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Pancreas: Anatomy & Physiology

Sanjay Munireddy Sinai Hospital 11/21/2006

Pancreas- Brief History
‡ Herophilus, Greek surgeon first described pancreas. ‡ Wirsung discovered the pancreatic duct in 1642. ‡ Pancreas as a secretory gland was investigated by Graaf in 1671. ‡ R. Fitz established pancreatitis as a disease in 1889. ‡ Whipple performed the first pancreaticoduodenectomy in 1935 and refined it in 1940.

Pancreas
‡ Gland with both exocrine and endocrine functions ‡ 6-10 inch in length ‡ 60-100 gram in weight ‡ Location: retro-peritoneum*, 2nd lumbar vertebral level ‡ Extends in an oblique, transverse position ‡ Parts of pancreas: head, neck, body and tail

neck.Embryology of pancreas ‡ Endodermal origin ‡ Develops from ventral and dorsal pancreatic buds ‡ Ventral bud becomes the uncinate process and inferior head of pancreas ‡ Dorsal bud becomes superior head. body and tail ‡ Ventral bud duct fuses with dorsal bud duct to become mail pancreatic duct (Wirsung) .

Embryology of Pancreas .

Pancreas .

2 3 cm thick ‡ Attached to the 2nd and 3rd portions of duodenum on the right ‡ Emerges into neck on the left ‡ Border b/w head & neck is determined by GDA insertion ‡ SPDA and IPDA anastamose b/w the duodenum and the rt.Head of Pancreas ‡ Includes uncinate process ‡ Flattened structure. lateral border .

mostly no branches to pancreas ‡ ‡ ‡ ‡ .Neck of Pancreas 2. SMV and splenic vein confluence to form portal vein ‡ Posteriorly.5 cm in length Straddles SMV and PV Antero-superior surface supports the pylorus Superior mesenteric vessels emerge from the inferior border ‡ Posteriorly.

Pancreas .

kidney ‡ Splenic vein runs embedded in the post. renal vessels and upper 1/3rd of lt. adrenal gland.Body of Pancreas ‡ Elongated. related to aorta. separated from stomach by lesser sac ‡ Posterior surface. Surface ‡ Inferior surface is covered by tran. lt. long structure ‡ Anterior surface. mesocolon . lt.

short segment Lies at the level of the 12th thoracic vertebra Ends within the splenic hilum Lies in the splenophrenic ligament Anteriorly. related to splenic flexure of colon May be injured during splenectomy (fistula) .Tail of Pancreas ‡ ‡ ‡ ‡ ‡ ‡ Narrow.

20 secondary branches ‡ Ductal pressure is 15 30 mm Hg (vs. duct ‡ Lesser duct (Santorini) drains superior portion of head and empties separately into 2nd portion of duodenum . 7 17 in CBD) thus preventing damage to panc.Pancreatic Duct ‡ Main duct (Wirsung) runs the entire length of pancreas ‡ Joins CBD at the ampulla of Vater ‡ 2 4 mm in diameter.

Arterial Supply of Pancreas ‡ Variety of major arterial sources (celiac. SMA and splenic) ‡ Celiac Common Hepatic Artery Gastroduodenal Artery Superior pancreaticoduodenal artery which divides into anterior and posterior branches ‡ SMA Inferior pancreaticoduodenal artery which divides into anterior and posterior branches .

Arterial Supply of Pancreas ‡ Anterior collateral arcade b/w anterosuperior and anteroinferior PDA ‡ Posterior collateral arcade b/w posterosuperior and posteroinferior PDA ‡ Body and tail supplied by splenic artery by about 10 branches ‡ Three biggest branches are ± Dorsal pancreatic artery ± Pancreatica Magna (midportion of body) ± Caudal pancreatic artery (tail) .

Arterial Supply of Pancreas .

Venous Drainage of Pancreas ‡ Follows arterial supply ‡ Anterior and posterior arcades drain head and the body ‡ Splenic vein drains the body and tail ‡ Major drainage areas are ± ± ± ± Suprapancreatic PV Retropancreatic PV Splenic vein Infrapancreatic SMV ‡ Ultimately. into portal vein .

Venous Drainage of Pancreas .

Lymphatic Drainage ‡ Rich periacinar network that drain into 5 nodal groups ± Superior nodes ± Anterior nodes ± Inferior nodes ± Posterior PD nodes ± Splenic nodes .

Innervation of Pancreas ‡ Sympathetic fibers from the splanchnic nerves ‡ Parasympathetic fibers from the vagus ‡ Both give rise to intrapancreatic periacinar plexuses ‡ Parasympathetic fibers stimulate both exocrine and endocrine secretion ‡ Sympathetic fibers have a predominantly inhibitory effect .

calcitonin gene-related peptide. and galanin ‡ Rich afferent sensory fiber network ‡ Ganglionectomy or celiac ganglion blockade interrupt these somatic fibers (pancreatic pain*) . vasoactive intestinal peptide.Innervation of Pancreas ‡ Peptidergic neurons that secrete amines and peptides (somatostatin.

