foreign [Music] the topic of discussion for today's session is the anatomy of the pancreas as well as its clinical importance pancreas is an elongated accessory digestive gland that lies on the posterior abdominal wall it lies in the epigastric umbilical as well as left hypochondriac regions at the level of L1 and L2 vertebra it is an EXO endocrine gland it produces exocrine secretions that is the pancreatic juice from the asinar cells these secretions enter into the second part of the duodenum where the duct which is present called as the main pancreatic dirt along with its accessory pancreatic duct secrete these secretions which help in the digestion of macromolecules such as lipids carbohydrates and proteins and also it has an endocrine activity the endocrine secretions like glucagon insulin somatostatin which secreted directly into the bloodstream and helps mainly in maintaining the glucose homeostasis which take part in the metabolic processes if you see the shape of the pancreas it is of J shaped or shaped and bowl of the represents head of the pancreas and stem of the represents the neck body as well as tail of the pancreas so here if you talk about the measurements of the pancreas it is of approximately 12 to 15 centimeters in length and the width is three to four centimeters and the thickness is approximately 1.5 to 2 centimeters and the weight is 80 to 90 grams now the pancreas has been divided into various parts for a better understanding so here first is the head next to the neck body and tail these are the four parts of the pancreas now first is the head of the pancreas it is elongated and disc shaped and it is flattened at the right end of the pancreas so it lies in the concavity of the c-shaped used in a loop at the level of L2 vertebra so what are the external features of the head the head of the pancreas has three borders it has Superior inferior and the lateral it has totally three borders and it has two surfaces one is anterior Annex is the posterior so it has three borders two surfaces as well as one process called as unseenate process which comes from the head of the pancreas so what are the relations of the pancreas so when we talk about the relations of the pancreas the superior border is related to the first part of the diode and Superior pancreatico duodenal artery next is the inferior border the inferior border is related to the third part of the deodinum and inferior pancreaticode duodenal artery and next is the right border which is also called as a lateral border which is related to the second part of the duodenum and also the arastromotic channels between the two pancreatico duodenal arteries and next are the surfaces the anterior surface is related with the following structures from above to below they are the first part of the diode next is the transverse colon root of the transverse miso colon and the jejunum the next is the posterior surface of the head of the pancreas the posterior surface is mainly related to the inferior vena cava left renal vein bile duct as well as the right crest of the diaphragm and next if you see the ancient process which is projected from the head of the pancreas is mainly related to anteriorly with the superior mesentric vuzels and posteriorly to the abdominal iota so this is what you need to know about the relations of the head of the pancreas and next is the neck it is slightly constricted part of the gland and is located or situated between the head as well as the body and it is 2.5 centimeters long and it is directed upwards and towards left so what are the external features the neck of the pancreas has totally two surfaces that is anterior and posterior and it has two borders that is upper as well as lower or we can say Superior or inferior border so the anterior surface is related to the pylorus the posterior surface is related to determination of superior mesentric vein and beginning of the portal vein the upper border is related to the first part of the geogenum and the lower border is related to the root of the transverse missile colon and after the neck next is the body of the pancreas it is the elongated part of the pancreas which is extending from the neck to the tail it lies to the left of the superior mesentric vuzzles passing over the Iota as well as L2 vertebra so what are the external features of this gland if you see the cross section of the body it is triangular in shape so that's the reason it has totally three borders that is anterior Superior and inferior and it has three surfaces that is anterior posterior and inferior and one process which is called as tuber omentality the tuber omentale is the projection from the part of the body above the Lesser curvature of the stomach and the next are the relations of the body of the pancreas so the anterior border which gives attachment to the root of the transverse meso colon and the superior border is related to the Celiac artery that is able tuber or mentally and also the hepatic artery which is right of the tuber omentale and the splenic artery which is related to the left of the tuber or mentality Alex is the inferior border the inferior border