Posted on September 15, 2017February 17, 2023 by Ashley Davidoff

Pancreas – Hermit of the Abdomen

Ashley Davidoff MD

O’ Dear pancreas

You have been called the hermit of the abdomen
By whom I do not know
But in your dark and hidden way, you have
spoken without a word
from the gurgling depths of the abdomen
Yes – you have earned this lonely title
and a coin should be tossed
to the person who coined the phrase

But it took a long time to understand who this hermit was – and what he was doing in the darkness of the abdomen

From the day of antiquity
You have been looked upon by many
Herophilus, the father of anatomy had the first incisive insights into you
As he was one of very few who had the guts to explore the guts in open fashion

Aristotle at the same time seemed to have known something about you
But then you lay unharmed and unexplored for almost 500 years
Until Rufus mistook you for a piece of meat –
You must have laughed at the “pan kreas” thing
How wrong he was – you evasive little trickster

And then the Talmud – always seeming to be right
Thought you were the finger of the liver –
Little did they know how independant you were

While Vesalius was up to your “hide and seek” game
The magical eyes of da Vinci missed you completely
Even though he saw the serpiginous splenic artery snake right above you

Your ducts seemed to have intrigued the next generation, Wharton, Wirsung, and de Graaf
As you sustained the pain of the quill penetrating your inner gut
(I forget you were already dead but it must of hurt just watching!)

A little later it was that man called Vater and the little Italian Santorini found your minor duct and your nipple
And so by this time we had a good understanding of you in your nakedness
But of course, as said – you were dead

And so young Bernard explored your factories, and got a sense of your canine workings,
But you were able to hold on to your sweet secret for just a little longer
Until the Langerhans found the family jewels in the famous 2% of your population-
The islets – those beautiful eyelits – governess of all things sweet in the body

Eberle Bernard Danilevsky, and Kuhne joined up across the world to expose your antacid and enigmatic enzymatic brew
And once again your wonderful workings for a better world were exposed –
And we knew then, that you were the quiet and effective type –
A hermit who did good
But did not want the limelight

To see you as you lived and breathed in the flesh
was the mission of Wilhelm the X-Ray man
who crusaded the path to visualise 40,000 Angstroms under the skin

abdomen, pancreas, liver, gallbladder, kidneys, CT scan, Art in Anatomy, Ashley Davidoff MD

And then there was a slew of heroes who learned to slew your sickened parts – including the famous Whipple who was able to Whipple you in an inimitable way

And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
Exposed the insular chemistry of you 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 borne

And so we try to understand your form as our scans explore you as you live and breathe
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
And we are happy – so happy for you that you are well nourished by a double blood supply
And we wonder why you have no skin – we thought all the organs had a skin
Except for your tail – almost a foreskin

And you are off axis on two planes – what is that all about? – kinda crooked

And your twin origins and the intimacy with the duodenum, of the ventral twin
And the strange fusion of the Wirsung guy excluding the little Italian Santorini
It seems to me that your matrimonial fusion with Wirsung and the bile duct has led to more problems than the merger was worth
It does not seem in the long run, to have been a marriage made in heaven
What was that all about? Is there a grand plan to come?

And so we try to understand your diseases
And in some way we understand that the guy glugging down the bottle
Could be punished by your reaction
But why Oh why are you so nasty to those whose misfortune it is to have stones roll down and get no satisfaction.. down the green vile bile route
Have you not learned to live with the green secretion by now
And did you not know that by reacting the way you do, that you are cutting off your nose to spite you head?

While type 2 seems remote from you
We don’t know about this Type 1 business
Why are you made to suffer so much at the hands of your own body on your own body?
We feel sorry for you – to have your own buddies reject you – must be awful
And then to see so many young ones suffer because you don’t work
And we once again see and understand what power you control from that deep dark hermit home of yours

And the cancer thing … so silently it creeps on you causing your collagen to counter
And only making things worse as it strangles nerve, blood vessel, and your spouse duct – the green one, – without regard

And then I think of you in your prime and in your happiness
When you are with you 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

Posted on November 20, 2015February 17, 2023 by Ashley Davidoff

Emphysema – a Poem

Emphysema

Perspective of an Alveolar Cell

Healthy Alveolus

When I was young my cell buddies and the tissues around us felt invincible

The ease and elasticity with which we opened and closed –

Allowing the breeze of

Beautiful oxygen ….in

And dirty carbon dioxide ….out

Was executed without effort

It really was a breeze – right through our strong bodies

No effort

Alveolus in Healthy Lungs

Then one day – when the guy in charge was about 14

When his hormones started to fill his psyche

He went to a party

Lots of little talk

And “cool” this and “cool” that

And “come on … try this” and “try that”

And in his psyche I read

(though he did not consciously know it )

“I want to fit in”… “I want to look cool”

And suddenly while waiting for my beautiful blue oxygen

A wave of black and gray stink air imploded in my face

“Yech” I shouted

And that was the beginning of the end

Day after day

Smelly smoke continued to come down the pipeline

.. and it took control of him

Even though he knew better

Early morning when we woke up

After breakfast with a cup of coffee

Same after lunch and after dinner

And just before sweet repose

He blew this black-gray muck in our faces

And we had no power

Over the years

We lost our elasticity

And we lost hope

Then and Now

He hid his habit from his children and grandchildren who said “yech”

His breathing had a deathly rattle

He coughed green and yellow stinky mucus

His breath stank

His clothes stank

He aged before his time

His skin wrinkled

His voice was coarse

And his arteries became rigid and narrowed pipes

And our small airways were stretched and stretched

Till we looked like big black holes in a ghost town

Of rotting and stale air that could not move…

What We Were… and Now …Big Black Holes

So when we look back

And try to learn, ……

It all started when he wanted to fit in

A human weakness we need to address at a time

When

The psyche of our children

…. and many adults

Have a need to pursue superficiality to

Look cool and fit in

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Posted on November 19, 2015February 17, 2023 by Ashley Davidoff

Emphysema – What Does It Feel Like?

Emphysema

What does it feel like?

Emphysema?

Take a breath and hold it-

While holding that breath … Take another breath on top of that – and hold it –

While holding that breath .. Take a third breath on top of that – and hold that – and then do it a fourth and a fifth time

and maybe a 6th if you can

That is what emphysema feels like!!!

Big Lungs of Stale Air in Emphysema

No more room in the chest to take in any fresh air

It is beyond discomfort – With no relief …

You cannot take a magic medicine

And wake up the next morning

.. and finally take in a full deep breath of fresh air

Like you used to do

You have lost that blessing of life

Medicine and oxygen may help

But

The ability to feel a full breath of pure fresh air….

That feeling is gone forever…

Why did I not listen?

A lesson taught by Dr Bartolome Celli MD

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Posted on November 19, 2015February 17, 2023 by Ashley Davidoff

Art of Anatomy of the Pancreas

Introduction

Pancreas in the Sky

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.

“Pancreas in Pink”

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”

Shapes of the Pancreas

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.

Ravages of Diabetes

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

“Arteries of the Pancreas”

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

Pancreas and Buddies

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

See All Blogs

ART IN ANATOMY

Tag: Disease

Pancreas – Hermit of the Abdomen

Pancreas – Hermit of the Abdomen

Emphysema – a Poem

Emphysema

Perspective of an Alveolar Cell

Emphysema – What Does It Feel Like?

Emphysema

What does it feel like?

Art of Anatomy of the Pancreas

Art of Anatomy of the Pancreas

Introduction