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Pancreas

from Greek: pánkreas, pán - "all", kréas - "flesh"
German: Pankreas

1 Definition

The pancreas is a gland organ situated crosswise in the human epigastric region, which produces digestive enzymes and hormones.

2 Anatomy

2.1 Construction

The pancreas is approximately 14-18 cm long and weighs 70-100 g; a wedge-shaped organ, which is divided into irregular lobules. It lies retroperitoneally between the stomach and the large abdominal vessels (aorta and inferior vena cava) at the level of the second lumbar and is closely connected to the duodenum, which encloses the head of the pancreas.

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The pancreas is roughly divided into three sections:

  • Head of the pancreas (caput pancreatis): The head of the pancreas is the thickest part of the pancreas, it lies to the right of the spine in the duodenal bend. It has a hook-shaped extension (uncinate process), which surrounds the superior mesenteric artery arteria mesenterica superior. It occurs at this point (incisura pancreas) from dorsal at the front of the pancreas.
  • Body of the pancreas: The elongated, horizontally extending body of the pancreas lies approximately at the level of LWK I-II. Its rear side is adherent to the dorsal abdominal wall, however the ventral side of peritoneum is coated, thus forming the dorsal wall of the bursa omentalis. The section of the body lying in front of the aorta abdominalis is given the name tuber omentale, and bulges into the lesser sac bursa omentalis.
  • Cauda-pancreatis (tail of the pancreas): the pancreatic tail tapers, while slightly extending cranially-left all the way to the spleen.
Due to its function as a digestive gland, the pancreas possesses a duct, the  ductus pancreaticus (ductus wirsungianus), which together with the bile duct ("ductus choledochus") coming from the liver and gall bladder closed in a wart-like involution - the so-called papilla duodeni major - opens into the duodenum. This duct is about 2mm wide and takes up short, perpendicular inflows from the pancreatic lobules. Also involved is another pancreatic duct which is present, the accessory pancreatic duct ductus pancreaticus accessorius, which opens into the minor duodenal papilla papilla duodeni minor.

2.2 Arterial supply

The pancreas is arteriall supplied:

The two arteriae pancreaticoduodenales anastomose into the pancreatic flow area, there is thus a collateral circulation between the celiac trunk truncus coeliacus and the arteria mesenterica superior.

2.3 Venous outflow

Venous drainage of the pancreas is achieved via the venae pancreaticoduodenales which, among other things, opens into the vena mesenterica superior. Smaller veins on the dorsal side of the pancreas (venae pancreaticae) also open into the splenic vein vena lienalis.

2.4 Nerve supply

The pancreas is like other abdominal organs supplied by the vegetative system. The parasympathetic supply is achieved by fibres of the nervus vagus. The sympathetic supply is conducted by fibres from the ganglion coeliacum

3 Function

The pancreas has both exocrinal and endocrinal functions.

3.1 Exocrine function

The exocrine pancreatic is a purely serous gland. It stands as the provider of the most important digestive glands in humans and secretes numerous digestive enzymes and/or proenzymes. The amount and composition of the pancreatic juices depends on the type of food consumed. In humans, up to 1.5 litre secretions can be produced daily. The secretion contains:

In particular the proteases lie within the gland initially in an inactive form, in order to avoid prior self-digestion of the gland tissue. They are activated in the duodenum.

3.2 Endocrine function

Besides this exocrinal gland function of endocrine glands, endocrinal hormones are also delivered by the endocrine gland portion directly into the blood: Approximately 5% of the cells are combined in an island-like form into so-called pancreatic islet and are collectively referred to as insular apparatus. This is distributed over the whole pancreas, but mainly distributed on the body and the tail of the pancreas. Depending on the hormone produced there are evident distinctions:

Cell type Produced hormone Percentage of produced hormone in human islet cells
α-Cells Glucagon 15–20 %
β-Cells Insulin 60–80 %
δ-Cells Somatostatin 5–15 %
PP-Cell Pancreatic polypeptide
ε-Cells Ghrelin

4 Clinic points

4.1 Diseases

Diseases of the pancreas include:

4.2 Study methodology

In addition to the medical history, the biochemical study of the blood plays a prominent role in the event of pancreatic diseases, ie. determining the blood concentration of amylase and lipase. Besides this diagnosis by means of ultrasound, computed tomography and magnetic resonance imaging and ERCP are also important.

4.3 Chirurgy

Since the omental foramen foramen omentale is too small an as access to the pancreas, the lesser sac bursa omentalis is opened by the separation of the ligamentum gastrocolicum, ligamentum hepatogastricum and ligamentum gastrosplenicum so as to allow surgical access.

See also: digestion, alcohol, diabetes mellitus

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