Lecture notes for medical students

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. PANCREAS:
Anatomy ,Physiology
,Investigations

3. Pancreas

4. Pancreas
• Gland with both exocrine and
endocrine functions
• 6-10 inch in length
• 60-100 gram in weight

5. Pancreas
• Location: Retro-peritoneum,
2nd lumbar vertebral level
• Extends in an oblique,
transverse position
• Parts of pancreas: head, neck,
body and tail

7. -

8. Anterior Relations

9. Anterior Relations
• From Right to Left-
– Transverse colon
– Attachment of transverse mesocolon
– The lesser sac
– Stomach

11. Arterial Supply of Pancreas

12. 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

13. Arterial Supply of Pancreas
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)

14. Venous Drainage of the Pancreas

15. Venous Drainage of the Pancreas
• Follows arterial supply
• Anterior and posterior arcades drain head and
the body
• Splenic vein drains the body and tail
• Ultimately, into portal vein

16. Lymphatic Drainage

17. Lymphatic Drainage
• Rich periacinar network that drain into 5 nodal
groups
– Superior nodes
– Anterior nodes
– Inferior nodes
– Posterior PD nodes
– Splenic nodes
Ultimately drain into Celiac and Superior mesenteric
Lymph nodes

18. Innervation of Pancreas

19. 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

20. 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

21. Histology-Exocrine Pancreas

22. Histology-Exocrine Pancreas
• 2 major components – Acinar cells and
Ducts
• They constitute 80% to 90% of the
pancreatic mass
• 20 to 40 acinar cells coalesce into a unit
called the acinus
• Acinar cells secrete the digestive enzymes
• Centroacinar cell (2nd cell type in the acinus)
is responsible for fluid and electrolyte
secretion by the pancreas

23. -

24. Physiology – Exocrine Pancreas

25. 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

26. Bicarbonate Secretion

27. 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

28. Enzyme Secretion

29. Enzyme Secretion
• Acinar cells secrete isozymes
–amylases, lipases, and proteases
• Major stimulants
–Cholecystokinin, Acetylcholine,
Secretin, VIP

30. Enzymes
• Amylase
– only digestive enzyme secreted by the pancreas in
an active form
– hydrolyzes starch and glycogen to glucose,
maltose, maltotriose, and dextrins
• Lipase
– emulsify and hydrolyze fat in the presence of bile
salts

31. -
-
Physiology – Endocrine Pancreas

32. Insulin

33. Insulin
• Synthesized in the B cells of the islets of
Langerhans
• Stimulates transport of glucose from serum
into cells.

34. Glucagon

35. 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

36. Somatostatin

37. 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

38. Investigations
• Laboratory investigations
• Imaging studies

39. Laboratory investigations

40. Laboratory investigations
• Estimation of pancreatic enzymes in body
fluids
– Serum amylase
– S. Lipase
• Pancreatic function tests
– Test meal, Secretin Test, CCK test
• The nitroblue tetrazolium–para-
aminobenzoic acid (NBT–PABA) test
• Pancreolauryl test
• Elastase in stool

41. Imaging

42. Imaging
• Ultrasound scan
• Computerised tomography
• Magnetic resonance imaging MRCP
• ERCP-Endoscopic retrograde
cholangiopancreatography
• Endoscopic ultrasound
• Plain radiography
– Chest
– Upper abdomen

43. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

44. Get this ppt in mobile

45. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
=0
• https://www.facebook.com/doctorpradeeppa
nde/?ref=pages_you_manage