The Pancreas

The Pancreas

1. The Pancreas Dr. Amaan 26 th June 2021 Saturday

2. PANCREAS

3. PANCREAS The pancreas is a gland , lies at the level of L1-L2 It is party endocrine & party exocrine Endocrine part secretes hormones, eg insulin Exocrine part secretes the digestive pancreatic juices It is soft lobulated & elongated organ

4. LOCATION It lies transversely behind the stomach across the posterior abdominal wall It lies at the level of L1-L2 .

5. Size and shape It is J-shaped or retort-shaped, set obliquely The pancreas is divided into head, neck, body and the tail It is 15 - 20 cm long 2.5 – 3.8 cm broad 1.2 – 1.8 cm thick It weighs almost around 90 gms The head is enlarged and lies within the concavity of the duodenum The tail reaches the hilum of the spleen

6. Head of the Pancreas Head is the enlarged flattened right end of pancreas Situated within the “ C-shaped” curve of the duodenum

7. Relations of Head Three Borders • The superior border • The inferior border • The right lateral border Two Surfaces • The anterior surface • The posterior surface Uncinate Process It is related anteriorly to the superior mesenteric vessels, and posteriorly to the aorta.

8. Three boarders The superior border Overlapped by the 1 st part of the duodenum Related to the superior pancreaticoduodenal artery . 2. The inferior border Related to the 3 rd part of the duodenum and Inferior pancreaticoduodenal artery . 3. The right lateral border Related to the 2 nd part of the duodenum The terminal part of the bile duct and the anastomosis between the two pancreaticoduodenal arteries

9. Location of the pancreas and parts of pancreas

10. TWO SURFACES Anterior surface is related, from above downwards : 1. The 1 st part of the duodenum 2. The transverse colon, 3. The jejunum

11. TWO SURFACES Posterior surface is related 1. The inferior vena cava. 2. The terminal parts of the renal vein 3. The right crus of the diaphragm 4. The bile duct

12. Uncinate process

13. NECK OF THE PANCREAS Constricted part of the pancreas between its head and body It is directed forwards, upwards and to the left Portal vein is formed behind the neck of pancreas It has two surfaces, anterior and posterior.

14. Body of the pancreas The body of the pancreas is elongated It extends from its neck to the tail It passes towards the left with a slight upward and backward inclination .

15. BODY OF THE PANCREAS It has 3 borders, 3 surfaces Three Borders 1. The anterior border 2. The superior border 3. The inferior border Three Surfaces 1. The anterior surface 2. Posterior surface 3. The inferior surface

16. Three borders The anterior border provides attachment to the root of the transverse mesocolon. The superior border is related to coeliac trunk over the tuber omentale, the hepatic artery to the right ,and the splenic artery to the left. The inferior border is related to the superior mesenteric vessels at its right end.

17. Three surfaces The anterior surface It is concave and is directed forwards and upwards It is covered by peritoneum , and is related to the lesser sac and to the stomach

18. 2. The posterior surface is devoid of peritoneum , and is related to The aorta with the origin of the superior mesenteric artery The left crus of the diaphragm The left suprarenal gland The left kidney Left renal vessels Splenic vein

19. 3. The i n ferior su r face is covered by peritoneum & is related to: The duodenojejunal flexure Coils of jejunum Left colic flexure

20. TAIL OF THE PANCREAS This is the left end of the pancreas It lies in the lienorenal (splenorenal) ligament together with the splenic vessels It comes into contact with the lower part of the spleen

21. DUCTS OF THE PANCREAS The exocrine pancreas is drained by two ducts 1 . The main p anc r ea t i c d u ct (d u ct of Wirsung) 2 . The access o ry pan c r eatic d u ct (d u ct of Santorini)

22. DUCTS OF THE PANCREAS The main pancreatic duct of Wirsung 3 mm in diameter lies near the posterior surface of the pancreas and is recognized easily by its white color It receives many small tributaries which join it at acute angles forming V shaped pattern/ herring bone pattern within the head of the pancreas the pancreatic duct is related to the bile duct The two ducts enter the wall of the 2 nd part of the duodenum, and join to form the hepatopancreatic ampulla of Vater which opens by a narrow mouth on the summit of the major duodenal papilla, 8 to 10 cm distal to the pylorus

23. The pancreatic ducts

24. 2. The accessory pancreatic duct of Santorini It begins in the lower part of the head crosses the front of the main duct opens into the duodenum at the minor duodenal papilla . The papilla of accessory pancreatic duct is situated 6 to 8 cm distal to the pylorus .

25. Arterial Supply 1. Pancreatic branches of the splenic artery 2. The superior pancreaticoduodenal artery 3. The inferior pancreaticoduodenal artery.

26. Venous Drainage of Pancreas V ein drain i nto : Splenic , S u p er i or mesen t er i c and portal veins

27. Lymphatic drainage Lymphatic drainage follows the arteries & drains into the Pancreaticosplenic Coeliac Superior mesentric group of lymph nodes

28. The function of the exocrine pancreas is to produce pancreatic juice containing enzymes that digest carbohydrates , proteins and fats. THE EXOCRINE PANCREAS

29. The endocrine pancreas Distributed throughout the gland are groups of specialised cells called the pancreatic islets (islets of langerhans). The islets have no ducts so the hormones diffuse directly into the blood. The endocrine pancreas secretes the hormones insulin and glucagon , which control of blood glucose levels . Production of Pancreatic Hormones by Three Cell Types Alpha cells produce glucagon. Beta cells produce insulin. Delta cells produce somatostatin.

30. Thank you