THE PANCREAS

I. Introduction/General Information A. Located in epigastric & left hypochondriac regions B. Dimensions:

1. 5 - 6 length x 2. 1-1/2 width x 3. 1/2 - 1 thick

C. Lies Retroperitoneally at

T-12/L-1 to L-3

The Pancreas in situ

Right lobe of liver Falciform ligament

Gallbladder
Pancreas Duodenum L-3

D. Head fills concavity of duodenum

E. Body crosses left kidney

F.

Tail reaches hilus of the spleen

G. Related anteriorly to transverse colon

Pancreas in situ

Duodenum Head of Pancreas

H. Aorta, IVC lie posterior

I.

Uncinate process:
a. Lies posterior to SMA and SMV

b. Lies anterior to aorta

J. Neck lies anterior to SMV, with pylorus just above

Venous Drainage of the Pancreas

IVC

SMV

L. Body related
posteriorly to left crus, left adrenal, left renal vein, and splenic vein

K. Celiac Axis (trunk, artery) lies superior to body

II. Detailed Anatomy

A. Landmark structures 1. Splenic Artery: a. Branch of celiac trunk b. passes right to left c. Course is along upper margin of body and tail

2. Hepatic Artery:
a. Branch of celiac trunk b. courses left to right c. along upper margin of neck and head

3. Superior Mesenteric Artery: at its origin from aorta, points at body of pancreas

Arterial Supply to Pancreas

Proper Hepatic Artery Common Hepatic Artery Superior Mesenteric Artery

4. Splenic Vein:
a. runs parallel to artery b. on posterior surface of pancreas c. Terminates in portal vein

Landmark structures, continued

5. Superior & Inferior Mesenteric Veins:

a. pass (inferior to superior) deep to pancreas b. merge with splenic vein c. Terminate in portal vein

6. Common Bile Duct:

a. passes behind first portion of duodenum b. then through head of pancreas c. Terminates at ampulla of vater

B. Head of Pancreas

1. Important clinically because:

a. Numerous ducts and vessels traverse it b. Carcinoma usually located here

2. Tumor will compress surrounding structures a. First indication may be jaundice b. Tumor may compress duodenum c. May involve local vessels *Metastases may spread through these vessels*

3. Lymphatics from head of pancreas

a. Drain to celiac nodes

b. metastases may follow lymph

c. Metastases may spread via lesser omentum to liver d. Some terminate in lumbar nodes

Head of Pancreas, Detailed Anatomy, continued

1. Anterior branch of pancreaticoduodenal artery a. superior branch:

anterior superior pancreaticoduodenal artery

b. inferior branch:
anterior inferior pancreaticoduodenal artery

The nerves of the pancreas are derived from the vagus and abdominopelvic splanchnic nerves.

Head of Pancreas, Detailed Anatomy, continued

2. Posterior branch of pancreaticoduodenal artery

a. superior branch:
posterior superior pancreaticoduodenal artery

b. inferior branch:
posterior inferior pancreaticoduodenal artery

**extensive blood supply**

Anterior Pancreaticoduodenal Artery

Branches are continuous with one another Superior branches originate from the GDA Inferior branches originate from the SMA

C. Body & Tail of Pancreas:

1. Supplied by splenic artery 2. Have three surfaces: a. Anterior surface

1. Concave 2. Deep to stomach 3. Separated from stomach by lesser sac of peritoneum
(aka omental bursa)

Anterior surface of pancreas

Epiploic foramen

Anterior surface of pancreas

4. Lesser sac bounded by: a. Liver, superiorly b. Below, extends to greater omentum c. Anteriorly: lesser omentum, stomach, greater omentum

d. Posteriorly: greater omentum transverse colon, transverse mesocolon

e. Laterally:
1. Foramen of Winslow on right 2. Spleen on left

f. Foramen of Winslow

(Epiploic Foramen):
1. Lies between greater & lesser sacs of peritoneum 2. posterior to free edge of lesser omentum 3. close to porta hepatis

2. Posterior surface: a. b. c. d. e. f.

separated from vertebrae by

Aorta Splenic vein Left kidney and renal vessels Left adrenal gland Left Crus of diaphragm SMA and SMV

3. Inferior surface of Pancreatic body: a. Rests on duodeno-jejunal flexure b. Left extremity (tail)
1. Rests on splenic flexure 2. Abuts hilus of spleen

D. Pancreatic Duct System

1. Pancreatic Duct (of Wirsung) a. Course is left to right b. Receives numerous small ducts c. @ neck of pancreas, duct turns inferior, posterior & to the right d. AKA main pancreatic duct

Duct of Wirsung (Main pancreatic duct)

d. joins CBD at Ampulla of Vater 3 - 4 below pylorus e. results from fusion of ducts during fetal development
1. One from ventral pancreas 2. One from dorsal pancreas

Duct of Wirsung

Duct of Wirsung

2. Duct of Santorini: a. accessory pancreatic duct b. Not universally identified c. joins duodenum @ minor papilla d. part of duct from dorsal pancreas

Duct of Santorini

E. Tail of Pancreas 1. May be visualized through fluid-filled stomach 2. Tail seen as 2-3 cm rounded mass anterior to hilus of left kidney

The pancreas produce :

An exocrine secretion ( pancreatic juice from the acinar cells) that enter the duodenum through the main and accessory pancreatic ducts. Endocrine secretion (glucagon & insulin) from the pancreatic islets (of langerhans) that enter blood.

Smooth muscle sphincter that control the flow of bile & pancreatic juice into duodenum : - Sphincter of the pancreatic duct - Sphincter of the bile duct - Sphincter of hepatopancreatic (sphincter of Oddi)

IV. Pancreatic Disorders

A. Pancreatitis: diagnosis depends on clinical evidence

1. Usually secondary to biliary tract disease 2. Surgery of biliary tract or stomach, alcoholism are other causes