2. Competency
AN. 47.5
Describe and demonstrate major viscera of
abdomen under the following headings
1.Position and peritoneal relations
2. External and internal features
3. Relations
4. Blood supply ,nerve supply , lymphatic
drainage and applied aspects
3. Competency
AN .47.6
1. Explain the anatomical basis of Splenic notch
2. Anatomical basis of Accessory spleen
3. Kehr’s sign.
4. 1. PANCREAS
1 . General features .
2. Location and surface markings .
3. Parts and Relations .
4 . pancreatic ducts
5. Arterial supply ,venous drainage ,nerve
supply & lymphatic drainage .
6. Microscopic structure
7 .Development
8. Applied importance .
5. 1. General features
-> Pancreas is a soft elongated lobulated gland, located
in the posterior abdominal wall.
Length : 12 to 15 cm
Extend : from the concave medial border of duodenum
on the RT side to the hilum of spleen on the LT side .
-> It is an exocrine and endocrine gland .
-> Exocrine part secretes ,lipase ,amylase ,tripsin ,
bicarbonate to maintain the Ph.
-> Endocrine part [ Islets of Langerhans ] secrete Insulin
& glucagon to control the blood glucose level .
6. 2. Location & surface marking
a) Located in the posterior abdominal wall
-> Retro peritoneal organ ,
[except tail which lies in the lieno renal ligament]
Head of pancreas :
-> over the anterior surface of 1st & 2nd lumbar vertebrae,
Body of pancreas :
-> lies oblique in the trans pyloric plain [ L1 ] from RT to LT
Tail of pancreas: level with 12th Thoraxic vertebra .
7.
8.
9. 3. Parts , borders and surfaces
4 parts
-> Head , Neck ,Body and Tail .
1. Head : 3 borders
-> Superior border
-> RT border
-> Inferior border
2. Body : 3 borders
Superior , Inferior and Anterior borders
10.
11. Surfaces
1. Head :
-> Anterior surface & posterior surface.
2. Body :
1. Anterior surface [ area between superior &
anterior borders ]
2. Posterior surface [area between superior &
inferior borders ]
3. Inferior surface [ anterior & inferior borders ]
12. 4. RELATIONS
1. Head :
a) Anterior surface -> covered with peritoneum
[ attachment of] -> Transevers mesocolon
b) Posterior surface
-> IVC
-> RT renal vein
-> pancreatic duct & common bile duct
-> portal vein
13. Relations
c) Superior border -> to 1st part of duodenum
d) RT border -> to 2nd part of duodenum
e) Lower border -> 3rd part of duodenum .
f) Uncinate process :
hook –shaped process arising from lower
border of head
Posteriorly -> abdominal aorta
Anteriorly -> superior mesenteric artery .
14.
15. Relations
2. Neck :
Posteriorly -> superior mesenteric vein
-> splenic vein [ together Portal vein ]
Anteriorly -> peritoneum forming lesser sac
-> stomach pylorus
3. Body :
a) Superior border ->
-> Tuber omentale [conical elevation ]
-> Celiac trunk ,RT Hepatic artery [ RT of Tuber omenta:]
-> Splenic artery [ LT Tuber omentale ]
16. Relations
b) Inferior border :
-> transverse mesocolon attached
c) Anterior border :
-> attachment of greater omentum .
Surfaces of body related to :
a) Anterior surface -> covered with paritonium ,
and form part of stomach bed
17. Relations
b) Inferior surface of body -> related to
-> peritoneum
-> deuodeno jejunal fluxur
-> coils of jejunum
-> Lt colic flexure
c) Posterior surface : -> Abdominal aorta ,
-> LT suprarenal gland ,
-> LT kidney ,
-> LT renal vessels and
-> Splenic vessels .
20. 5. Duct system of pancreas
Main pancreatic duct of Wirsung :
Formation :
-> Starts at tail of pancreas , runs towards RT to
the Head .
-> Receives tributaries from body & neck at
right angle to the main duct .
-> At 2nd part of duodenum it joins with
common bile duct ,form Ampulla of Vater
21. Duct system
-> It opens into the 2nd part of duodenum in
the posterio medial wall , at major duodenal
papillae .
Accessory pancreatic duct :
[ some times present ]
it opens into the minor duodenal papillae
situated above the major duodenal papillae
27. Lymphatic drainage
1.Head & Neck -> pass to the RT
-> to Pancreatico deuodenal lymph nods
2.Body & tail -> pass to the LT -> to the
-> Splenic nodes in the hilum of the kidney .
NERVE SUPPLY
Autonomic nerve supply :
-> Sympathetic [lower thoracic spinal segments ]
-> Parasympathetic [ vagus nerve ]
28.
29. 7.Development
GIT -> develop from Foregut ,Midgut & Hindgut .
Step 1.
-> 2 diverticulum out pouch arise from the
distal end of fore gut named as
1. Ventral bud pancreatic [anterior bud ]
Hepatopancreatic bud [ liver & pancreas]
2. Dorsal bud pancreatic [ posterior bud ]
30.
31.
32. Development
Due to rotation of gut ->
Ventral pancreatic duct rotate to the RT and
dorsally ,fuse with dorsal pancreatic duct .
1. Lower part of head and uncinate process
develop from -> Ventral pancreatic bud .
2. Upper part of head, neck ,body and tail ->
develops from -> Dorsal pancreatic bud
33.
34. Development
3. Duct system : ducts of dorsal & ventral buds
establish communication
Main pancreatic duct -> develop
a) Proximal part -> Ventral pancreatic bud
b) Distal part -> Dorsal pancreatic bud
Proximal part of Dorsal bud degenerates
[ if it persists forms- Accessory pancreatic duct ]
Islets of langerhans develop from detached acinar
cells ,forms clusters around sinusoids .
35. Developmental anomaly
1. Annular pancreas :
->A ring of pancreatic tissue encircle the 2nd part
of duodenum .
-> Ventral bud divided in to 2 parts
-> both pass anterior & posterior to the foregut
encircling during rotation and then joins
with dorsal bud .
-> Result in duodenal obstruction.
36.
37.
38. Developmental anomaly
2 . Pancreas divisum :
Duct of ventral bud does not fuse with duct of
dorsal bud , both separately opens into 2nd
part of duodenum.
1. Body and tail of pancreas drain through the
dorsal bud duct via minor duodenal
papillae.
2. Head drains through the ventral bud duct to
major duodenal papillae .
40. Developmental anomaly
3 . Ectopic pancreatic tissue :
seen in -> Greater omentum &
-> Meckel’s diverticulum
[Enzymes produced these sits may cause
ulceration and perforation ].
41. 8. Microscopic structure
1. Capsule :
[Peritoneal covering and connective tissue ]
2. Lobules :
[Extensions from connective tissue divide the
pancreatic parenchyma into lobules ]
3. Contents of lobules :
a) Sections of serous acini surrounded by
myo epithelial cells
42. Microscopic structure
b) Intra lobular ducts -> lined with cuboid cells
c) Islets of Langerhans :
with numerous capillaries , more towards tail
consists of Alpha cells & Beta cells
d) Interlobular ducts: in the interlobular
connective tissue -> lined with columnar cells.
43.
44. Applied anatomy
1. Pancreatitis : Inflammation of pancreas
[ complication of Mumps ]
Symptoms : Fever ,back ache, loss of appetite ,
nausea, fat filled stool
2.Carcinoma of head of pancreas: compression of
a) 2nd part of duodenum -> intestinal obstruction
b) Common bile duct -> obstructive jaundice
c) portal vein -> Ascitis
