The structure and functional significance of the pancreas. Pancreas: where is it located and how does it hurt in humans? Pancreas: anatomy

Functions of the pancreas.

I. Exocrine. It consists of secretion pancreatic juice– a mixture of digestive enzymes that enter the duodenum and break down all components of chyme;

II. Endocrine. It involves the production of hormones.


Pancreas - parenchymal lobular organ.

The stroma of the gland is represented by a capsule, which merges with the visceral peritoneum and trabeculae extending from it. The stroma is thin, formed by loose fibrous tissue. Trabeculae divide the gland into lobules. In the layers of loose fibrous tissue there are excretory ducts of the exocrine part of the gland, vessels, nerves, intramural ganglia, lamellar Vater-Pacini corpuscles.

The parenchyma is formed by a set of secretory departments ( acini), excretory ducts and Langerhans Islands. Each lobule consists of exocrine and endocrine parts. Their ratio is ≈ 97: 3.

Exocrine pancreas is a complex alveolar-tubular protein gland. The structural and functional unit of the exocrine part is pancreaticacini. It is formed by 8–14 acinar cells ( acinocytes) and centroacinous cells ( centroacinocytes). Acinous cells lie on the basement membrane, have a conical shape and pronounced polarity: the basal and apical poles differ in structure. The expanded basal pole is uniformly stained with basic dyes and is called homogeneous. The narrowed apical pole is stained with acidic dyes and is called zymogenic, because it contains zymogen granules - proenzymes. At the apical pole of acinocytes there are microvilli. The function of acinocytes is the production of digestive enzymes. Activation of enzymes secreted by acinocytes normally occurs only in the duodenum under the influence of activators. This circumstance, as well as enzyme inhibitors and mucus produced by ductal epithelial cells, protect the pancreatic parenchyma from autolysis (self-digestion).

Pancreas, lobule , drawing, high magnification:

1 – terminal section (acinus):

a – apical (oxyphilic) part of the cell, contains a zymogen,

b – basal (basophilic) – homogeneous part of the cell;

2 – hemocapillary;

3 – islet of Langerhans (insula).

Endocrine part of the gland. The structural and functional unit of the endocrine pancreas is Langer islethansa (insula). It is separated from the acini by loose fibrous unformed tissue. The islet is made up of cells insulinocytes, between which lies loose fibrous connective tissue with fenestrated hemocapillaries. Insulocytes vary in their ability to stain with dyes. In accordance with this, insulinocytes of types A, B, D, D1, PP are distinguished.

B cells (basophilic insulinocytes) stain in Blue colour basic dyes. Their number makes up about 75% of all islet cells. They are located in the center of the insula. The cells have a developed protein-synthesizing apparatus and secretory granules with a wide light rim. Secretory granules contain hormone insulin in combination with zinc. The function of B-insulocytes is to produce insulin, which reduces the level of glucose in the blood and stimulates its absorption by the body's cells. In the liver, insulin stimulates the formation of glycogen from glucose. [With a lack of insulin production, diabetes mellitus is formed].

A cells (acidophilus) - make up 20-25% of all islet cells. They are located on the periphery of the insula. They contain granules that are stained with acidic dyes. In an electron microscope, granules have a narrow rim. The cells also contain a developed protein-synthesizing apparatus and secrete the hormone glucagon . This hormone is an insulin antagonist (counterinsular hormone) because it stimulates the breakdown of glycogen in the liver and helps increase blood glucose levels.

D-cells constitute about 5% of the endocrine cells of the islet. They are located on the periphery of the insula. Contains moderately dense granules without a light rim. The granules contain a hormone somatostatin, inhibiting the function of A, B cells of islets and acinocytes. It also has a mitosinhibiting effect on various cells.

D1-cells contain granules with a narrow rim. Produce vasointestinal polypeptide, downward arterial pressure and stimulating the production of pancreatic juice. The number of these cells is small.

