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Pancreas
FromWikipedia,thefreeencyclopedia

Thepancreas/pkris/isaglandularorganinthedigestivesystemandendocrinesystemofvertebrates.In
humans,itislocatedintheabdominalcavitybehindthestomach.Itisanendocrineglandproducingseveral
importanthormones,includinginsulin,glucagon,somatostatin,andpancreaticpolypeptidewhichcirculatein
theblood.Thepancreasisalsoadigestiveorgan,secretingpancreaticjuicecontainingdigestiveenzymesthat
assistdigestionandabsorptionofnutrientsinthesmallintestine.Theseenzymeshelptofurtherbreakdownthe
carbohydrates,proteins,andlipidsinthechyme.

Pancreas

Contents
1 Structure
1.1 Margins
1.2 Surfaces
1.3 Bloodsupply
1.4 Histology
1.5 Variation
2 Development
3 Function
3.1 Sugarcontrolandmetabolism
3.2 Digestion
4 Clinicalsignificance
4.1 Inflammation
4.2 Cancer
4.3 Diabetes
4.3.1 Type1diabetes
4.3.2 Type2diabetes
5 History
6 Otheranimals
7 Additionalimages
8 Seealso
9 References
10 Externallinks

https://en.wikipedia.org/wiki/Pancreas

Anatomyofthepancreas

1:Headofpancreas
2:Uncinateprocessofpancreas
3:Pancreaticnotch
4:Bodyofpancreas
5:Anteriorsurfaceofpancreas
6:Inferiorsurfaceofpancreas
7:Superiormarginofpancreas
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Structure

8:Anteriormarginofpancreas
9:Inferiormarginofpancreas
10:Omentaltuber
11:Tailofpancreas

Thepancreasisanendocrineorganthatliesintheupperleftpartoftheabdomen.Itisfoundbehindthe
stomach.[2]Thepancreasisabout15cm(6in)long.[3]
Anatomically,thepancreasisdividedintotheheadofpancreas,theneckofpancreas,thebodyofpancreas,
andthetailofpancreas.Theheadissurroundedbytheduodenuminitsconcavity.Theheadsurroundstwo
bloodvessels,thesuperiormesentericarteryandvein.Fromthebackoftheheademergesasmalluncinate
processwhichextendstothebackofthesuperiormesentericveinandendsatthesuperiormesentericartery.[4]
Theneckisabout2.5cmlongandliesbetweentheheadandthebody,andinfrontofthesuperiormesenteric
arteryandvein.Itsfrontuppersurfacesupportsthepylorus(thebase)ofthestomach.Theneckarisesfromthe
leftupperpartofthefrontofthehead.Itisdirectedatfirst,upwardandforward,andthenupwardandtotheleft
tojointhebodyitissomewhatflattenedfromabovedownwardandbackward.Ontherightitisgroovedbythe
gastroduodenalartery.Thebodyisthelargestpartofthepancreasandliesbehindthepylorus,atthesamelevel
asthetranspyloricplane.[5]Thetailendsbyabuttingthespleen.
Thepancreasisasecretorystructurewithaninternalhormonalrole(endocrine)andanexternaldigestiverole
(exocrine).Ithastwomainducts,themainpancreaticduct,andtheaccessorypancreaticduct.Thesedrain
enzymesthroughtheampullaofVaterintotheduodenum.[6]

12:Duodenum
Details
Precursor Pancreaticbuds
Artery

Inferiorpancreaticoduodenalartery,
anteriorsuperiorpancreaticoduodenal
artery,posteriorsuperior
pancreaticoduodenalartery,splenic
artery

Vein

Pancreaticoduodenalveins,pancreatic
veins

Nerve

Pancreaticplexus,celiacganglia,vagus
nerve[1]

Lymph

Margins
Theuppermarginofthepancreasisbluntandflattotherightnarrowandsharptotheleft,nearthetail.
Itbeginsontherightintheomentaltuber,andisinrelationwiththeceliacartery,fromwhichthehepaticartery
coursestotherightjustabovethegland,whilethesplenicarteryrunstowardtheleftinagroovealongthis
border.

