MEDS12002 Lecture Notes - Lecture 1: Gastroduodenal Artery, Pancreatic Juice, Gastrinoma
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WEEK 1: The Pancreas
ANATOMY
Medical definition: “An elongated lobulated retroperitoneal gland extending from the duodenum to the
spleen; it consists of a flattened head (caput) within the duodenal concavity, an elongated three-sided body
extending transversely across the abdomen, and a tail in contact with the spleen. The gland secretes from
its exocrine part pancreatic juice that is discharged into the intestine, and from its endocrine part the internal
secretions, insulin, and glucagon.
Lie of the pancreas
• Length 12cm-18cm
• An endocrine and exocrine gland
• Retroperitoneal organ located posterior to
the lesser sac
Pancreatic divisions
• Elongated organ, lies in a transverse and oblique orientation
• Located in the epigastric and hypochondriac regions
• Divided into: head, uncinate process, neck, body, and tail
Pancreatic Head and Uncinate process
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Uncinate process
• Pancreatic head and uncinate process
• Lies medial to descending duodenum at level L2-L3
• Lateral to SMV and anterior to IVS
• Gastroduodenal Artery in anterolateral pancreatic
head
• Common bile duct in posterolateral pancreatic head
• The uncinate process is the portion of the
pancreatic head directly posterior to SMV and
anterior to IVC
Pancreatic neck
• Lies directly anterior to the superior mesenteric vein and
portosplenic confluence
• Lies posterior to the pylorus of the stomach
Pancreatic body
• Largest and most anterior aspect of the pancreas
• Lies anterior to the aorta, SMA, SMV, splenic vein, left
renal vein and spine
• Lies posterior to the antrum of the stomach
Pancreatic Tail:
• Most superior portion of the pancreas
lying anterior and parallel with the
splenic vein
• Lies anterior to the upper pole of the
left kidney, posterior to the stomach
and lateral to the spine
• Extends towards the splenic hilum
Vascular supply
• Anterior and inferior
pancreaticoduodenal arteries supply
pancreatic head
• Splenic artery supplies the pancreatic
body and tail through smaller
tributaries of the splenic and superior mesenteric veins
Pancreatic ducts
Duct of Wirsung: primary duct, extends the entire length
of the gland
Duct of Santorini: Secondary duct that drains the upper
anterior head
Vascular and Ductal Pancreatic landmarks
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• Celiac axis and branches
• Splenic artery
• Common hepatic artery
• Gastroduodenal artery
• Superior mesenteric artery
• Portal vein and tributaries
• Common bile duct
Anatomical anomalies of the pancreas
• Pancreatic divisum
o Most common anomaly
o Results from failure of fusion
between the dorsal and ventral
pancreatic buds, of no significance
• Annular pancreas
o Head of the pancreas surrounds the second portion of the duodenum
• Ectopic pancreatic tissue
o Pancreatic tissue grows in other organs, e.g. stomach
• Pancreatic agenesis
o Failure to develop pancreatic head/body or tail
o Extremely rare
Pancreatic ultrasound Transverse plane
Relational anatomy of the pancreas
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Document Summary
The gland secretes from its exocrine part pancreatic juice that is discharged into the intestine, and from its endocrine part the internal secretions, insulin, and glucagon. Lie of the pancreas: length 12cm-18cm, an endocrine and exocrine gland, retroperitoneal organ located posterior to the lesser sac. Pancreatic divisions: elongated organ, lies in a transverse and oblique orientation, located in the epigastric and hypochondriac regions, divided into: head, uncinate process, neck, body, and tail. Pancreatic neck: lies directly anterior to the superior mesenteric vein and portosplenic confluence, lies posterior to the pylorus of the stomach. Pancreatic body: largest and most anterior aspect of the pancreas, lies anterior to the aorta, sma, smv, splenic vein, left renal vein and spine, lies posterior to the antrum of the stomach. Vascular supply: anterior and inferior pancreaticoduodenal arteries supply pancreatic head, splenic artery supplies the pancreatic body and tail through smaller tributaries of the splenic and superior mesenteric veins.