is related to the superior mesentric vessels this is what you need to know about the relations with respect to that of borders next are the surfaces the anterior surface which is concave and directed forwards and upwards and it is related to lesser Sac as well as stomach and next one is the posterior surface which is devoid of peritoneum and it is related to the Iota and the origin of the superior mesentric artery left crust of the diaphragm as well as the left suprarenal gland left kidney left renal vessels and the splinic Queen NXT is the inferior surface the inferior surface is covered by the peritoneum and the posterior surface is not covered by the peritoneum so the inferior surface is related to the duodenal judging reflection coils of jejinum so this is what you need to know about the body of the pancreas and next one is the tail the tail is the narrow left end of the pancreas that lies in the Lino renal ligament along with the splenic vessels the tail contains large number of eyelids or Flying Hands per unit tissue when compared to that of other parts of the pancreas well this part is mainly related to the visceral surface of the spleen between gastric impression and the colic impression so this is what you need to know about the head neck body as well as tail of the pancreas next is the ducts of the pancreas so the pancreas has two ducts one is the main pancreatic dirt and another one is the accessory pancreatic duct so these two dirts drain the exocrine secretions into the second part of the diode first one is the main pancreatic duct it is also called as the duct of worsen it begins in the tail and travel along the whole length of the gland near its posterior surface it is approximately 3 mm in diameter and here the main pancreatic duct receives small tributaries at acute angles throughout its length it pierces the duodenal wall by joining the bile duct to form hepat or pancreatic ampulla which is also called as ampulla of water which opens into the descending part which is the second part of the diode that is at the apex of the major duodenal papilla which is 8 to 10 centimeters distal to the top pylorus what we studied in the module of diode here the smooth muscle sphinctures that is the sphincter of the pancreatic duct which is located around the terminal part of the pancreatic duct and also there is a separate sphincter for the bile duct too that is the sphincter of the bile duct which is located around the terminal aspect of the bile duct and also there is a common sphincter for both the bile as well as pancreatic dirt which is called as the hepatopancreatic sphincter which is called as the sphincter of ODI and which opens around the hepatopancreatic ampulla and controls the flow of the bile as well as pancreatic juice into the ampulla and prevents The Reflex of the duodenal content into the ampuller this is what you need to know about the main pancreatic duct next one is the accessory pancreatic duct so here it begins in the lower part of the head and it runs upwards and medially and opens into the second part of the diode at the tip of the minor duodenal papilla that is two to three centimeters above the opening of main pancreatic dirt or six to eight centimeters distal to the top pylors so usually the accessory duct communicates with the main pancreatic duct but in some cases the main pancreatic duct is smaller than the accessory pancreatic dirt that is the reason it cannot be connected in such cases the axisary duct carries most of the pancreatic juice so this is what you need to know about the anatomical aspects of the pancreas now let us talk about the neurovascular structures which are supplying the pancreas and the first one is the arterial Supply so pancreas is highly vascular structure and supplied by the following arteries one is the splenic artery which is the branch of celiac artery it is the main source of the blood supply to the body as well as tail of the pancreas as many as 10 branches may pass from the splenic artery to the body as well as the tail of the pancreas and also there is one large Branch known as arteriopancreatic Magna which arises near the Tail of the pancreas and runs towards the neck and there are other small branches we can say one small branch which is known as arteria called a pancreatica which runs towards the tip of the tail of the pancreas and the next one is a superior pancreatico duodenal artery which is the branch of gastrodiodinal artery and another artery which is the inferior pancreatico diodenal artery which is the branch of superior mesentric artery so this is what you need to know about the blood supply of the pancreas now let us talk about the venous drainage of the pancreas pancreas drains into portal vein Superior missionary queen and the splinic queen so what is the lymphatic drainage the pancreatic lymph vessels follow the arteries so most of the pancreatic lymph vessels and in the pancreaticosplenic lymph nodes which lie along the splenic artery so here some vessels end in the pyloric lymph nodes and the efferent vessels from these nodes drain the superior mesentric lymph nodes or the Celiac lymph nodes