Pancreas and Spleen
Prof. Dr. Selda Önderoğlu
Pancreas
• Retroperitoneal
• Soft, lobulated, greyish-pink gland
• Length:12-15 cm
• W:70-100gm.
• Location: epigastric and left hypochondriac
regions (Extends across post. abdominal wall, from duodenum to
spleen, behind stomach)
• 4 parts:
Head neck body tail
•
head
• Lies within duodenal curve
• At Upper border:sup part (1st) of
duodenum lies anteriorly
Head-Uncinate process
• From lower and left part of
head, hook-like uncinate
process projects upwards and to the left, behind sup mesenteric vessels
Head’s
posterior surface
• Inf v. cava
• Renal vv.
• Right crus (diaphragm
Bile duct
• In a groove on
posterosup surface of head or embedded on its substance
Neck
• L: 2 cm
• Projects forwards, upwards and to left from the head
• Ant surface: covered with peritoneum, adjoins pylorus
• Gastroduodenal and ant sup.
pancreaticoduodenal aa.
descend in front
• Post surface: sup
mesenteric v., portal v.
Body-surfaces
• 3 surfaces:
1-Anterior 2-posterior 3- inferior
• Ant: Covered by
peritoneum,
• Posterior:
Devoid of peritoneum
• Inferior surface:
Left end rests on left colic flexure
Body-borders
• 3 borders:
1- Superior, 2- Anterior 3- inferior
1- superior border
• Omental tuberosity
Anterior border
• Along this border, two layers of
transverse mesocolon diverge, one passing up over ant
surface, the other
backwards over inf
surface
Inferior border
• Sup
mesenteric vessels
emerge from under this border
Tail
• Narrow
• Reaches spleen
• Attaches to spleen by splenorenal lig (splenic vessels)
Ducts of pancreas:main+accessory
Main pancreatic duct
• Begins in tail
• In the head, turns inferiorly
• Joins bile duct
• Hepatopancreatic ampulla
• Opens :Major duodenal papilla
Accessory pancreatic duct
• Opens:Minor duodenal papilla
• Usually, (60 %) accessory duct communicates with main duct
Sphincters of ducts
• Sphincter of pancreatic duct
• Sphincter of bile duct
• Hepatopancreatic sphincter around the ampulla (sphincter of Oddi)
• Smooth muscle sphincters
• Control flow of bile and pancreatic
juice into duodenum
Aa. of pancreas
• Splenic a.
• Ant and post sup pancreaticoduod enal aa.
(gastroduodenal a.)
• Ant and post inf pancreaticoduod enal aa. (sup
mesenteric a.)
Vv. of pancreas
• Portal v.+Splenic v.+Sup mesenteric v.
Lymph vessels of pancreas
• Pancreaticosplenic nodes (most)
• Pyloric lymph nodes
• Efferent vessels from the first 2 drain to celiac, hepatic, sup
mesenteric lymph nodes
Nn. of pancreas
• Vagus n.
• Thoracic
splanchnic nn.
• Symph and parasymph fibers reach pancreas by passing along aa. from celiac and sup
mesenteric plexus
Accessory pancreatic tissue
Stomach Duodenum Ileum
May contain islet cells that produce glucagon and insulin
• Pancreatitis
– Pancreatic duct blocked (ex. Gallstone)
– Reflux of bile from hepatopancreatic ampulla into pancreatic duct
• Pancreatectomy (removal of most of pancr.) (chronic pancreatitis)
• Rupture
• Pancreatic cancer
– Cancer of head oftencompresses and obstructs bile duct / hepatopancreatic ampulla
(obstructive jaundice)
Spleen
• Large encapsulated organ of
Reticuloendothelial system
• Location:left
hypochondriac (Between
fundus of stomach and diaphragm)
• Soft, lobulated
• Shape: varies
• After fixation in situ, shape varies from slightly curved wedge to
tetrahedron
• Long axis fits the plane of 10th rib
• Post border 4 cm from middorsal line at the level of vertebral
spine of T10
• Ant border reaches
midaxillary line
• Size and weight vary (age,
individual, in same individual under different conditions)
• Adult:
L:12 cm
7 cm broad, 3-4 cm wide
• Adult weight:
150 gr
Functions of spleen
1. Removal of particulate material including aging erythrocytes from circulation
2. Provision of lymphocytes and antibodies (part of body’s system of secondary lymphoid
tissue)
3. Is not essential to survival
Topography
• Surfaces:
Diaphragmatic visceral
• Borders:
Sup inf
• extremities : Ant
post
relations:Diaphragmatic surface
• Convex
• Smooth
• Related to abdominal surface of diaphragm
Visceral surface
• Faces abdominal cavity
• Gastric impression
• Renal impression
• Pancreatic impression
• Colic impression (left colic flexure,
phrenicocolic lig)
• Near inf limit; hilum
Superior border
• Convex
• 1 or 2 notches, near lateral end
Inferior border
• More blunt and rounded than sup border
• In position to 11th rib’s lower margin
extremities :Post and ant
• Post extremity:
Faces vertebral column
• Ant extremity:
More expanded
– Related to left colic flexure, phrenicocolic lig
Spleen
• intraperitoneal
• adheres firmly to its capsule
• Recesses of greater sac separate it from stomach and left
kidney
• connected to post abdominal wall and stomach by 2 folds of peritoneum
– Lienorenal lig – Gastrosplenic lig
• Lienorenal lig
– Splenic vessels
• Gastrosplenic lig
– Short gastric a.
(splenic a.)
– Left gastroepiploic a. (splenic a.)
In the living
• Soft
• Friable
• Dark purple (depending amount of blood)
Variations of spleen
• Accessory spleens;
especially within
gastrosplenic lig and greater omentum
– Small encapsulated nodules of splenic tissue
– Isolated or connected to spleen by thin bands
• May retain its fetal lobulated form
Position of spleen
• In the living, assessed by percussion
• Dull area extends over 9-11th ribs in vertical extent
• Should not go forward beyond midaxillary line
• Normal spleen is not palpable
Aa. of spleen
• Splenic a. (large, tortuous branch of coeliac trunk)
– Gives minor branches to
pancreas, stomach – Divides in lienorenal
lig before reaching spleen (2 or 3 main branches, from
which 4-5 or more segmental branches enter hilum.
– Segmental branches supply splenic
segments
Vv. of spleen
• Minor vv. pass from red pulp into
trabeculae
• Thence into segmental vv.
• Segmental vv. drain into splenic v. (in lienorenal lig)
• Splenic v. + sup mesenteric v. Portal v.
Lymph vessels of spleen
• Leave lymph nodes in hilum
• Pancreaticosplenic lymph nodes
• Coeliac lymph nodes
Nn. of spleen
• Celiac plexus
– Parasymph: Vagus n.
– Symph: Greater splanchnic nn.
– Distributed along
branches of splenic a.
– Vasomotor in function – Concerned with
regulation of blood flow
