1. Anatomy of Pancreas

2. Objectives Identify location of the Pancreas
Recognize important anatomical relations to the pancreas
Identify different parts of the pancreas
Recognize main and accessory pancreatic ducts
Identify blood supply of the pancreas
Discuss lymphatic drainage, and nerve supply of the pancreas

3. Pancreas Pancreas is an elongated accessory digestive gland
It is a retro peritoneal organ that lies transversely crossing the bodies of L1-L2 vertebra “ trans pyloric plane”
It is both an endocrine and exocrine organ
Is a gland with an exocrine and an endocrine functions
6-10 inch in length
gram in weight

4. Location: Retro-peritoneum, 2nd lumbar vertebral level
Has an oblique, transverse position
Parts of pancreas: head, neck, body and tail

5. Anatomical relations & Parts
Body
Head,
Neck,
Tail
Uncinate process

6. Head of Pancreas Includes uncinate process Flattened, 2 – 3 cm thick
Right border: related to the 2nd and 3rd portions of duodenum
Superior Pancreatico Duodenal Artery(SPDA) and Inferior Pancreatico Duodenal Artery (IPDA) anastamose between the rt. lateral border & the duodenum

7. Neck of Pancreas 2.5 cm in length Straddles SMV and PV
Superior border relates to the pylorus
Superior mesenteric vessels emerge from the inferior border
Posteriorly, SMV and splenic vein confluence to form portal vein
Posteriorly, most often no branches to pancreas

8. Parts of Pancreas

9. 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 closer to the superior border
Inferior surface is covered by transverse mesocolon

10. Posterior relations

11. 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)

12. Pancreatic Duct Main duct (Wirsung) runs the entire length of pancreas
Joins CBD at the ampulla of Vater
2 – 4 mm in diameter, drains up to 20 secondary branches
Ductal pressure is 15 – 30 mm Hg (vs. 7 – 17 in CBD) thus preventing reflux and damage to panc. duct
Lesser duct (Santorini) drains superior portion of head and empties separately into 2nd portion of duodenum

13. 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

14. Arterial Supply of Pancreas
Anterior and posterior collateral arcade between the superior and inferior PDA supply head
Body and tail supplied by splenic artery by about 10 branches
Three big branches from splenic are
Dorsal pancreatic artery
Pancreatica Magna (midportion of body)
Caudal pancreatic artery (tail)

15. Venous Drainage of Pancreas
Follows arterial supply
Ultimately, into portal vein
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

16. Lymphatic Drainage
Rich periacinar network that drain into 5 nodal groups
Superior nodes
Anterior nodes
Inferior nodes
Posterior PD nodes
Splenic nodes

17. 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

18. Innervation of Pancreas
Rich afferent sensory fiber network
Ganglionectomy or celiac ganglion blockade interrupt these somatic fibers (pancreatic pain)
However the origin of pancreatic pain is difficult to explain anatomically

19. Recommended readings
Keith L. Moore Clinically Oriented Anatomy Sixth edition pages

20. Refeneces
Keith L. Moore Clinically Oriented Anatomy Sixth edition pages