GROSS ANATOMY OF THE
PANCREASE
UNO, VICTOR KANU
INTRODUCTION
The pancreas is a soft, finely lobulated, elongated exo-endocrine gland.
The exocrine part secretes the pancreatic juice and the endocrine part secretes
the hormones, viz.,insulin, etc.
The pancreas (in Greek pan: all 1 kreas: flesh) is presumably so named because
of its fleshy appearance.
The pancreatic juice helps in the digestion of lipids, carbohydrates, and
proteins, whereas the pancreatic hormones maintain glucose homeostasis.
SIZE AND SHAPE
The pancreas is “J”-shaped or
retort shaped being set
Obliquely.
Its measurements are:
Length: 12–15 cm.
Width: 3–4 cm.
Thickness: 1.5–2 cm.
Weight: 80–90 g.
LOCATION
The pancreas lies more or less
horizontally on the posterior
abdominal wall in the epigastric and
left hypochondriac regions.
It crosses the posterior abdominal
wall obliquely from concavity of the
duodenum to the hilum of spleen
opposite the level of T12–L3
vertebrae
The greater part of the gland is
retroperitoneal behind the serous
floor of the lesser sac. Its left
extremity—the tail, lies in the
lienorenal ligament.
PARTS (HEAD OF PANCREAS)
It is the enlarged, disc-shaped right end of
the pancreas, which lies in the concavity of
the C-shaped duodenal loop in front of the
L2 vertebra
The head presents the following external
features:
1. Three borders: Superior, inferior, and right
lateral.
2. Two surfaces: Anterior and posterior.
3.One process: Uncinate process. (It is a
hook-like process from the lower and left
part of the head. It extends toward the left
behind the superior mesenteric vessels.)
RELATIONS OF THE HEAD
NECK OF THE PANCREAS
It is a slightly constricted part of the gland
which connects
the head with the body. It is about 2.5 cm
(1 inch) long and is directed forward,
upward, and to the left.
External Features
It presents the following external features:
Two surfaces: Anterior and posterior.
Two borders: Upper and lower.
Anterior surface is related to pylorus.
Posterior surface is related to
commencement of the portal vein.
Upper border is related to the first part of
the duodenum
BODY OF THE PANCREAS
It is the elongated part of the gland extending from
its neck to the tail.
It passes toward the left of midline with a slight
upward and backward inclination
It lies in front of the vertebral column at or just
below the transpyloric plane
External Features
It is somewhat triangular in cross section and
presents:
1. Three borders: Anterior, superior, and inferior.
2. Three surfaces: Anterior, posterior, and inferior.
3. One process: Tuber omentale (a part of the body
projects above the lesser curvature of the stomach
and comes in contact with the lesser omentum across
the lesser sac).
TAIL OF THE PANCREAS
It is the narrow left extremity of the
pancreas.
2. It lies in the lienorenal ligament
along with splenic
vessels.
3. It is mobile unlike the other major
retroperitoneal parts of the gland.
4.It contains the largest number of
islets of Langerhans per unit of
tissue as compared to other parts of
the gland.
These are related to the visceral
surface of spleen between gastric
impression and colic impression.
DUCT OF THE PANCREAS
Usually there are two ducts: main and
accessory, which drain the exocrine
secretion into the duodenum.
The main pancreatic duct (duct of
wirsung) joins the bile duct as it pierces
the duodenal wall (second part) to form
the hepatopancreatic ampulla (of Vater)
which opens by a narrow mouth on the
summit of major duodenal papilla 8–10
cm distal to the pylorus
The accessory pancreatic duct (duct of
Santorini) opens into the second part of
the duodenum on the summit of minor
duodenal papilla about 2–3 cm above the
opening of main pancreatic duct (6–8 cm
distal to pylorus).
ARTERIAL SUPPLY
The pancreas is a high vascular structure
and supplied by the following arteries:
Splenic artery, a branch of coeliac trunk,
Its branches (arteria pancreatica magna
and arteria caudae pancreatica )supply
the body and tail of pancreas.
Superior pancreaticoduodenal artery:
The superior pancreaticoduodenal
artery is a branch of gastroduodenal
artery
Inferior pancreaticoduodenal artery: The
inferior pancreaticoduodenal artery is a
branch of superior mesenteric artery
Venous drainage, lymphatic drainage and nerve supply
The veins of the pancreas drain into (a)
portal vein, (b) superior mesenteric
vein, and (c) splenic vein.
The lymphatics drain into the following
lymph node Pancreaticosplenic nodes
(main group), Coeliac nodes, Superior
mesenteric nodes, Pyloric nodes.
The sympathetic and parasympathetic
nerve fibres reach the gland along its
arteries from coeliac and superior
mesenteric plexuses.
The sympathetic supply is vasomotor
whereas the parasympathetic supply
controls the pancreatic secretion.
CLINICAL CORRELATION
Carcinoma of the head of pancreas is common, It compresses the bile duct
leading to persistent obstructive jaundice. It may press the portal vein or may
involve the stomach due to close vicinity of these structures to the head of
pancreas.
Acute pancreatitis is the acute inflammation of the pancreas. It occurs due to
obstruction of pancreatic duct, ingestion of alcohol, viral infections (mumps), or
trauma. It is serious condition because activated pancreatic enzymes leak into
the substance of pancreas and initiates the autodigestion of the gland.
Clinically, it presents as very severe pain in the epigastric region radiating to the
back, fever, nausea, and vomiting. The serum amylase, level is raised four times
