Pancreas Clinical Anatomy and Physiology



the pancreas is a soft elongated gland consisting of two main functions exocrine and endocrine and the pancreas comes from the Greek word pan which is means all and crius which means flesh flesh your organ the pancreas sits somewhat horizontally and can be divided into few parts the uncinate head neck body and tail as shown the tail of the pancreas tickles the spleen behind the pancreas it's the left kidney the head and uncinate of the pancreas interacts with the first part of the small intestine called the duodenum the beginning of the second part of the small intestine College dunam also interacts with the inferior surface of the pancreas sitting anterior and superior to the pancreas is a stomach which joins to the duodenum the liver lies in the right upper quadrant of the abdomen and is the source of bile production bile is produced and travels from the liver down the right and left hepatic ducts the right and left hepatic ducts merge and form the common hepatic duct the bile can be stored actually in the gallbladder the organ just below the liver and the bile can be carried out from the gallbladder into the cystic duct the cystic duct actually joins with a common hepatic duct we talked about to form the common bile duct the common bile duct joins with the main pancreatic duct here before entering into the small intestine the duodenum let's take a closer look at this area and to understand a bit more about the common bile duct and the pancreatic duct the flow of bile is controlled by the sphincter chol it occurs pancreatic juices during digestion travels through the pancreatic duct and joins with a common bile duct there's also a sphincter called the sphincter pancreatic is the common bile duct and pancreatic duct will join to form the ampulla Vata the ampulla varta is surrounded by the sphincter papillae the sphincter papillae sphincter pancreatic as' and sphincter clínicas make up what is known as the sphincter of Oddi the major duodenal papilla is the opening into the duodenum so just a reminder here is a duodenal wall and here is the pancreas so let's take a closer look now at the pancreas and its physiology how it helps in food digestion and in particular what actually stimulates its function here again is a pancreas surrounded by other organs the pancreas is open here as I have drawn remember when we eat food is in the stomach and the content is actually acidic and it's because the stomach is is where acid is produced and it really helps the first phase of digestion food then will enter the duodenum the first part of the small intestine when food is in the small intestine the gallbladder is stimulated to secrete its stored bile into the duodenum also the pancreas is stimulated to secrete digestive juices into the main pancreatic duct and then into the duodenum the juices are produced from the Asuna cells which again produce the enzymes to help in the digestion of food the juices the common bile duct and main pancreatic duct converge at the angle of ATO before entering the duodenum through the major duodenal papilla it's important to know there is an accessory pancreatic duct which also has its own opening in the duodenum now it's also important to remember that 98% of cells in the pancreas are exocrine cells which means cells that produce enzymes the digestive juices and the other 3% are the endocrine cells which are responsible for the hormones such as insulin these hormone cells of the pancreas are found in clusters and these clusters are called the islets of langerhans and their role in the human body is so important let's take a closer look at how everything works now so here you have the asana cells which make up the exocrine function of the pancreas they secrete enzymes such as amylase lipase and peptidase into the main pancreatic duct and then eventually the pancreatic duct will carry this into the duodenum to help with the digestion of food the islets of Langerhans sits around the Asuna cells and are part of the endocrine function of the pancreas the hormones there are a few types of cells which make up the islets of Langerhans and these include the Alpha cells which secrete secrete glucagon the beta cells which produce insulin the gamma cells which produce polypeptides and the Delta cells which produce somatostatin hormones are secreted from these cells into the bloodstream and obviously after you eat insulin is the hormone that is produced by the beta cells to help store all this energy that that we have just eaten now let's go back and see how everything is regulated specifically the enzyme in digestion so imagine you ate a meal and you have food coming down into the duodenum from the stomach here is the duodenal women cells of the small intestine and in the basement membrane below and then below that is the circulation the blood you have two important cells in the small intestine the s cells and the AI cells when acidic food from the stomach arrives in the duodenum it will stimulate the s cells to produce secretin proteins and fats in the small intestine will stimulate the eyes cells to secrete cholecystokinin CCK another important hormone let's look at the function of secreting first secreting has several function one is to reduce bile production and secretion from the liver and gall bladder the second function of secretion is that it reduces stomach motility and activity to get the small intestine prepared and to stop acidic food content from coming into the duodenum secretin is also responsible for telling the ductile cells on the pancreas to produce bicarbonate and this is in order to neutralize the acidity which is now in the small intestine cholecystokinin is a hormone which which main function is to stimulate the digestive process essentially it stimulates the Asuna cells to secrete its pancreatic juices so it can digest the proteins and the fats which are right now in the duodenum also it will tell the gall bladder and liver to produce and to secrete bile to help in the digestion of fat also important to remember that when we absorb glucose it will stimulate the pancreas to produce the hormone insulin some clinical anatomy now is acute pancreatitis which is acute inflammation of the pancreas due to many causes the two main ones are gold stones and alcohol the pathophysiology is basically Auto digestion the enzymes which are meant to go into the pancreatic duct essentially throw everywhere else the enzyme particularly are the proteases and lipases which eat up everything around causing inflammation and severe epigastric pain let us now focus more on the arteries