Pancreas: Anatomy &

Physiology
Winarko Luminturahardjo
RS Panti Nirmala Malang

History
Pancreas derived from the Greek pan,
all, and kreas, flesh, probably referring
to the organs homogenous appearance
Herophilus, Greek anatomist and Surgeon,
first identified the pancreas in 335 280
BC
Ruphos, another Greek anatomist, gave
pancreas its name after few hundred years

Anatomy
Approximate length of gland 15 cm
Divided into the head, uncinate process,
neck, body and tail
Lies immediately behind the peritoneum of
the posterior abdominal wall
Transpyloric plane (L1) is the guide to the
surface marking

Pancreas

Head of pancreas
Broadest part
Moulded into the C shaped concavity of
duodenum
Lies over the inferior venacava, the right
and left renal veins at the level of L2
Posterior surface is indented by the
terminal part of the bile duct

Neck of pancreas
Lies infront of the superior mesenteric and
portal veins

Body of the pancreas

Body passes across the left renal vein and aorta,
left crus of diaphragm, left psoas muscle, lower
pole of left suprarenal gland to the hilum of left
kidney
Upper border crosses the aorta at the origin of
the celiac trunk
Splenic artery passes to the left along the upper
border
Lower border crosses the origin of the superior
mesenteric artery

Body of the pancreas

Splenic vein is closely applied to the
posterior surface
Inferior mesenteric vein joins the splenic
vein behind the body of the pancreas

Tail of the pancreas

Passes forward from the anterior surface
of the left kidney at the level of hilum
Lies within two layers of the lienorenal
ligament along with splenic artery, vein,
lymphatics and touches the hilum of
spleen

Uncinate process
Lower part of the posterior surface of the
head prolongs as uncinate process behind
the superior mesenteric artery and vein
infront of the aorta

Pancreatic duct
Duct of Wirsung continuous tube leading from
the tail to the head
Joined by the bile duct at 60 degrees at the
hepatopancreatic ampulla
In intubation during ERCP, the catheter
preferentially enters the pancreatic duct
Drains most part of the pancreas except for the
uncinate process and lower part of head which
drains by the duct of Santorini
Accessory duct opens into the duodenal papilla
situated about 2 cm proximal to the major papilla

Blood supply of Pancreas

Splenic artery supplies neck, body and tail
Superior and inferior pancreaticoduodenal
arteries supply head
Venous return into the splenic vein,
superior pancreaticoduodenal vein into the
portal vein and inferior
pancreaticoduodenal vein into the SMV

Lymph drainage
Lymphatics follow the course of the
arteries
Retro pancreatic nodes
Celiac group
SMV group

Nerve supply
Parasympathetic vagal from posterior
vagal trunk and celiac plexus stimulate
exocrine secretion
Sympathetic vasoconstrictor impulse
Spinal cord segments T6-T10 via
splanchnic nerves and celiac plexus
Pain fibers accompany sympathetic supply
Pancreatic pain radiate thoracic
dermatomes T6 T10

FISIOLOGI PANKREAS
Fungsi eksokrin (Asini pankreas)

Sekresi getah pencernaan dlm duodenum

Ensim: amilase, lipolitik, tripsin
Fungsi endokrin (Pulau langerhans)
Sel alfa (20-30%) produksi glukagon
Sel beta (60%) produksi insulin
Sel delta (10%) produksi somatostatin
Sel F polipeptida pankreas (fungsi ???)

Pancreatic Hormones, Insulin and Glucagon,

Regulate Metabolism

Exocrine system
Consists of two functional units :

Acinar cells which secrete primarily digestive

enzymes
Centroacinar or ductal cells which secrete fluids and
electrolytes

Pancreatic secretion is regulated by several

peptides that are released from the GIT either
inhibits or stimulates secretion by the pancreas
90% of the gland need to be destroyed to
produce maldigestion and serious nutritional
deficiencies - pancreatic enzymes are secreted
in great excess

Exocrine
Pancreatic enzyme is a clear isotonic solution
with a pH of 8 and specific gravity varies
between 1.007 and 1.035
At lower secretory rates the concentrations of
chloride and bicarbonate ions are equivalent to
plasma
With neurohormonal stimulation, the bicarbonate
component increases in concentration while the
chloride concentration falls
Sodium and potassium in the effluent remains
constant

Bicarbonate secretion
Isosmotic juice 1500-3000 ml/day
pH range 8 8.5
Total concentration of major anions chloride &
Bicarb approaches 150mEq/L
At maximum output, chloride concentration <50
mEq/L whereas Bicarb concentration reaches 150
mEq/L
High pH neutralizes acidic gastric chyme and
provides optimum pH for the enzymatic digestion

Enzyme secretion
Four classes of enzymes are secreted

Proteolytic
Lipolytic
Carohydrate-hydrolyzing
Nucleolytic

Proteolytic

Trypsin secreted as trypsinogen

Chymotrypsin secreted as chymotrypsinogen

Both zymogens require enterokinases secreted

by mucosa of proximal intestine for activation

Enzyme secretion
Once trypsinogen is activated it activates
further zymogens
Lipolytic enzymes
Secreted in active form
Lipase is the major component
Hydrolyzes triglycerides

Amylase is a carbohydrate-hydrolyzing
enzyme and acts on starch

Endocrine pancreas
Principal function is to maintain glucose
homeostasis
Insulin and glucagon play a major role in
glucose homeostasis
In addition endocrine pancreas secrete
somatostatin, pancreatic polypeptide,
amylin

Insulin
Insulin is synthesized by the beta cells of
the pancreas
Insulin and C peptide are packaged into
secretory granules and released together
into the cytoplasm
95% belong to reserve pool and 5% stored
in readily releasable pool
Thus small amount of insulin is released
under maximally stimulatory conditions

Insulin release
Stimulation of Beta cells results in exocytosis of
the secretory granules
Equal amount of insulin and c peptide are
released into portal circulation
Insulin circulates in free form and has half life of
4-8 minutes
Liver predominantly degrades insulin
C peptide is not readily degraded in the liver
Half life of c peptide averages 35 minutes

Glucagon
Released by the alpha cells of the islets
Antagonistic effect on insulin action
Release is inhibited by hyperglycemia and
stimulated by hypoglycemia
Somatostatin also inhibit glucagon release
Main physiologic role of glucagon is to
increase plasma glucose level

Somatostatin
Secreted by delta cells of pancreas
Release is stimulated by high fat, protein
rich , high carbohydrate meal
Generalized inhibitory effect

Conclusion
Pancreas is a composite gland
Has exocrine and endocrine function

Plays major role in digestion and glucose

homeostasis