Identifiers
Latin

Pancreas

Greek

Pankrous

MeSH

A03.734(https://www.nlm.nih.gov/cgi/m
esh/2011/MB_cgi?mode=&term=Pancr
eas)

TA

A05.9.01.001(http://www.unifr.ch/ifaa/
Public/EntryPage/TA98%20Tree/Entit
y%20TA98%20EN/05.9.01.001%20Ent
ity%20TA98%20EN.htm)

FMA

7198(http://xiphoid.biostr.washington.e
du/fma/fmabrowserhierarchy.html?fma

Thelowermarginofthepancreasseparatestheposteriorfromtheinferiorsurfacethesuperiormesenteric
vesselsemergeunderitsrightextremity.
Thefrontalmarginofthepancreasseparatestheanteriorfromtheinferiorsurfaceofthepancreas,andalongthis
borderthetwolayersofthetransversemesocolondivergefromoneanotheronepassingupwardoverthefrontal
surface,theotherbackwardovertheinferiorsurface.

Surfaces
https://en.wikipedia.org/wiki/Pancreas

Spleniclymphnodes,celiaclymph
nodesandsuperiormesentericlymph
nodes

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Theinferiorsurfaceofthepancreasisnarrowontherightbutbroaderontheleft,andiscoveredbyperitoneum
itliesupontheduodenojejunalflexureandonsomecoilsofthejejunumitsleftextremityrestsonthesplenic
flexureofthecolon.

id=7198)
Anatomicalterminology
[editonWikidata]

Theanteriorsurfaceofthepancreasfacesthefrontoftheabdomen.Mostoftherighthalfofthissurfaceisin
contactwiththetransversecolon,withonlyareolartissueintervening.
Fromitsupperpartitjoinstotheneckofthepancreasatawellmarkedprominence,theomentaltuberwhich
abutsthelesseromentum.Itsrightedgeismarkedbyagrooveforthegastroduodenalartery.
Thelowerpartoftherighthalf,belowthetransversecolon,iscoveredbyperitoneumcontinuouswiththeinferior
layerofthetransversemesocolon,andisincontactwiththecoilsofthesmallintestine.
Thesuperiormesentericarterypassesdowninfrontofthelefthalfacrosstheuncinateprocessthesuperior
mesentericveinrunsupwardontherightsideofthearteryand,behindtheneck,joinswiththelienalveintoform
theportalvein.

Bloodsupply
Thepancreasreceivesbloodfrombranchesofboththecoeliacarteryandsuperiormesentericartery.Thesplenic
arteryrunsalongthetopmarginofthepancreas,andsuppliestheneck,bodyandtailofthepancreasthroughits
pancreaticbranches,thelargestofwhichiscalledthegreaterpancreaticartery.Thesuperiorandinferior
pancreaticoduodenalarteriesrunalongtheanteriorandposteriorsurfacesoftheheadofthepancreasatitsborder
withtheduodenum.Thesesupplytheheadofthepancreas.[4]
Thebodyandneckofthepancreasdrainintothesplenicveintheheaddrainsintothesuperiormesentericand
portalveins.[4]

Histology
Thepancreascontainstissuewithanendocrineandexocrinerole,andthisdivisionisalsovisiblewhenthe
pancreasisviewedunderamicroscope.[6]
Thetissueswithanendocrinerolecanbeseenunderstainingaslightlystainedclustersofcells,calledpancreatic
islets(alsocalledisletsofLangerhans).[6]

https://en.wikipedia.org/wiki/Pancreas

1.Bileducts:2.Intrahepaticbileducts,3.Left
andrighthepaticducts,4.Commonhepatic
duct,5.Cysticduct,6.Commonbileduct,7.
AmpullaofVater,8.Majorduodenalpapilla
9.Gallbladder,1011.Rightandleftlobesof
liver.12.Spleen.
13.Esophagus.14.Stomach.15.Pancreas:16:
Accessorypancreaticduct,17:Pancreaticduct.
18.Smallintestine:19.Duodenum,20.
Jejunum
2122:Rightandleftkidneys(silhouette).
Theanteriorborderoftheliverislifted
upwards(brownarrow).Gallbladderwith
Longitudinalsection,pancreasandduodenum
withfrontalone.Intrahepaticductsandstomach
intransparency.