and veins of the pancreas the pancreas sits in front of the inferior vena cava and the descending aorta the tail of the pancreas tickles the spleen and the head of the pancreas is next to the duodenum the descending aorta runs here and the celiac trunk branches at about t12 to l1 of the table level the celiac trunk has three main branches which supply the organs around it at about l2 another important artery called the superior mesenteric artery comes off the descending aorta and runs behind the pancreas and over the duodenum adjacent to the superior mesenteric artery is a superior mesenteric vein which comes also behind the pancreas but it does not drain into the inferior vena cava let's focus more on the arteries so here is a pancreas remember the celiac trunk branches at t12 l1 it has three main branches the left gastric artery will supply the stomach the splenic artery the second branch is a very tortuous artery and has some branches supplying the superior part of the pancreas as well as the greater curvature of the stomach the splenic artery ends at the spleen the common hepatic artery is the last branch of the celiac trunk and it will branch off to the right and has many actually branches it becomes the common hepatic proper which will supply the liver with oxygen but also the gold ladder nearby the other branch is the gastroduodenal artery the gastroduodenal artery branches again into the superior pancreaticoduodenectomy Styria pot to it so where does the inferior pancreaticoduodenectomy it comes from the superior mesenteric vein which if you remember comes off the descending aorta here l1 to l2 level the inferior pancreaticoduodenectomy er portions some clinical anatomy there's a thing called superior mesenteric artery syndrome it is a rare condition in which the duodenum is compressed against the superior mesenteric artery and the abdominal aorta or the descending aorta let's take a look at the descending aorta and the superior mesenteric artery from the side remember the superior mesenteric artery is a branch of the descending aorta and goes over the duodenum right under the superior mesenteric artery here is actually the left renal vein as well and then below this is the duodenum surrounding all these structures is mesenteric fat which is really important in maintaining everything where it is you can say it protects the superior mesenteric artery and the duodenum so you can imagine if you become malnourished resulting in cat Ixia it can be due to anorexia or malabsorption you lose all this mesenteric fat this causes duodenal compression which will essentially give symptoms of bowel obstruction but when you think about it superior mesenteric artery syndrome the angle is very acute and it can also cause left renal vein obstruction which can cause kidney injury and also left-sided varicocele so those are the important arteries to remember about the pancreas let's look at the veins now here is a pancreas again and behind it is the inferior vena cava and the descending aorta draining from the spleen is a splenic vein and this travels posterior behind the pancreas the inferior mesenteric vein which carries blood from the hindgut drains into the splenic vein then there is a superior mesenteric vein which carries blood from the mid gut and also joins to the splenic vein and together the superior mesenteric vein and the splenic vein will form what's called the portal vein you have to realize that the blood drain from these GI T veins carry a lot of nutrition all this glucose protein will travel via the portal vein into the liver where further biochemical reactions will take place so these veins from the GI T don't drain into the inferior vena cava but will drain into the liver via the portal vein which is very important to understand now let's look at the embryology of the pancreas you have the duodenum here here is your dorsal pancreatic bud and then you have your ventral pancreatic but on the other side the biliary system here is a common bile duct will drain into the main pancreatic duct which is it actually where the ventral pancreatic duct will be during embryo djegal development the gut normally rotates and so does the ventral pancreatic bud it will go around and carry the bile duct with it the ventral pankrac bud will fuse with a dorsal pancreatic odd the ventral pankrac bud will then become the uncinate process the ventral and dorsal pancreatic buds ducts we'll anastomose and this again will become the main pancreatic duct and this will become the accessory duct we spoke about and of course the common bile duct here will join with the main pancreatic duct and drain into the duodenum the ventral bud again becomes the uncinate process of the pancreas some clinical Anatomy annular pancreas it is a developmental anomaly in which a ring of the pancreas tissue completely encircles the duodenum what happens here is the ventral pancreatic bud may consist of two lobes which will maybe rotate to either end of the dorsal pancreatic bud encircling the duodenum really annular pancreas is a cause of pancreatitis and also symptoms of partial bowel obstruction surgical correction is often required you

32 comments

  1. It would be a nice idea if you collect all of your drawings accordingly and make them into a book. I would definitely purchase a copy!

  2. This is a very good way of understanding, Like everything sticks in your mind like a drawing, Thank you, But please post more Videos.

  3. I want to come face to face to everyone who gave this a thumbs down and punch their throats

  4. Secretin secreted from duodenum actually increases bile productin while CCK stimulating gall-bladder contractions thus together they aid emulsifying the dietary fat being digested via pancreatic lipases.

  5. You are so good at what you do Armando, the artistic impressions are so on point and makes learning so easy. I teach nursing students and many times I have to watch your video first just to get the picture clear. Keep it up!

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  8. Your videos are excellent .I-am a medical student and I used to search your videos for every topic in my study and it helps me allot thank u very very much for your efforts

  9. I'm really jealous of how you can demonstrate all your thoughts in drawing is that a talent or by training!

  10. This is again a very good educational video. I'm really jealous of all the freshman who can learn at this time so much easier than when I was a medical student. But I am glad that I can learn so much more now than I knew before.

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