DR.V.Ramesh Dept of Anatomy sri Venkateshwaraa Medical College & Research Centre Puducherry

2.  Introduction
 Developmental Anatomy
 Gross Anatomy
 Functional Anatomy
 Clinical Anatomy
 Recent Advances

3.  Pancreas – derived from the Greek pan, “all”, and
kreas, “flesh”, probably referring to the organ’s
homogenous appearance
 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.

4. The pancreas is the organ that we barely remember until
we experience a disease associated with it. So, it is
important to learn about this essential gland that is
located behind the stomach and responsible for
secreting juices that allow to digestion of the food.

5.  It is one of accessory organ of digestion.
 It is an soft lobulated greyish pinkish gland
 It situated in the upper part of the posterior
abdominal wall extending from duodenum on
right side
 to spleen on the left side
 Lies behind the stomach separated from it by
lesser sac
 Structurally it is an elongated compound and
mixed gland, functionally it has exocrine and
endocrine parts

8.  Pancreas is an elongated, accessory digestive gland
that lies retroperitoneally
 The pancreas lies more or less horizontally on the
posterior abdominal wall
 It is occupies posterior part of epigastrium and left
hypochondriac region
 It crosses the posterior abdomen wall obliquely
from concavity of the duodenum, to the hilum
of the spleen . The level of T12 to L3

9.  Salmon pink in colour with a soft, lobulated
surface.
 The Pancreas is J shaped (or) resembles a retort
shaped flask.
 Length- 12-15 cm
 Breadth- 3- 4 cm
 Thickness- 1.5- 2 cm
 Weight- 80- 90 gms

10. The pancreas subdivided in to four parts
1. Head (with one process – uncinate process
2. Neck
3. Body
(with one process
-tuber omentale)
4. Tail
Body
Neck

11.  It the enlarged, disc shaped right end of the
pancreas
 It lies in the concavity of the C-shaped curve of
duodenum in front of the L2 vertebrate
 External feature –the head presents the following
features
 Three borders –superior, inferior, and right lateral
 Two surfaces-anterior & posterior
 One process-Uncinate process (hook like process
from the lower and left part of the head

12. Superior border- 1st part of
duodenum, and superior
pancreaticoduodenal artery,
hepatic branch of coeliac trunk
Inferior border- 3rd part of
duodenum and inferior
pacreaticoduodenal arteries
Right lateral border- 2nd part of
duodenum and anastomoses
between superior and inferior
pacreaticoduodenal arteries
Uncinate process –It projects to the
left behind superior mesenteric
vessels

13.  Triangular Projection.
 Extends from inferior lateral
end of the gland
 Anterior- superior
mesenteric vessels
 Posterior - aorta
 Inferiorly - 3rdpart of
duodenum
 Tumours do not cause
obstruction of bile duct but
compresses the 3rd part of
Duodenum.

14. Anterior surface:
Upper part – non peritoneal part ,
Transverse colon, 1st part of the duodenum
Lower part-peritoneal part
Transverse mesocolon
Coils of jejunum
Posterior surface: non perioneal
Inferior venacava
Terminal parts of renal veins
Right crus of diaphragm
In upper lateral part -Common bile duct

15. Inferior venacava
Right crus of
diaphragm
Common
bile duct

16.  It is slightly constricted part of the gland
which connects the head with the body
 It is about 2.5 cm long and is directed
forward, upwards and to left upper part of
anterior aspect of head
 It has two surface
 Anterior &
 Posterior Surface

17. Anterior surface
The peritoneum of the lesser sac and pyloric end of
the stomach
Posterior surface(np)
Shallow groove -Terminal part of superior mesenteric
vein in the lower part and trunk of portal vein in the
upper part joined to splenic vein.
Upper border-
1st part of the duodenum,
lower border –
Root of transverse mesocolon

18.  It is largest part of the gland extending left side of
neck to tail
 Extends from front of the Aorta to Left Kidney
 Triangular in cross section
 It passes towards to the left with slight upward and
backward inclination
It lies at the level of L1.
3 Surfaces:
Anterior, Posterior ,Inferior
3 Borders:
Superior, Anterior and Inferior

19.  Anterior surface:
 Concave forward and upwards
 Covered by peritoneum of lesser sac
 Its related to Posterio-Inferior surface of stomach
separate from lesser sac
 Inferior surface:
Duodeno - jejunal flexure A
Coils of Jejunum
Left colic flexure
A

20. Posterior surface
It is a non-peritoneal part
A) Abdominal aorta &
origin of the SMA
B) Left kidney
C) Left crus of diaphragm
D) Left suprarenal gland
E) Left renal vein
F) Splenic vein

21. Left suprarenal gland
Left Kidney
Left renal vessels
& renal pelvis
Left crus of diaphragm
Abdominal aorta
POSTERIOR
Left Colic flexure
Coils of jejunum
Duodeno jejunal
flexure
Inferior surface

22. Borders:
Superior border:
It is close to the right end. It presents a
conical projection known as tuber
omantale
Tuber omentale is related to coeliac trunk,
splenic artery and common hepatic artery

23. Anterior border:
Two layers of transverse mesocolon diverge from
each other
Inferior border:
At its right end it is
related to superior
mesenteric vessels.