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Darkerstainingcellsformclusterscalledacini,whicharearrangedinlobesseparatedbyathinfibrousbarrier.The
secretorycellsofeachacinussurroundasmallintercalatedduct.Becauseoftheirsecretoryfunction,thesecellshavemany
smallgranulesofzymogensthatarevisible.Theintercalatedductsdrainintolargerductswithinthelobule,andfinally
interlobularducts.Theductsarelinedbyasinglelayerofcolumnarepithelium.Withincreasingdiameter,severallayersof
columnarcellsmaybeseen.[6]

Variation
Thesizeofthepancreasvariesconsiderably.[2]Severalanatomicalvariationsexist,relatingtotheembryological
developmentofthetwopancreaticbuds.Thepancreasdevelopsfromthesebudsoneithersideoftheduodenum.The
ventralbudeventuallyrotatestolienexttothedorsalbud,eventuallyfusing.Ifthetwobudseachhavingaduct,donot
fuse,apancreasmayexistwithtwoseparateducts,aconditionknownasapancreasdivisum.Thisconditionhasno
physiologicconsequence.[7]Iftheventralbuddoesnotfullyrotate,anannularpancreasmayexist.Thisiswheresectionsof
thepancreascompletelyencircletheduodenum,andmayevenleadtoduodenalatresia.[4]

Pancreatictissue,includinga
pancreaticislet

Anaccessorypancreaticductmayexistifthemainductofpancreasdoesnotregress.[8]

Development
Aspartofembryonicdevelopmentthepancreasformsfromtheembryonicforegutandisthereforeofendodermalorigin.Pancreaticdevelopmentbeginswiththe
formationofaventralandadorsalpancreaticbud.Eachstructurecommunicateswiththeforegutthroughaduct.Thedorsalpancreaticbudformsthehead,neck,
body,andtail,whereastheventralpancreaticbudformstheuncinateprocess.[8]
Differentialrotationandfusionoftheventralanddorsalpancreaticbudsresultsintheformationofthedefinitivepancreas.[9]Astheduodenumrotatestotheright,
itcarrieswithittheventralpancreaticbudandcommonbileduct.Uponreachingitsfinaldestination,theventralpancreaticbudfuseswiththemuchlargerdorsal
pancreaticbud.Atthispointoffusion,themainductsoftheventralanddorsalpancreaticbudsfuse,formingthemainpancreaticduct.Theductofthedorsalbud
regresses,leavingthemainpancreaticduct.[8]
Differentiationofcellsofthepancreasproceedsthroughtwodifferentpathways,correspondingtothedualendocrineandexocrinefunctionsofthepancreas.In
progenitorcellsoftheexocrinepancreas,importantmoleculesthatinducedifferentiationincludefollistatin,fibroblastgrowthfactors,andactivationoftheNotch
receptorsystem.[9]Developmentoftheexocrineaciniprogressesthroughthreesuccessivestages.Thesearethepredifferentiated,protodifferentiated,and
differentiatedstages,whichcorrespondtoundetectable,low,andhighlevelsofdigestiveenzymeactivity,respectively.

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Themultipotentpancreaticprogenitorcellshavethecapacitytodifferentiateintoanyofthepancreaticcells:
acinarcells,endocrinecells,andductalcells.Theseprogenitorcellsarecharacterisedbythecoexpressionof
thetranscriptionfactorsPDX1andNKX61.Undertheinfluenceofneurogenin3andISL1,butintheabsence
ofnotchreceptorsignaling,thesecellsdifferentiatetoformtwolinesofcommittedendocrineprecursorcells.
Thefirstline,underthedirectionofaPaxgene,formsandcells,whichproduceglucagonandpancreatic
polypeptides,respectively.Thesecondline,influencedbyPax6,producesbetacells()anddeltacells(),
whichsecreteinsulinandsomatostatin,respectively.
Insulinandglucagoncanbedetectedinthehumanfetalcirculationbythefourthorfifthmonthoffetal
development.[9]

Function
Thepancreasisinvolvedinbloodsugarcontrolandmetabolismwithinthebody,andalsointhesecretionof
substanceswhichhelpdigestion.Classically,thesearedividedintoan"endocrine"role,relatingtothe
secretionofinsulinandothersubstanceswithinpancreaticisletsandhelpingcontrolbloodsugarlevelsand
metabolismwithinthebody,andan"exocrine"role,relatingtothesecretionofenzymesinvolvedindigesting
substancesfromoutsideofthebody.