PP cells(2-5%) are located on the periphery of the islets, and can sometimes be found as part of the exocrine part of the gland. Contain granules of various shapes, densities and sizes. Cells produce pancreatic polypeptide, inhibiting the exocrine activity of the pancreas.

The pancreas is one of the digestive organs. In its exocrine part, enzymes and electrolytes are produced, which enter the intestinal lumen and participate in the process of food digestion. In addition, in the structure of the organ there are clusters of cells that perform endocrine function. These are the islets of Langerhans, which produce hormones that help maintain glucose balance in the body. Damage to the endocrine part of the gland leads to the development diabetes mellitus, and exocrine - to pancreatitis.

Organ anatomy

Projection of the organ to the front abdominal wall

The pancreas is located in abdominal cavity at the level of 1st and 2nd lumbar vertebrae. It lies behind the peritoneum and is covered on the outside with a capsule of connective tissue. Behind it are the aorta, left renal and inferior vena cava, the spine is located, and in front is the stomach.

The gland consists of two parts - exocrine and endocrine. Each of them performs different functions.

The organ has an elongated shape. Its structure consists of the following parts:

  • body;
  • head;
  • tail.

The head of the gland is slightly flattened and is surrounded on three sides by the duodenum - top, side and bottom. Its posterior surface is adjacent to the right renal and initial sections of the portal veins. Located in front of the gland right part colon.

The body has the shape of a prism. Its anterior surface is covered with peritoneum and borders the stomach, and the posterior surface is in contact with the spine, aorta, inferior vena cava and celiac plexus. The underside is narrower and only partially covered by the peritoneum. The splenic artery and vein are adjacent to the upper part of the body. The tail of the gland is directed to the left and located slightly above the head. It is adjacent to the visceral surface of the spleen. Behind him is top part left kidney with adrenal gland.

Anatomy and topography of the pancreas

With the help of connective tissue partitions (trabeculae), the thickness of the gland is divided into lobules. They contain secretory departments- pancreatic acini, each of which consists of 8–14 pyramidal cells. These formations perform an exocrine function. From these, intercalary grooves begin, which then merge into intralobular and interlobular grooves. The latter pass in trabeculae and form the main excretory, or Wirsung duct. It originates in the tail area, passes through the body and head, and then flows into the lumen of the descending part duodenum. Its final section has a sphincter formed by thickening of the circular muscles. The main duct opens in the area of ​​the major papilla along with the common bile duct, which comes from the gallbladder. There are options when their holes are located separately. The gland has an accessory duct, the contents of which also enter the duodenum. Often it has anastomoses connecting it to the main one.

In newborns, the gland is located slightly higher and more mobile. Its length is 4–5 cm, and its weight is 2–3 g. By 4 months, the mass of the organ doubles. The location and type of iron characteristic of an adult takes on the appearance of iron at the age of 5–6 years.

Normal size and weight of the pancreas in adults:

Exocrine part

Digestive enzymes are produced in the exocrine part. They enter the duodenum along with pancreatic juice, where they take part in the process of digesting food.

About 2 liters of juice are produced per day. It also contains water, sodium, calcium, potassium and magnesium ions, bicarbonates, sulfates, and chlorides. Enzyme synthesis occurs in the acini. Trypsin, chymotrypsin and carboxypeptidase break down proteins. Pancreatic amylase is involved in the processing of carbohydrates, and lipase - fats. RNA and DNA contained in food are affected by ribonucleases and deoxyribonucleases, and connective tissue components are affected by elastases. Bicarbonates are produced by the cells lining the ducts. They are necessary for alkalization food bolus

, which enters the duodenum.