24. TAIL:
 This is the left end of the gland, variable in size.
 It passes between the layers of the lienorenal
ligament and reaches the spleen with the splenic
vessels.
 Islets of Langerhans are most numerous in the tail

25. Exocrine pancreas drained by two ducts
a) Main pancreatic duct
b) Accessory pancreatic duct

28. Head and neck:
Branches from superior and inferior pancreatico
duodenal arteries
Body and tail:
Pancreatic Branches
from splenic artery
Splenic artery
Superior pancreaticoduodenal
artery
Inferior
pancreaticoduodenal artery

30. Venous drainage:
Body and tail-Splenic vein
Uncinate process and lower part of head-
Superior mesenteric vein
Upper part of head and neck- portal vein

31. 31
Inf.pan.duo.vein
Sup. Mesentric-vein
Splenic Vein
Portal
Vein

32.  Head and neck - drain in
to ventral and dorsal
group of pancreatico –
duodenal lymph nodes
 Body and tail-drain in to
pancraetico – splenic
lymph nodes
 Efferent vessels of these
nodes terminate into
coeliac and superior
mesenteric group of pre-
aortic lymph node

33.  Sympathetic nerves are derived from coelic and superior
mesenteric plexus around its arteries
 Parasympathetic nerves are derived from both vagus
nerves
 Sympathetic nerves are vasomotor, parasympathetic
nerves control the pancreatic secretion .
(Exocrine pancreatic secretion are controlled by nerves and
enzymes like Secretin and pancreozymin)

34.  Its Covered with a very thin layer of
loose connective tissue
 Thin septa arising from capsule and
divide the gland into many lobules.
 Inter lobular connective tissue
contains large ducts, blood vessels
and nerve fibers.
 Interlobular- surrounds the acini &
Islets
 Most of the substance of lobules is
made of exocrine pancreas with
scattered endocrine islets.

35.  It is the serous gland.
 The exocrine part of the
pancreas is made up of
acinar cell, intralobular
and interlobular ducts.
 Acini are typical serous
acini.

36.  They are small rounded
cluster of pyramidal cells
with a very small lumen.
 Each cell has a rounded
basal nucleus.
 Supranuclear portion
contains secretory
granules.

37.  Centroacinar cells. These
are the initial segments of
cuboidal cells of
intercalated ducts
invaginated into the
acinus.

38.  The cuboidal cells of intercalated ducts are later
replaced by taller cuboidal and eventually
columnar cells more distally.
 The intralobularducts drain into larger
interlobular ducts lined by columnar epithelium
and goblet cells.

39.  The endocrine part of
pancreas consists of islets or
insulae of Langerhans,
composed of spheroidal or
ellipsoidal cluster of cells.
 The human pancreas may
contain more than a million
islets usually most in the tail.
 The cells of islets are
polyhedral in shape and are
pervaded by fenestrated
capillaries and a rich
autonomic innervation.

40.  There are 3 types of cells, designated A, B, and D.
 A cells - secretes glucagon
 B cells - secrete insulin
 D cells - secrete somatostatin,

41. DEVELOPMENT
OF
PANCREAS

42. The pancreas develops from
2 buds arising from the
endoderm of the caudal
part of foregut :
A ventral pancreatic bud :
which develops from the
proximal end of hepatic
diverticulum (forms the
liver & gall bladder).
A dorsal pancreatic bud :
which develops from dorsal
wall of duodenum slightly
cranial to the ventral bud.
Most of pancreas is derived
from the dorsal pancreatic
bud.

43.  When the duodenum
rotates to the right
and becomes C-
shaped, the ventral
pancreatic bud moves
dorsally to lie below
and behind the dorsal
bud.
 Later the 2 buds fused
together and lying in
the dorsal mesentery.

44.  The ventral bud
forms :
 Uncinate process.
 Inferior part of
head of pancreas.
 The dorsal
pancreatic bud
forms :
 Upper part of of
head.
 Neck.
 Body &
 Tail of pancreas.

45.  The main pancreatic duct is
formed from :
 The duct of the ventral bud.
 The distal part of duct of
dorsal bud.
 The accessory pancreatic duct
is derived from :
 Proximal part of duct of
dorsal bud.
 The parenchyma of pancreas
is derived from the endoderm
of pancreatic buds.
 Pancreatic islets develops
from parenchymatous
pancreatic tissue.
 Insulin secretion begins at 5th
month of pregnancy.

46. 46

48.  Digestive
 Endocrine
 Pancreatic juice

50. Annular pancreas
 A rare condition where a abnormal ring of
pancreatic tissue that forms a circle around the
duodenum causing partial or complete
obstruction of the duodenum and block or
impair the flow of food to the rest of the
intestines.
Annular pancreas, a ring of pancreas caused by
a failure of the embryologic ventral pancreatic
bud to migrate to the right of the duodenum

51. Symptoms from annula pancreas
are nausea, vomiting, feeling of fullness after
and feeding problem in newborns

52. Ectopic pancreas
 It is the detatched portion of Pancreatic tissue
usually uncinate process situated outside the
normal pancreas.
 Ectopic pancreatic tissue can be found in the
Stomach, Duodenum, Jejunum, Ileum and
Meckle's diverticulum
Typical
picture of
accessory
pancreas

54. Accessory pancreas situated in
the greater curvature of the
pyloric antrum
Accessory pancreatic tissue in
duodenum

55. CANCER OF PANCREAS
 95% of all cancer tumors start in the head of the
pancreas where the digestive juices are made.
 5% of the cancer tumors start in the tail where
hormones such as insulin are made

56. Obstruction to bile duct
Leading to-
Obstructive jaundice
Portal vein-Ascitis
Pyrlorus
Of stomach
(Pyloric obstruction)

58.  The diseased pancreas can cause a LOT of
trouble
 Diabetes:
 In the United States, 25.8 million adults and
children (8.3% of population) have diabetes
 Systemic disease
 Pancreatic cancer – 4th most common cause of
cancer-related death, extremely poor prognosis
 Pancreatitis is an emergency situation