetes involves insulin resistance, where cells fail to
respond effectively to insulin. Management includes lifestyle modifications, medications, and
insulin therapy.

2. Pancreatitis
Pancreatitis, characterized by inflammation of the pancreas, can be acute or chronic. Gallstones,
alcohol consumption, and certain medications are common causes. Symptoms range from
abdominal pain to digestive disturbances. Treatment involves pain management, dietary changes,
and, in severe cases, surgery.

3. Pancreatic Cancer
Pancreatic cancer is a formidable adversary known for its late-stage diagnosis and aggressive
nature. Risk factors include smoking, genetics, and chronic pancreatitis. Treatment options include
surgery, chemotherapy, and radiation therapy. Early detection remains challenging, emphasizing
the importance of risk factor awareness.
Diagnostic Methods
1. Imaging Techniques
Advanced imaging techniques play a crucial role in diagnosing pancreatic conditions. Ultrasound,
CT scans, and MRI provide detailed images of the pancreas, aiding in the identification of
structural abnormalities, tumors, or inflammation.

2. Laboratory Tests
Blood tests for enzyme levels, including amylase and lipase, are valuable in diagnosing
pancreatitis. Genetic testing may identify hereditary predispositions to pancreatic diseases,
allowing for early intervention.

Treatment and Management

1. Diabetes Management
Managing diabetes involves a multifaceted approach, including lifestyle modifications such as a
healthy diet, regular exercise, and medications. Insulin therapy may be necessary in cases of Type
1 diabetes or advanced Type 2 diabetes.

2. Pancreatitis Treatment
Treatment for pancreatitis includes pain management, dietary adjustments (such as a low-fat
diet), and addressing the underlying cause. Severe cases may require hospitalization, intravenous
fluids, and, in rare instances, surgical intervention.

3. Pancreatic Cancer Treatment

The treatment of pancreatic cancer is complex and often requires a multidisciplinary approach.
Surgical removal of tumors, chemotherapy, and radiation therapy aim to control or eradicate
cancer cells. Palliative care focuses on improving the quality of life for individuals with advanced-
stage pancreatic cancer.

Importance of Pancreatic Health

1. Role in Digestion and Nutrient Absorption
The pancreas's critical role in digestion cannot be overstated. The enzymes it produces are
essential for breaking down carbohydrates, fats, and proteins, facilitating nutrient absorption in
the small intestine.
2. Impact on Overall Metabolic Balance
The pancreas's endocrine functions are integral to overall metabolic balance. Regulation of blood
glucose levels influences energy utilization and storage, impacting various physiological processes
throughout the body.

3. Lifestyle Choices for Pancreatic Health

Promoting awareness of lifestyle choices that positively impact pancreatic health is crucial.
Avoiding excessive alcohol consumption, maintaining a balanced diet, staying physically active,
and managing stress contribute to the overall well-being of the pancreas.

Conclusion
In conclusion, this comprehensive exploration of the pancreas highlights its anatomical intricacies,
diverse functions, susceptibility to diseases, diagnostic methods, and treatment options. From its
location in the abdominal cavity to its microscopic cellular composition, the pancreas emerges as a
linchpin in the complex tapestry of human physiology. Awareness of pancreatic diseases and
proactive measures, including a healthy lifestyle, are essential for preserving the health and
functionality of this vital organ. The pancreas, often working behind the scenes, deserves
recognition for its indispensable contributions to our well-being.
Bibliography
1. Johns Hopkins medicine
2. Columbia University Department of Surgery
3. National Institute of Health UK
RISHIRAJ SONI