Anatomy

Dr. Aguirre

Pancreas

Exocrine volume much greater than endocrine

Lies retroperitoneal, largely in the transpyloric plane
15 cm long, lobulated with fine capsule
Alveoli of serous secretory cells lead to ductules then to principal ducts
Islets of Langerhans lie between alveoli
Main duct (Wirsung) leads to ampulla of Vater
Accessory duct (Santorini) from uncinate process opens proximally, may be absent, often
communicates with main duct
Arteries: gastroduodenal, inferior/superior pancreaticoduodenal, arteria pancreatica magna
from splenic
Veins: pancreaticoduodenal, superior to portal, inferior to superior mesenteric
Lymphatics: in groove between head and duodenum and root of superior mesenteric artery and
vein
Nerves: Parasympathetic (posterior vagus) to stimulate exocrine secretion- sympathetic for
vasoconstriction and pain
Secretion: secretin and cholecystokinin (from small bowel) cause release of trypsin, lipase,
bicarbonate, alpha islet cells give glucagon, beta cells give insulin, delta gives somatostatin

Head of Pancreas
Incudes uncinate process
Flattened structure, 2-3 cm thick
Attached to the 2nd and 3rd portions of duodenum on the right
Emerges into neck on the left

Neck of Pancreas
2.5 cm in length
Straddles SMV and PV
Antero-superior surface supports the pylorus
Superior mesenteric vessels emerge from the inferior border
Posteriorly, SMV and splenic vein confluence to form portal vein

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
 Inferior surface is covered by transverse mesocolon

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)

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

Arterial Supply of Pancreas

Anterior collateral arcade between anterosuperior and anteroinferior PDA
Posterior collateral arcade between posterosuperior and posteroinferior PDA
Body and tail supplied by splenic artery by about 10 branches
Three biggest branches are
o Dorsal pancreatic artery
o Pancreatica Magna (midportion of body)
o Caudal pancreatic artery (tail)

Venous Drainage of Pancreas

Follows arterial supply
Anterior and posterior arcades drain head and the body
Splenic vein drains the body and tail
Major drainage areas are
o Suprapancreatic PV
o Retropancreatic PV
o Splenic vein
o Infrapancreatic SMV
Ultimately, into portal vein
Lymphatic Drainage
Rich periacinar network that drain into 5 nodal groups
o Superior nodes
o Anterior modes
o Inferior nodes
o Posterior PD nodes
o Splenic nodes

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