Parts of the pancreas, anatomy of the main pancreatic and common bile ducts Control of the secretion of pancreatic juice during meals is carried out.different ways

  • There are several phases in stimulating the functioning of the gland:
  • brain;
  • gastric;

intestinal Under the influence taste sensations at the first stage irritation occurs vagus nerve

. Impulses from it enter the pancreas and trigger the secretion of its enzymes. After food enters the stomach, the second phase begins. During this period, the production of pancreatic juice is stimulated by gastrin and cholecystokinin, substances produced in the stomach and intestines. Activation of the vagus nerve also plays a role. The main intestinal phase occurs under the influence of secretin and cholecystokinin of the duodenum. The first of them accelerates the production of bicarbonates and water, and the second - the production of enzymes. Inflammation of the exocrine part of the organ leads to the development of pancreatitis. diseases are intense painful sensations in the abdominal area. Depending on the location of the lesion, they can be localized on the right or left. If the entire gland is involved in the pathological process, the pain is girdling in nature. The temperature rises, digestion is disrupted, flatulence, nausea, vomiting, constipation or diarrhea are possible.

Endocrine cells

Structures that perform endocrine functions are located among the pancreatic acini in the form of formations called the islets of Langerhans. They look like clusters of oval or stellate cells. Most of them are concentrated in the tail area. Each islet has a well-developed blood supply and innervation system. Their number ranges from 200 thousand to 1.8 million. Thanks to the action of pancreatic hormones, the blood maintains certain concentration glucose. Currently, the islets of Langerhans are considered an independent organ of internal secretion.

Structure of the islets of Largehans and acini

There are 5 types of endocrine cells:

  1. 1. Beta cells.
  2. 2. Alpha cells.
  3. 3. Delta cells.
  4. 4. Epsilon cells.
  5. 5. PP cells.

More than half of the entire islet is occupied by beta cells, which produce insulin. It stimulates the uptake of glucose by peripheral tissues - liver, muscle and fat. Alpha cells are the second most common. They produce the hormone glucagon, which pulls sugar into the blood from the liver when needed. Somatostatin, produced in delta cells, slows the secretion of insulin and glucagon. PP cells produce pancreatic polypeptide. It affects the functioning of the exocrine part of the organ, helping to reduce the volume of pancreatic juice. Ghrelin, produced by epsilon cells, reduces insulin secretion.

At autoimmune lesions insular apparatus or dysfunction of its beta cells, diabetes mellitus develops. The disease occurs for a long time without any symptoms and is detected only by testing glucose levels. The pancreas does not hurt and does not cause digestive disorders. As the pathology progresses, thirst, frequent urination, and dry mouth appear. Long-term diabetes leads to complications - damage to the heart and blood vessels.

The pancreas (pancreatic) gland plays a huge role not only in the digestion process, but also in the functioning of the entire organism as a whole. This body digestive and endocrine systems produces enzymes necessary for the breakdown of food that enters the stomach, and hormones for regulating carbohydrate and fat metabolism.

The pancreas is a collection of lobules, each of which produces enzymes involved in the digestion of food.

The pancreas is located in the retroperitoneal space behind the stomach between the rings of the duodenum on the sides and the upper vertebrae lumbar region over the kidneys. Externally, the iron resembles an elongated “comma”. The weight of the organ in adults ranges from 80-90 g.

The structure of the pancreas under a microscope is a collection of glandular lobules with excretory ducts. Pass through the lobules blood vessels. The lobules produce pancreatic juice, the digestive enzymes of which (lactase, trypsin, lipase, invertase) affect the process of breaking down food. This part of the pancreas is called its exocrine part.

A canal runs along the entire length of the gland, through which pancreatic juice enters the duodenum. There it mixes with bile and together with it ensures the processes of intestinal digestion.

Clusters of cells between the lobules with a well-developed network of capillaries are called islets of Langerhans. These formations from alpha, beta and delta cells produce hormones (glucagon, insulin) and belong to the endocrine part of the pancreas.

The organ has the following structure:

  • the head, measuring 2.5-3.5 cm, fits tightly to the bend of the duodenum;
  • neck;
  • the triangular body of the gland no more than 2.5 cm in length is located to the left of the spine and directed to the spleen;
  • a pear-shaped tail 3 cm long, through which the main pancreatic duct passes, interacting with the duodenum.