Schematicillustratingthedevelopmentofthe
pancreasfromadorsalandaventralbud.During
maturation,theventralbudflipstotheothersideof
theguttube(arrow)whereittypicallyfuseswith
thedorsallobe.Anadditionalventrallobethat
usuallyregressesduringdevelopmentisomitted.

Sugarcontrolandmetabolism
Approximately3millioncellclusterscalledpancreaticisletsarepresentinthepancreas.[10]Withintheseisletsarefourtypesofcellswhichareinvolvedinthe
regulationofbloodglucoselevels.Eachtypeofcellsecretesadifferenttypeofhormone:alphacellssecreteglucagon(increaseglucoseinblood),betacells
secreteinsulin(decreaseglucoseinblood),deltacellssecretesomatostatin(regulates/stopsandcells)andPPcells,or(gamma)cells,secretepancreatic
polypeptide.[11]Theseacttocontrolbloodglucosethroughsecretingglucagontoincreasethelevelsofglucose,andinsulintodecreaseit.
Theisletsarecrisscrossedbyadensenetworkofcapillaries.Thecapillariesoftheisletsarelinedbylayersofisletcells,andmostendocrinecellsareindirect
contactwithbloodvessels,eitherbycytoplasmicprocessesorbydirectapposition.Theisletsfunctionindependentlyfromthedigestiveroleplayedbythe
majorityofpancreaticcells.[12]
Activityofthecellsintheisletsisaffectedbytheautonomicnervoussystem:
Sympathetic(adrenergic)
2:decreasessecretionfrombetacells,increasessecretionfromalphacells,2:increasessecretionfrombetacells
Parasympathetic(muscarinic)
M3:increasesstimulationofalphacellsandbetacells[13]
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Digestion
Thepancreasplaysavitalroleinthedigestivesystem.Itsecretesfluidthatcontainsenzymesintotheduodenum.These
enzymeshelptobreakdowncarbohydrates(usuallystarch),proteinsandlipids(fats).Thisroleiscalledthe"exocrine"role
ofthepancreas.Cellsarearrangedclusterscalledacini.Secretionsintothemiddleoftheacinusaccumulateinintralobular
ductsthatdraintothemainpancreaticduct,whichdrainsdirectlyintotheduodenum.
Bloodglucoselevelsaremaintained
ataconstantlevelinthebodybya
negativefeedbackmechanism.When
thebloodglucoselevelistoohigh,
thepancreassecretesinsulinandwhen
thelevelistoolow,thepancreasthen
secretesglucagon.Theflatlineshown
representsthehomeostaticsetpoint.
Thesinusoidallinerepresentsthe
bloodglucoselevel.

Thecellsarefilledwithgranulescontainingthedigestiveenzymes.Thesearesecretedinaninactiveformcalled(termed
zymogensorproenzymes).Whenreleasedintotheduodenum,theyareactivatedbytheenzymeenteropeptidasepresentin
theliningoftheduodenum.Theproenzymesarecleaved,creatingacascadeofactivatingenzymes:enteropeptidase
activatestheproenzymetrypsinogenbycleavingittoformtrypsin.Thefreetrypsinthencleavestherestofthetrypsinogen,
aswellaschymotrypsinogentoitsactiveformchymotrypsin.
Thepancreassecretessubstanceswhichhelpinthedigestionofstarchandothercarbohydrates,proteinsandfats.[14]
Proteases,theenzymesinvolvedinthedigestionofproteins,includetrypsinogenandchymotrypsinogen.Theenzyme
involvedinthedigestionoffatsislipase.Amylase,alsosecretedbythepancreas,breaksdownstarch(amylum)andother
carbohydrates.ThepancreasalsosecretesphospholipaseA2,lysophospholipase,andcholesterolesterase.
Secretionoftheseproenzymesisviathehormonesgastrin,cholecystokininandsecretin,whicharesecretedbycellsinthe
stomachandduodenuminresponsetodistensionand/orfood.

