Art of Anatomy of the Pancreas
Introduction
Ashley Davidoff MD Copyright 2015
is a photograph that shows a cloud formation embodying the shape of a pancreas
The anatomy of the pancreas is unusual and the physiology is multifaceted. It is a gland and is part of both the digestive and hormonal systems of the body. Structurally it is characterised by its unusual shape and position and the absence of a capsule. Functionally it is involved in the digestion of food as well as in the metabolism of glucose. The most common diseases include pancreatitis, pancreatic carcinoma and diabetes. Serum tests, ultrasound, CT scan, MRI and endoscopy are most commonly used in diagnosis of pancreatic disease. Treatment options include medical treatment (eg insulin in type 1 diabetes) minimally invasive procedures, and surgery.
is artwork derived from a CT scan and shows the upper abdominal cavity with the pancreas in bright pink surrounded by the liver, gallbladder, and kidneys. The aorta and inferior vena cava are the major transport vessels and serve to connect the organs.
Structure
Unusual Shape
“…and we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue”
from “Hermit of the Abdomen”
The pancreas has been compared to many objects including an elongated comma on its side, an elongated number 9 on its side, a prism, a banana, an inverted and curved upside down tobacco pipe, and even an old fashioned revolver. Placing a seahorse or a woodpecker with head down and tail up probably brings us closest to the complex shape of the pancreas. The objects used for description are so varied and disparate, that one wonders if we truly have a grasp of the shape of this organ. A more practical way to look at the shape of the organ is to define the shape of its component parts.
Structure – Position
Deep in the Abdomen in the Retroperitoneum
The pancreas lies in the anterior pararenal space of the retroperitoneum surrounded by a vertebral body and kidneys posteriorly, the liver and gall bladder to its right, the spleen to its left, and the stomach and left lobe of the liver in front. This AiA rendering shows the pancreas cycling through the seasons. In the spring it is in shades of pink, the summer in blue, the fall in red, and in the winter in ice blue and white.
Function
The pancreas has dual functions in the the metabolism of the body. It acts as an as both an exocrine gland (secretes into ducts) and an endocrine gland (secretes into the circulation).
As an exocrine gland it secretes enzymes into ducts that lead to the duodenum. These enzymes aid in the digestion of fat, proteins, and carbohydrates. As an endocrine gland it is a key player in the control of glucose metabolism which it accomplishes by secreting insulin into the circulation.
The acini are the microscopic glands making up 98% of the parenchyma and they function as the exocrine component.
“Blueberries of the Glands of the Pancreas”
is a rendering of the histological appearance of the pancreatic acinar glands. The artpiece illustrates the ductules that subtends the acini which are the exocrine glandular cells. The shape of the acinar cells and ductules are reminiscent of grapes or berries on a stalk.
“Histology of the Glands of the Pancreas”
The exocrine hormones of the pancreas that aid in the digestion of fats, proteins and carbohydrates are produced in the acinar cells in the glandular unit called the acinus. The art piece shows the acinus with acinar cells and the duct that transports the secretions to the pancreatic duct and eventually to the duodenum where they aid in the digestion of proteins fats and carbohydrates.
The islets of Langerhans secrete insulin into the blood stream, very soon after ingestion of a meal in order to control blood sugar and intracellular glucose concentrations. The endocrine cells called the islets of Langerhans represent only 1-2% of the tissue volume of the pancreas, but play a vital role in body function and well being. They are most numerous in the tail of the pancreas.
Islets of Langerhans
Immunohistochemistry on mouse pancreas for insulin shows the brown stained Islets of Langerhans that secrete insulin among the acinar cells. They represent only 2% of the population of pancreatic cells.
(Modified Image – Courtesy Billyboy Wikipedia Public Domain)
Diseases
Acute Necrotic Pancreatitis
This is a CT of an elderly man who had severe pancreatitis. Within the retroperitoneum there is necrotic pancreas (asterisk). It is enlarged and consists mostly of air (arrow), fluid, and high density hemorrhagic components. The findings are consistent with a gangrenous pancreatic abscess. The surgeon noted that the pancreas looked and smelled like a “dead fish…. that had been dead for quite a long time.” Other structures including the gallbladder(gb), liver, kidneys, spleen and stomach surround the pancreas
Pancreatic Cancer with Spread to the Liver
The CT scan shows a primary pancreatic cancer (red asterisk) with metastases to the liver. Four of many metastases are identified with white asterisks
Normal Pancreatic Cells and Pancreatic Cancer Cells
In the upper image the cellular makeup of the acinar cells of the pancreas manifest with a normal nuclear to cytoplasmic ratio reflecting the relative size of the nucleus to the cytoplasm. The 2nd image show cancerous cells of the exocrine pancreas. The blue nuclii are far too large for the amount of the cytoplasm of the cell (abnormal nuclear to cytoplasm ratio). The malignant cells are also too dark (hyperchromatic) and lack uniformity and organization. These are all features of malignant cells . Cancerous cells do not obey the rules of the body and have no regard for the body at large. Malignant cells are equivalent to rebels in the community. They destroy and do not contribute to the wellbeing of the society. They also invade the territory of neighboring structures.
The foot of a person with diabetes following amputation of the 2nd, 3rd, and 4th digits as a result of poor circulation of the tissues. The magnified view shows the calcification and hardening of the arteries.
Diagnosis
“Doppler Ultrasound of the Pancreas-Hermit of the Abdomen”
shows the pancreas in black in front of the splenic vein
“ERCP – Ductal Skeleton of the Pancreas”
is from an ERCP with an injection into normal the dorsal pancreatic duct of Wirsung with contrast also noted in the distal common bile duct
is from an angiogram of the celiac axis and shows the multiple arteries that supply the pancreas. The head of the pancreas is supplied by the superior pancreatico-duodenal vessels which arises from the gastroduodenal artery, and inferior pancreatico-duodenal artery which arises from the SMA. The body is supplied by the splenic artery and the superior mesenteric artery.
Treatment
Treatment options include medical treatment (eg insulin in type 1 diabetes) minimally invasive procedures for drainage and relief of obstruction, and surgery.
3D Nuclear Magnetic Resonance Structure of Insulin Dimer
(Modified from public domain image from Wikipedia and Courtesy Jawahar Swaminathan Jawahar Swaminathan and MSD staff at the European Bioinformatics Institute)
“And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
exposed the insular chemistry of your insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was born
from “Hermit of the Abdomen” Davidoff
This aquatic scene shows the relationship of the pancreas to its neighbours particularly the splenic vein and left renal vein which run a parallel course, almost like a bunch of buddies romping in the water. The arching bodies with heads all in the same direction is quite beautiful
And then I think of you in your prime and in your happiness
When you are with your two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever”
from “Hermit of the Abdomen” Davidoff
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