In newborn children, the length of the gland is about 5-6 cm, and by the age of four the organ increases in size to 7-8 cm. In a 10-year-old child, the pancreas reaches 12-15 cm. The size of this organ in an adult varies between 16-23 cm.

The pancreatic gland grows quite slowly in children; its growth accelerates during puberty. It is at this time that she becomes most sensitive to diet violations.

The role of the pancreas in the body

Everyone knows that necessary for the body a person receives substances with food. However, in food products these substances are in a complex form, and it is impossible to absorb them without interacting with digestive enzymes. The pancreas produces pancreatic juice, which enters the duodenum through the excretory duct (canal). There the products are broken down to the state required for absorption. In medicine, this is called exocrine pancreatic function.

Food is broken down under the influence of hydrolytic enzymes, which are responsible for the interaction nutrients with water. Pancreatic juice consists of all types of hydrolases, each of which performs specific function. They are divided into 4 main groups:

  1. Lipases (lipolytic enzymes). They break down fats into complex components - higher fatty acid and glycerin, ensure digestibility fat-soluble vitamins A, D, E, K.
  2. Proteases (proteolytic enzymes - carboxypeptidase, chymotrypsin, trypsin) activate enzymes that break down proteins into amino acids.
  3. Nucleases. These enzymes break down nucleic acids and “build” their own genetic formations.
  4. Carbohydrases (amylolytic enzymes - amylase, lactase, maltase, invertase). They are necessary for the breakdown of carbohydrates into glucose.

The mechanism of the pancreas is very complex. Digestive enzymes begin to be actively produced in a certain amount within 2-3 minutes after food enters the stomach, it all depends on the concentration of proteins, fats and carbohydrates contained in it. In the presence of required quantity bile production of pancreatic juice with enzymes can last up to 12 hours.

The endocrine function is carried out thanks to the work of insulocytes - special cells of the islets of Langerhans. Insulocytes produce a number of hormones:

  • c-peptide,
  • thyroliberin,
  • somatostatin,
  • gastrin,
  • insulin,
  • glucagon.

Hormones enter the blood and are actively involved in regulation carbohydrate metabolism in organism. Glucagon is involved in metabolic processes, insulin ensures the absorption process simple substances, helps maintain constant level blood glucose.

When the pancreas is functioning in a balanced manner, insulin and glucagon regulate each other's activation.

Considering such multifaceted functions of the pancreatic gland, it is clear that its normal activity largely provides favorable conditions for the growth and development of the child’s body.

Common diseases of the pancreas


One of the serious and common diseases of the pancreas is diabetes mellitus.

For any dysfunction of the pancreas - pathological change structure, inflammation or injury - there is a failure in the production of enzymes and hormones, as a result of which the normal functioning human body. In children, disorders of the functionality of the gland are most often associated with a sudden change (translation to artificial feeding, the beginning of the visit kindergarten or school).

The most common diseases of the pancreatic gland (in both adults and children):

  1. – inflammation of the gland tissue, accompanied by a disruption in the release of pancreatic juice into the intestines. The main symptoms of the disease are abdominal pain, vomiting, nausea, etc.
  2. occurs when the cells of the islets of Langerhans stop functioning normally, causing blood glucose levels to rise. The main signs of the disease are weight loss, thirst, excessive urine production, etc.

The child may also have diseases of the pancreas such as benign cysts, abscesses, fistulas.

The following symptoms most often indicate a dysfunction of this organ in children:

  • emaciation;
  • the appearance of a specific taste in the mouth;
  • weakness;
  • bloating;
  • flatulence;
  • nausea;
  • pain in the side, back, lower back, abdomen;
  • vomiting, etc.