Clinicalsignificance
Aperforationofthepancreas,whichmayleadtothesecretionofdigestiveenzymessuchaslipaseandamylaseintotheabdominalcavityaswellassubsequent
pancreaticselfdigestionanddigestionanddamagetoorganswithintheabdomen,generallyrequirespromptandexperiencedmedicalintervention.
Itispossibleforonetolivewithoutapancreas,providedthatthepersontakesinsulinforproperregulationofbloodglucoseconcentrationandpancreaticenzyme
supplementstoaiddigestion.[15]

Inflammation
Inflammationofthepancreasisknownaspancreatitis.Pancreatitisismostoftenassociatedwithrecurrentgallstonesorchronicalcoholuse,althoughavarietyof
othercauses,includingmeasles,mumps,somemedications,thecongenitalconditionalpha1antitrypsindeficiencyandevensomescorpionstings,maycause
pancreatitis.Pancreatitisislikelytocauseintensepaininthecentralabdomen,thatoftenradiatestotheback,andmaybeassociatedwithjaundice.Inaddition,
duetocausingproblemswithfatdigestionandbilirubinexcretion,pancreatitisoftenpresentswithpalestoolsanddarkurine.[16]

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Inpancreatitis,enzymesoftheexocrinepancreasdamagethestructureandtissueofthepancreas.Detectionofsomeoftheseenzymes,suchasamylaseandlipase
intheblood,alongwithsymptomsandfindingsonXray,areoftenusedtoindicatethatapersonhaspancreatitis.Apersonwithpancreatitisisalsoatriskof
shock.Pancreatitisisoftenmanagedmedicallywithanalgesics,removalofgallstonesortreatmentofothercauses,andmonitoringtoensureapatientdoesnot
developshock.[16]

Cancer
Pancreaticcancers,particularlythemostcommontype,pancreaticadenocarcinoma,remainverydifficulttotreat,andaremostlydiagnosedonlyatastagethatis
toolateforsurgery,whichistheonlycurativetreatment.Pancreaticcancerisrareinthoseyoungerthan40,andthemedianageofdiagnosisis71.[17]Riskfactors
includesmoking,obesity,diabetes,andcertainraregeneticconditionsincludingmultipleendocrineneoplasiatype1andhereditarynonpolyposiscoloncancer
amongothers.[18]About25%ofcasesareattributabletotobaccosmoking,[19]while510%ofcasesarelinkedtoinheritedgenes.[17]
Thereareseveraltypesofpancreaticcancer,involvingboththeendocrineandexocrinetissue.Pancreaticadenocarcinoma,whichaffectstheexocrinepartofthe
pancreas,isbyfarthemostcommonform.Themanytypesofpancreaticendocrinetumorsarealluncommonorrare,andhavevariedoutlooks.Howeverthe
incidenceofthesecancershasbeenrisingsharplyitisnotcleartowhatextentthisreflectsincreaseddetection,especiallythroughmedicalimaging,oftumorsthat
wouldbeveryslowtodevelop.Insulinomas(largelybenign)andgastrinomasarethemostcommontypes.[20]IntheUnitedStatespancreaticcanceristhefourth
mostcommoncauseofdeathsduetocancer.[21]Thediseaseoccursmoreofteninthedevelopedworld,whichhad68%ofnewcasesin2012.[22]Pancreatic
adenocarcinomatypicallyhaspooroutcomeswiththeaveragepercentagealiveforatleastoneandfiveyearsafterdiagnosisbeing25%and5%
respectively.[22][23]Inlocalizeddiseasewherethecancerissmall(<2cm)thenumberaliveatfiveyearsisapproximately20%.[24]Forthosewithneuroendocrine
cancersthenumberaliveafterfiveyearsismuchbetterat65%,varyingconsiderablywithtype.[22]
Asolidpseudopapillarytumourisalowgrademalignanttumourofthepancreasofpapillaryarchitecturethattypicallyafflictsyoungwomen.[25]

