Pankreas & Lien Anatomi & Fisiologi

dr. Rohmania Setiarini

Pancreas
Gland with both exocrine and endocrine functions 6-10 inch in length 60-100 gram in weight

Pancreas
Location: Retro-peritoneum, 2nd lumbar vertebral level Extends in an oblique, transverse position Parts of pancreas: head, neck, body and tail

Pancreas

Head of Pancreas
Includes uncinate process Flattened structure, 2 3 cm thick Attached to the 2nd and 3rd portions of duodenum on the right Merges into neck on the left

Neck of Pancreas
2.5 cm in length Superior border relates to the pylorus Superior mesenteric vessels emerge from the inferior border

Pancreas

Body of Pancreas
Elongated, long structure Splenic vein runs embedded in the post. surface closer to the superior border Inferior surface is covered by transverse mesocolon

Tail of Pancreas
Narrow, short segment Lies at the level of the 12th thoracic vertebra Ends within the splenic hilum Lies in the splenophrenic ligament Anteriorly, related to splenic flexure of colon

Pancreatic Duct
Main duct (Wirsung) runs the entire length of pancreas Joins CBD at the ampulla of Vater 2 4 mm in diameter, drains up to 20 secondary branches Ductal pressure is 15 30 mm Hg (vs. 7 17 in CBD) thus preventing reflux and damage to panc. duct Lesser duct (Santorini) drains superior portion of head and empties separately into 2nd portion of duodenum

Arterial Supply of Pancreas

Variety of major arterial sources (Celiac, SMA and Splenic) Celiac Common Hepatic Artery Gastroduodenal Artery Superior pancreaticoduodenal artery which divides into anterior and posterior branches SMA Inferior pancreaticoduodenal artery which divides into anterior and posterior branches

Arterial Supply of Pancreas

Anterior and posterior collateral arcade supply head Body and tail supplied by splenic artery by about 10 branches Three big branches from splenic are

Dorsal pancreatic artery Pancreatica Magna (midportion of body) Caudal pancreatic artery (tail)

Venous Drainage of the Pancreas

Follows arterial supply Anterior and posterior arcades drain head and the body Splenic vein drains the body and tail Ultimately, into portal vein

Lymphatic Drainage
Rich periacinar network that drain into 5 nodal groups
Superior nodes Anterior nodes Inferior nodes Posterior PD nodes Splenic nodes

Innervation of Pancreas
Sympathetic fibers from the splanchnic nerves Parasympathetic fibers from the vagus Parasympathetic fibers stimulate both exocrine and endocrine secretion Sympathetic fibers have a predominantly inhibitory effect

Physiology Exocrine Pancreas

500 to 800 ml pancreatic fluid secreted per day Alkaline pH results from secreted bicarbonate which serves to neutralize gastric acid and regulate the pH of the intestine Enzymes digest carbohydrates, proteins, and fats

Bicarbonate Secretion
Centroacinar cells and ductular epithelium secrete 20 mmol of bicarbonate per liter in the basal state Fluid acts as a vehicle to carry inactive proteolytic enzymes to the duodenal lumen

Bicarbonate Secretion
Bicarbonate is formed from carbonic acid by the enzyme carbonic anhydrase Major stimulants
Secretin, Cholecystokinin, Gastrin, Acetylcholine

Major inhibitors
Atropine, Somatostatin, Pancreatic polypeptide and Glucagon

Enzyme Secretion
Acinar cells secrete isozymes

amylases, lipases, and proteases Cholecystokinin, Acetylcholine, Secretin

Major stimulants

Synthesized in the endoplasmic reticulum of the acinar cells and are packaged in the zymogen granules Released from the acinar cells into the lumen of the acinus and then transported into the duodenal lumen, where the enzymes are activated.

Anatomy of Spleen

Spleen/lien
Weight: 75250 grams. Cranial to caudal axis: 15cm, thickness: 23cm. The normal adult spleen contains 2040ml of blood. It receives about 5%of the cardiac output in the adult. The white pulp includes periarteriolar lymphoid sheaths containing T lymphocytes and antigen-presenting cells, and lymphoid nodules with germina centres (secondary lymphoid follicles). The red pulp comprises vascular sinusoids lined by fixed and free phagocytes and large numbers of interdigitating macrophages with long dendritic processes

Spleen Structure
The white pulp is circular in structure and is made up mainly of lymphocytes. It functions in a manner similar to the nodules of the lymph node. The red pulp surrounds the white pulp and contains mainly red blood cells and macrophages. The main function of the red pulp is to phagocytize old red blood cells.

Function
The spleen is a sophisticated filter that monitors and manages blood cells and immune functions During fetal development the spleen produces red and white blood cells Red cells that pass through the spleen undergo a cleaning or repair Abnormal and old cells are destroyed

Function
RBCs coated with IgG and IgM are removed and destroyed

The spleen is the site of destruction in autoimmune disease states (hemolytic anemia) Parasites such as malaria can be removed as well

The spleen is involved in specific and nonspecific immune responses (promotes phagocytosis and destruction of bacteria)