Nutrition

In order for the pancreas to function normally, it is necessary to monitor its condition and, if possible, create conditions for its proper functioning:

  • adhere to the principles of a healthy and balanced diet;
  • limit consumption of smoked, fatty, fried foods;
  • refuse or minimize the intake of alcohol, strong tea, lemonade, etc.;
  • minimize carbohydrate intake before bed;
  • cook with minimum quantity herbs, salt and spices;
  • (1.5-2 liters of water per day);
  • limit consumption of chocolate, sweets and flour products(ice cream, cakes, buns, sweets, etc.);
  • limit the consumption of unnatural dairy products (glazed cheese curds and curds, etc.);
  • refuse store-bought sauces, ketchups, mayonnaises;
  • include more in your diet plant food, with the exception of sour fruits and berries.

In relation to children, it is enough to observe age standards diet, do not overeat sweets, but completely exclude them from the children's diet.

For diseases of the pancreatic gland, a child, like an adult patient, is prescribed diet No. 5.

Summary for parents

Proper nutrition combined with in a healthy way life is the key to normal development and full-fledged work pancreas of the child, as well as comfortable digestion and absence of gastrointestinal diseases.

Educational video about the anatomy of the pancreas:

First city channel of Odessa, medical certificate on the topic “Pancreas”:


Where is the human pancreas located (photo in the article)? A healthy pancreas has a permanent location.

Knowing what kind of organ it is, where it is located in the stomach and how it hurts will help you notice a deviation in the gastrointestinal tract in time. Accordingly, there will be a reason to see a doctor in time and consult with him.

Localization of the pancreas

According to anatomy, the pancreas consists of:

  • Bodies. Localized just below the stomach.
  • Heads. It is supplemented by an uncinate process. Located near the bile duct.
  • Tail. Located near the spleen.

On which side is the gland located? The pancreas is located on the right side of the abdomen.

Pancreas location diagram:

  • In front of the organ is the stomach. The omental bag is located close to it.
  • Behind - the inferior vena cava and left renal vein, aorta.

The central part of the gland is located at the level of the 1st lumbar vertebra.

Interesting! In ancient times, when dissecting a recumbent corpse, the gland was actually located under the stomach. From this, the organ began to be called first the “pancreas” and then the “pancreas”.

Characteristic symptoms of pancreatic diseases

Pathological processes associated with reduced enzymatic activity of the pancreas have typical manifestations.

  • Symptoms are no different in men and women. The course of the process (acute, aggravated) depends on:
  • severity of pain;


intensity of dyspeptic symptoms.

  1. Signs of pancreatic incompetence that most often attract attention:
  2. Pain syndrome. The pancreas hurts on its own or after eating. A person can point to places where pain is usually localized: the upper part of the peritoneum, the hypochondrium on the left side. Regular nausea. It often ends in vomiting. A person feels bitter or sour taste
  3. . After vomiting the patient feels better.
  4. Distortion of appetite. A person’s need to eat gradually decreases and may disappear altogether.
  5. Stool disorders. Most often, a person is diagnosed with diarrhea. Due to the inadequate functioning of the pancreas, stool contains impurities of fat and undigested dietary fiber.

Incompetence of the pancreas negatively affects other internal organs:

  • Thus, the liver increases significantly in size. A person is bothered by itching.
  • Compression of the duodenum leads to intestinal obstruction.

Vegetative nervous system reacts to problems with a person’s pancreas like this:

  • heart rate increases;
  • fatigue increases;
  • sweating increases;
  • headaches and weakness become constant “companions” of the patient.

A person with a diseased pancreas changes in appearance:

  • He is losing weight rapidly.
  • His skin takes on a jaundiced tint. These changes are especially noticeable in the area of ​​projection of the pancreas.
  • Hair begins to fall out and becomes noticeably dull. Nails are crumbling.

Where is the pain most often localized: left or right?

The anatomical location of the pancreas is on the left. Pain due to organ pathologies is more common where: on the right or on the left? This question interests patients. Doctors explain that the localization of symptoms in a person can be different.