Histology-Exocrine Pancreas 2 major components acinar cells and ducts Constitute 80% to 90% of the pancreatic mass Acinar cells secrete the digestive enzymes 20 to 40 acinar cells coalesce into a unit called the acinus ‡ Centroacinar cell (2nd cell type in the acinus) is responsible for fluid and electrolyte secretion by the pancreas ‡ ‡ ‡ ‡ .

network of conduits that carry the exocrine secretions into the duodenum ‡ Acinus small intercalated ducts interlobular duct pancreatic duct ‡ Interlobular ducts contribute to fluid and electrolyte secretion along with the centroacinar cells .Histology-Exocrine Pancreas ‡ Ductular system .

islets of Langerhans ‡ Four major cell types ± Alpha (A) cells secrete glucagon ± Beta (B) cells secrete insulin ± Delta (D) cells secrete somatostatin ± F cells secrete pancreatic polypeptide .Histology-Endocrine Pancreas ‡ Accounts for only 2% of the pancreatic mass ‡ Nests of cells .

and D cells are located at the periphery of the islet .Histology-Endocrine Pancreas ‡ B cells are centrally located within the islet and constitute 70% of the islet mass ‡ PP. A.

Physiology Exocrine Pancreas ‡ Secretion of water and electrolytes originates in the centroacinar and intercalated duct cells ‡ Pancreatic enzymes originate in the acinar cells ‡ Final product is a colorless. and trypsinogen) . lipase. and isosmotic alkaline fluid that contains digestive enzymes (amylase. odorless.

and fats . proteins.Physiology Exocrine Pancreas ‡ 500 to 800 ml pancreatic fluid secreted per day ‡ Alkaline pH results from secreted bicarbonate which serves to neutralize gastric acid and regulate the pH of the intestine ‡ Enzymes digest carbohydrates.

0) acts as a vehicle to carry inactive proteolytic enzymes to the duodenal lumen ‡ Sodium and potassium concentrations are constant and equal those of plasma ‡ Chloride secretion varies inversely with bicarbonate secretion .6 to 9.Bicarbonate Secretion ‡ Centroacinar cells and ductular epithelium secrete 20 mmol of bicarbonate per liter in the basal state ‡ Fluid (pH from 7.

Acetylcholine ‡ Major inhibitors Atropine. Pancreatic polypeptide and Glucagon ‡ Secretin .released from the duodenal mucosa in response to a duodenal luminal pH < 3 . Somatostatin.Bicarbonate Secretion ‡ Bicarbonate is formed from carbonic acid by the enzyme carbonic anhydrase ‡ Major stimulants Secretin. Gastrin. Cholecystokinin.

Enzyme Secretion ‡ Acinar cells secrete isozymes ± amylases. . Acetylcholine. and proteases ‡ Major stimulants ± Cholecystokinin. VIP ‡ Synthesized in the endoplasmic reticulum of the acinar cells and are packaged in the zymogen granules ‡ Released from the acinar cells into the lumen of the acinus and then transported into the duodenal lumen. where the enzymes are activated. lipases. Secretin.

Enzymes ‡ Amylase ± only digestive enzyme secreted by the pancreas in an active form ± functions optimally at a pH of 7 ± hydrolyzes starch and glycogen to glucose. maltotriose. maltose. and dextrins ‡ Lipase ± function optimally at a pH of 7 to 9 ± emulsify and hydrolyze fat in the presence of bile salts .

elastase. converts trypsinogen to trypsin ± Trypsin. in turn. enterokinase. activates chymotrypsin. enzyme activation is prevented by an antiproteolytic enzyme secreted by the acinar cells .Enzymes of Pancreas ‡ Proteases ± essential for protein digestion ± secreted as proenzymes and require activation for proteolytic activity ± duodenal enzyme. carboxypeptidase. and phospholipase ‡ Within the pancreas.

or C peptide .Insulin ‡ Synthesized in the B cells of the islets of Langerhans ‡ 80% of the islet cell mass must be surgically removed before diabetes becomes clinically apparent ‡ Proinsulin. is transported from the endoplasmic reticulum to the Golgi complex where it is packaged into granules and cleaved into insulin and a residual connecting peptide.

pancreastatin. GIP. CCK. -Sympathetic fibers ‡ Major inhibitors ± somatostatin.Insulin ‡ Major stimulants ± Glucose. glucagon. sulfonylurea compounds. amino acids. amylin. sympathetic fibers .

Cholinergic fibers. somatostatin.Glucagon ‡ Secreted by the A cells of the islet ‡ Glucagon elevates blood glucose levels through the stimulation of glycogenolysis and gluconeogenesis ‡ Major stimulants ± Aminoacids. insulin. -sympathetic fibers . -Sympathetic fibers ‡ Major inhibitors ± Glucose.

and biliary secretion ‡ Used to treat both endocrine and exocrine disorders .Somatostatin ‡ Secreted by the D cells of the islet ‡ Inhibits the release of growth hormone ‡ Inhibits the release of almost all peptide hormones ‡ Inhibits gastric. pancreatic.