and this is what you need to know about the lymphatic drainage of the pancreas and next is the nerve supply of the pancreas the sympathetic Supply is from splanchic nerves which are Vaso motor in nature and the parasympathetic Supply is from vagus nerve which controls the pancreatic secretions and these pancreatic secretions are also influenced by the hormone cholecystokinin which is produced by the cells of the duodenal epithelium so this is what you need to know about the null supply of the pancreas the next is histology of the pancreas we will study histology under two headings one is the exocrine part and another one is the endocrine part so first is exocrine part of the pancreas it is made up of tubular asinine lined by the pyramidal cells with the basal round in nuclei containing xymogen granules so the exocrine part of the pancreas secrete digestive pancreatic juices which contains the digestive enzymes such as trypsin which breaks proteins into lower polypeptides amylase hydrolyze the starch as well as glycogen into disaccharides and lipase which breaks fat into fatty acids and glycerol Alex is the endocrine part of the pancreas endocrine part is made up of islets of langerhans which are small isolated mass of cells these cells are distributed throughout the pancreas with more numerous intake and most important type of cells which are mainly seen in the eyelids are beta cells approximately 80 percent which are granular basophilic and produce insulin which mainly helps in utilization of Sugar by the cells and other type of cells if you see are seen in the eyelids that is alpha cells 20 percent which are granular and acidophilic in nature and it has subtypes of A1 as well as A2 A1 cells belong to the enterochromaphene group which secrete the pancreatic gastrin and A2 cells secrete glucagon and next is the somatostatin the somatostatin is the other type of hormone we will study in the endocrine physiology in detail now let us talk about the development of the pancreas so if you see the development of the pancreas the pancreas is developed from two separate Birds dorsal bird and the ventral bird so the larger dorsal but if you see it arises proximally directly from the diode and forms part of the head and also whole of the neck body and tail of the pancreas so the duct of the dorsal pancreatic bird forms the main pancreatic duct with the duct of ventral word the part of the dirt of dorsal pancreatic dirt forms accessory pancreatic duct now next is the smaller ventral butt the smaller winter bird arises in common with a hepatic blood of the liver and forms unseenate process and inferior part of the head of the pancreas the duct of the ventral Bud opens into the duct of the dorsal pancreatic bird near its neck and forms the main pancreatic dirt which opens into the duodenum so this is what you need to know about the developmental aspects of the pancreas and next is the clinical Anatomy in a clinical Anatomy an important condition associated with the pancreas is pancreatitis which is the inflammation of the pancreas the etiology for the inflammation of the pancreas is mainly because of the presence of gallstones as well as alcohol consumption the symptoms include upper abdominal pain that is epigastric pain which may be severe as well as constant and may reach to the back or radiate to the back and the symptoms include nausea vomiting weight loss fatty stool smile jaundice diabetes low BP heart failure Atlas kidney failure these are all the signs and symptoms of acute pancreatitis next is a diabetes mellitus the diabetes mellitus is characterized by the hyperglycemia that is caused by inadequate production of the insulin or inadequate action of the insulin on the body tissues the types are as follows type 1 diabetes which is also known as the insulin dependent diabetes mellitus the type 2 diabetes which results from the insulin resistance of Target tissues a condition in which the body fails to properly utilize the insulin or fails to respond properly to the insulin action and these are the signs and symptoms of the diabetes mellitus polyurea excessive secretion of urine polydipsia thirst excessive loss of weight and tightness can be seen that is fatigue lethargy and more commonly the infections are associated the urinary tract as well as blooding of the vision mainly because of involvement of metabolites in the formation of the Cataract and the next is the annular pancreas it is a developmental anomaly in which second part of the duodenum is encircled by a ring of pancreatic tissue and what is the accessory pancreatic tissue it is a rare condition in which small group of pancreatic cells separate from the pancreas it may be found in the duodenum which can be considered as the most common site for the accessory pancreatic tissue to be located and other sites may be stomach small intestine Metals diverticulum great momentum and hilum of the spleen but the most common location is the diode so they usually single yellow is lobulated nodules which contain islets of langerhans so this is what you need to know about anatomy of the pancreas as well as its clinical importance