It all depends on which part of the pancreas is affected by the pathological process:

  • If the head of the gland is inflamed, then the pain can be determined by right side. The pain will also be in the epigastric region.
  • The location of the discomfort on the left indicates inflammation of the tail of the organ.

A person can obtain more accurate information about the causes of pain from a doctor after diagnostic measures.

What diseases cause pain in the pancreas?

Pain in the human pancreas is not a cause, but a consequence pathological processes, occurring in the organ.

Why does a person begin to worry about the pancreas?

  1. List of the most common ailments of this organ:
  2. Pancreatitis. The clinical picture of the pathology is as follows: pancreatic enzymes accumulate in the organ, which irritate its mucosa. The pancreas tissue becomes inflamed. The process is accompanied by indigestion and pain. Elements enter the bloodstream that can disrupt the function of the heart, liver, and lungs.
  3. Pancreatic necrosis. The cells of the pancreas gradually die (picture of the affected organ below). Pathology provokes internal bleeding. Cholestasis is a phenomenon that occurs in response to chronic inflammation
  4. Diabetes mellitus occurs due to insufficient insulin production. A person with diabetes looks like this: he is thin, his skin and visible mucous membranes are dry. He urinates frequently, eats frequently, and is unbearably thirsty. Over time, a person experiences vascular disorders in the limbs, heart, eye apparatus(symptoms are shown in the pictures).
  5. Benign tumors. The structure of the pancreas changes: its individual tissues actively multiply. The origin of the tumor can be glandular, connective or fatty. Can such a formation hurt? Tumor for a long time develops without causing discomfort to the patient. Reveals itself when it reaches significant size. It puts pressure on the intestines, liver, gallbladder, which leads to dysfunction of the latter.
  6. Cancer. Appears as a result of gland adenoma, diabetes mellitus. Malignancy of the cells of the organ and its ducts leads to compression of the latter.
  7. Abscess. Develops against the background of an inflamed pancreas and overuse alcoholic drinks. Dead cells accumulate in the tissues of the organ, which ends in suppuration of the mucous membrane.
  8. Splenic vein thrombosis is also a result of pancreatitis. The functioning of the spleen is impaired. A man vomits blood. His stomach hurts a lot.

How are pancreatic diseases diagnosed?

An ultrasound specialist can understand the cause of pain in a person’s pancreas.


He does an ultrasound in the area of ​​the “pancreas” to determine:

  • organ contours;
  • its structure;
  • patency of excretory tracts;
  • the presence or absence of gallstones.

The following also help to find a problem in the pancreas:

  • Laboratory research. Of particular importance is the identification of gland enzymes (level, activity) in feces, blood and serum, and urine.
  • Radiography.
  • Layered computed tomography.

Drug treatment for acute pain

Treat diseases in acute phase necessary in a hospital under the supervision of doctors and nurses.

In addition to fasting (1-2 days), bed rest the patient is prescribed:

  • Anesthetic solutions for intravenous administration(“Platifillin”).
  • Anticholinergics (“Atropine”).
  • Drugs that reduce enzymatic activity pancreas (“Kontrikal”, “Aprtinin”).
  • Saline solutions. They are needed to prevent dehydration of the body.

Attention! A bottle of ice is placed on the area where it hurts every half hour for 24 hours.

Treated after cupping acute symptoms recommended through diet. Doctors prescribe medications that improve digestion: Mezim-Forte, Panzinorm, Enzistal.

You need to eat small portions of steamed food. Recommended products:

  • porridge;
  • lean meat;
  • jelly;
  • eggs;
  • dairy products.

Video - Where is the human pancreas located?

The location of the pancreas in the body is important diagnostic value. Every person should know approximately where this organ is located. Information about which side you are experiencing pain can help your doctor make a preliminary diagnosis.

