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 pancreatico-
duodenectomy 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
 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, neck,
body and tail
• Ventral bud duct fuses with dorsal bud duct to
become mail pancreatic duct (Wirsung)
Embryology of Pancreas
Pancreas
 Head of Pancreas
• Includes uncinate process
• Flattened structure, 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. lateral border
 Neck of Pancreas
• 2.5 cm in length
• Straddles SMV and PV
• Antero-superior surface supports the pylorus
• Superior mesenteric vessels emerge from the
inferior border
• Posteriorly, SMV and splenic vein confluence
to form portal vein
• Posteriorly, mostly no branches to pancreas
Pancreas
 Body of Pancreas
• Elongated, long structure
• Anterior surface, separated from stomach by
lesser sac
• Posterior surface, related to aorta, lt. adrenal
gland, lt. renal vessels and upper 1/3rd of lt.
kidney
• Splenic vein runs embedded in the post.
Surface
• Inferior surface is covered by tran. mesocolon
 Tail of Pancreas
• Narrow, 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)
 Pancreatic Duct
• Main duct (Wirsung) runs the entire length of
pancreas
• Joins CBD at the ampulla of Vater
• 2 – 4 mm in diameter, 20 secondary branches
• Ductal pressure is 15 – 30 mm Hg (vs. 7 – 17 in
CBD) thus preventing damage to panc. duct
• Lesser duct (Santorini) drains superior portion
of head and empties separately into 2nd
portion of duodenum
 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
 Innervation of Pancreas
• Peptidergic neurons that secrete amines and
peptides (somatostatin, vasoactive intestinal
peptide, calcitonin gene-related peptide, and
galanin
• Rich afferent sensory fiber network
• Ganglionectomy or celiac ganglion blockade
interrupt these somatic fibers (pancreatic
pain*)
 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
 Histology-Exocrine Pancreas
• Ductular system - 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-Endocrine Pancreas
• Accounts for only 2% of the pancreatic mass
• Nests of cells - 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
• B cells are centrally located within the islet
and constitute 70% of the islet mass
• PP, A, and D cells are located at the periphery
of the islet
 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, odorless, and
isosmotic alkaline fluid that contains digestive
enzymes (amylase, lipase, and trypsinogen)
 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, proteins, and
fats
 Bicarbonate Secretion
• Centroacinar cells and ductular epithelium secrete
20 mmol of bicarbonate per liter in the basal state
• Fluid (pH from 7.6 to 9.0) 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
 Bicarbonate Secretion
• Bicarbonate is formed from carbonic acid by
the enzyme carbonic anhydrase
• Major stimulants
Secretin, Cholecystokinin, Gastrin, Acetylcholine

• Major inhibitors
Atropine, Somatostatin, Pancreatic polypeptide and Glucagon

• Secretin - released from the duodenal mucosa

in response to a duodenal luminal pH < 3
 Enzyme Secretion
• Acinar cells secrete isozymes
– amylases, lipases, and proteases
• Major stimulants
– Cholecystokinin, Acetylcholine, Secretin, 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.
 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, maltose,
maltotriose, and dextrins
• Lipase
– function optimally at a pH of 7 to 9
– emulsify and hydrolyze fat in the presence of bile salts
 Enzymes of Pancreas
• Proteases
– essential for protein digestion
– secreted as proenzymes and require activation for
proteolytic activity
– duodenal enzyme, enterokinase, converts trypsinogen
to trypsin
– Trypsin, in turn, activates chymotrypsin, elastase,
carboxypeptidase, and phospholipase
• Within the pancreas, enzyme activation is
prevented by an antiproteolytic enzyme secreted
by the acinar cells
 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, or C peptide
 Insulin
• Major stimulants
– Glucose, amino acids, glucagon, GIP, CCK,
sulfonylurea compounds, β-Sympathetic fibers
• Major inhibitors
– somatostatin, amylin, pancreastatin, α-
sympathetic fibers
 Glucagon
• Secreted by the A cells of the islet
• Glucagon elevates blood glucose levels through the
stimulation of glycogenolysis and gluconeogenesis
• Major stimulants
– Aminoacids, Cholinergic fibers, β-Sympathetic fibers
• Major inhibitors
– Glucose, insulin, somatostatin, α-sympathetic fibers
 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, and biliary
secretion
• Used to treat both endocrine and exocrine
disorders