Diabetes
Type1diabetes
Diabetesmellitustype1isachronicautoimmunedisorderinwhichtheimmunesystemattackstheinsulinsecretingcellsofthepancreas.Insulinisneededtokeep
bloodsugarlevelswithinoptimalranges,anditslackcanleadtohighbloodsugar.Asanuntreatedchroniccondition,diabeticneuropathycanresult.Type1
diabetescandevelopatanyagebutismostoftendiagnosedbeforeadulthood.Fortype1diabetics,insulininjectionsarecriticalforsurvival.[26]
Anexperimentalproceduretotreattype1diabetesisthetransplantationofpancreaticisletcellsfromadonorintothepatient'sliversothatthecellscanproduce
thedeficientinsulin.[27]
Type2diabetes
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Diabetesmellitustype2isthemostcommonformofdiabetes.Thecausesforhighbloodsugarinthisformofdiabetesusuallyareacombinationofinsulin
resistanceandimpairedinsulinsecretion,withbothgeneticandenvironmentalfactorsplayinganimportantroleinthedevelopmentofthedisease.The
managementoftype2diabetesreliesonaseriesofchangesindietandphysicalactivitywiththepurposeofreducingbloodsugarlevelstonormalrangesand
increasinginsulinsensitivity.[26]Biguanidessuchasmetforminarealsousedaspartofthetreatmentalongwithinsulintherapy.[28]

History
ThepancreaswasfirstidentifiedbyHerophilus(335280BC),aGreekanatomistandsurgeon.[29]Afewhundredyearslater,RufusofEphesus,anotherGreek
anatomist,gavethepancreasitsname.Etymologically,theterm"pancreas",amodernLatinadaptationofGreek,[30][("all","whole"),and
("flesh")],[31]originallymeanssweetbread,[32]althoughliterallymeaningallflesh,presumablybecauseofitsfleshyconsistency.Itwasonlyin1889whenOskar
Minkowskidiscoveredthatremovingthepancreasfromadogcausedittobecomediabetic(insulinwaslaterdiscoveredbyFrederickBantingandCharlesHerbert
Bestin1921).
Theorganismentionedprominentlyinthe1992filmEncinoMan.PaulyShore'scharacterStoneyoftenreferstotheorganinunrelatedcontexts,perhaps
demonstratingafundamentalmisunderstandingofwhatthepancreasdoes.

Otheranimals
Pancreatictissueispresentinallvertebrates,butitspreciseformandarrangementvarieswidely.Theremaybeuptothreeseparatepancreases,twoofwhicharise
fromventralbuds,andtheotherdorsally.Inmostspecies(includinghumans),thesefuseintheadult,butthereareseveralexceptions.Evenwhenasinglepancreas
ispresent,twoorthreepancreaticductsmaypersist,eachdrainingseparatelyintotheduodenum(orequivalentpartoftheforegut).Birds,forexample,typically
havethreesuchducts.[33]
Inteleosts,andafewotherspecies(suchasrabbits),thereisnodiscretepancreasatall,withpancreatictissuebeingdistributeddiffuselyacrossthemesenteryand
evenwithinothernearbyorgans,suchastheliverorspleen.Inafewteleostspecies,theendocrinetissuehasfusedtoformadistinctglandwithintheabdominal
cavity,butotherwiseitisdistributedamongtheexocrinecomponents.Themostprimitivearrangement,however,appearstobethatoflampreysandlungfish,in
whichpancreatictissueisfoundasanumberofdiscretenoduleswithinthewallofthegutitself,withtheexocrineportionsbeinglittledifferentfromother
glandularstructuresoftheintestine.[33]

Additionalimages

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Theduodenumand
pancreas

Pancreasofahuman
embryoatendofsixth
week

Dogpancreas
magnified100times

Thepancreasandits
surroundingstructures

Duodenumand
pancreas.Deep
dissection.

Seealso
Thisarticleincorporatestextinthepublicdomainfromthe20theditionofGray'sAnatomy(1918)

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