PANCREAS

Dr. Gurudasan

2

INTRODUCTIONThe pancreas is the

largest of the digestive glands and performs a range of both endocrine and exocrine functions.

The pancreas is salmon pink in colour with a firm, lobulated smooth surface.

The main portion is divided into four parts, head, neck, body and tail, purely on the basis of anatomical relations.

A blunt uncinate process arises

from the lower part of head and

turns to the left. This uncinate

process is anatomically and

embryologically distinct.15-05-2014

3

LOCATION In adults the pancreas

measures between 12 and 15 cm long.

It occupies the posterior part of epigastrium and left hypochondrium.

It lies behind the peritoneum on the posterior

Abdominal wall more or less in transpyloric plane.

It extends from the concavity of duodenum to hilum of spleen.

Head & Neck - L1& L2, Body – Transpyloric plane, Tail – T12

Head

Neck

BodyTa

il

Sple

en

Uncinate processDuodenum

15-05-2014

4

HEAD OF PANCREAS

The head of the pancreas lies to the right of the midline, anterior and to the right side of the vertebral column, within the curve of the duodenum. It is the thickest and broadest part of the pancreas but is still flattened in the anteroposterior plane.

Superior pancreatico-duodenal artery

(Anterior view)(Posterior view)

Common bile duct

Inferior pancreatico-duodenal artery

Superior mesenteric artery

Splenic artery

15-05-2014

5

NECK OF PANCREAS

It is the slightly constricted part of the gland which connects head with the body.It has anterior and posterior surfaces, upper and lower bordersAnterior surface – pylorusPosterior surface – commencement of portal vein and origin of superior mesentericartery

Pylorus

Superior mesenteric vessels

Portal veinSplenic vein

SuperiorMesentericvein

15-05-2014

6

BODY OF PANCREAS

It is the elongated part extending from neck to tail. It is triangular in cross-section. And it has 3 surfaces and 3 borders and one process(Tuber omentale). Anterior border – Attachment of transverse colonInferior border – Superior mesenteric vesselsSuperior border – Coeliac artery and its branches.

Tuber omentale

Coeliac artery

Attachment of transverse colonSuperior mesenteric vessels

15-05-2014

Body

7

Relations of Body of pancreas

Body

Duodeno-jejunal flexure

Left gonadalvein

Left colicflexure

Left kidney

Left suprarenal glandSplenic artery

15-05-2014

8

Relations of Body of pancreas

Coeliac artery

Portal vein

Superior mesenteric veinSuperior mesenteric artery

Splenic vein

15-05-2014

9

Visceral relations of pancreas

15-05-2014

10

Tail of pancreasIt is the narrow left

extremity of pancreas.It is present in the

lienorenal ligamentIt has umpteen

number of islets of pancreas.

Relations:It is related to the visceral surface of spleen and is present between gastric and colic impressions.

Lienorenal ligament

Tail

Spleen

Left colic flexure

During splenectomy the tail of pancreas is likely to be injured pancreatic enzymes will leakand destroy surrounding tissues Chemical peritonitis or pancreatic fistula 15-05-2014

11

Ducts of pancreasUsually there are 2I) Main pancreatic ductII) Accessory pancreatic

ductMain pancreatic duct: It runs in the whole

length of the gland. Increases in size as it

gathers more and more tributaries and form “herringbone pattern”

It forms hepato-pancreatic ampulla after joining with CBD and opens into the major duodenal papilla.

Herringbone pattern

Main pancreatic ductMajor duodenalpapillae

Accessory pancreatic duct

Minor duodenal papillae

Accessory pancreatic duct: It begins at the lower part of head and travels upwards crossing main duct and opens at the II part of duodenum at minor duodenal papilla.

15-05-2014

12

Development of pancreas

Ventral pancreaticbud

Bile duct(Hepaticoutgrowth)

15-05-2014

13

Arterial supplySplenic artery

Arteria pancreatica magna

Inferior pancreatico-duodenalartery

superior pancreatico-duodenalartery

As pancreas develops at the junction betweenforegut and midgut, it is supplied by the branches of artery of foregut (Coeliactrunk) and artery of midgut(superior mesentericartery )

ArteriaCaudapancreatica

15-05-2014

14

Venous drainagePortal vein

Superior mesentericvein

Splenic vein

15-05-2014

15

Nerve supply

15-05-2014

16

Nerve supply

Coeliac ganglia andplexus

Superior mesentericganglia and plexus

Greater,lesser and leastsplanchnic nerves

Sympathetic

and

parasympathetic

innervation reach

via coeliac and

Superior

mesenteric

plexuses.

Sympathetic:

Vasomotor

Parasympathetic:

Secretomotor

15-05-2014

17

Intrinsic nerve supply of pancreas

15-05-2014

18

Lymphatic drainage

Pancreatico-splenicNodes (Main group)

Coeliac nodes

Superior mesenteric nodes

Pyloric nodes

15-05-2014

19

Clinical Anatomy

Pancreatitis: Inflammation of pancreas. Symptoms: Loss of appetite, nausea, typical pancreatic backache, feverStools : Bulky and fat filledRecurrent pancreatitis predisposes stasis of pancreatic juice leading To calculus formation.

15-05-2014

20

Typical backpain in pancreatitis

15-05-2014

21

Pancreatic pseudocystLesser sac is

related anteriorly to the body of pancreas. Therefore inflammatory fluid collects in the omental bursa in pancreatitis.

Such a swelling gives a false impression of a cyst from pancreas, hence the name pancreatic pseudocyst.

15-05-2014

22

Carcinoma of head of pancreas

It produces symptoms related to compression of the surrounding structures.

CBD – Obstructive jaundice

II part of duodenum – intestinal obstruction

Portal vein – Portal hypertension and ascites

15-05-2014

23

THANK YOU

15-05-2014