Pancreas, pancreas (Fig. , , , see Fig. , , ), is a large gland located on the posterior wall of the abdomen behind the stomach, at the level of the lower thoracic (XI-XII) and upper lumbar (I, II) vertebrae. The bulk of the gland performs an exocrine function - this is exocrine part of the pancreas, pars exocrina pancreatis; the secretion secreted by it enters the duodenum through the excretory ducts.

The exocrine part of the pancreas has a complex alveolar-tubular structure. Around the main duct of the gland there are macroscopic pancreatic lobules, lobuli pancreatis, its parenchyma, consisting of a number of orders of smaller lobules. The smallest structures - pancreatic acini, acini pancreatici, consist of glandular epithelium. Groups of acini are combined into seventh-order lobules, in which the smallest excretory ducts are formed. The lobules of the gland are separated by connective tissue interlobular septa, septi interlobares.

Between the lobules lie pancreatic islets, insulae pancreaticae, representing the endocrine part of the pancreas (see “Endocrine glands”).

The pancreas is located almost transversely, crossing the spine in front, with 1/3 of it located to the right, i.e. to the right of spinal column(in the horseshoe of the duodenum), and 2/3 - to the left of the median plane of the body, in the epigastric region and in the left hypochondrium. It is projected onto the abdominal wall 5-10 cm above the level of the umbilical ring.

The pancreas has three sections located sequentially from right to left: head, caput pancreatis, body, corpus pancreatis, And tail, cauda pancreatis. All departments are surrounded by a capsule pancreas, capsula pancreatis.

There are anterior and posterior surfaces of the pancreas, and in the body there is also a lower surface and three edges: front, top and bottom.

The length of the pancreas is 16-22 cm, width 3-9 cm (in the head area), thickness 2-3 cm; weight 70-80 g. The gland has a grayish-pink color, almost the same as the parotid salivary gland. The head of the gland is located at the level of the I-II lumbar vertebrae, and the body and tail are blown obliquely to the left and upward, so that the tail is located in the left hypochondrium, at the level of the XI-XII ribs.

Head of the pancreas, caput pancreatis, is the widest part; its right edge is bent downwards and forms uncinate process, processus uncinatus(see fig.), directed to the left. When the head passes into the body of the gland, it narrows somewhat; this area is usually called the neck of the pancreas.

The right half of the body has a slight upward and forward curve, the left half forms a downward curve; the tail of the gland is directed upward (see Fig. , , ). At the lower edge of the neck of the gland there is pancreatic notch, incisura pancreatis, which separates the uncinate process and continues along back surface necks up and to the right in the form of an oblique groove in which the superior mesenteric artery and superior mesenteric vein lie (the latter merges here with splenic vein and continues as the portal vein).

The duodenum passes through the head of the pancreas, enclosing it in the form of a horseshoe: its top part it is adjacent to the head of the gland from above and partly in front, the descending part covers the right edge, and the horizontal (lower) part covers the lower edge.

In the upper half of the gap between the head of the pancreas and the descending part of the duodenum descends common bile duct, ductus choledochus. The posterior surface of the head of the pancreas adjoins the right renal vein, the renal artery and the inferior vena cava; in the cervical region with the left edge of the uncinate process it is adjacent to right leg diaphragm and abdominal aorta.

The anterior surface of the head of the pancreas is covered with a layer of parietal peritoneum; its middle is crossed by the root of the mesentery of the transverse colon, causing the upper part of the head to protrude into the cavity omental bursa, bursa omentalis, and is adjacent through the peritoneum to the posterior surface of the stomach (to its pyloric part). The lower part of the head, covered with peritoneum, as well as adjacent to it Bottom part duodenum, is located below the root of the mesentery of the transverse colon and faces the right sinus of the lower floor of the abdominal cavity, where loops are located near it small intestine.

Body of the pancreas, corpus pancreatis, lies at the level of the first lumbar vertebra. It is triangular (prismatic) in shape.

It distinguishes three surfaces: front, back and bottom, and three edges: top, front and bottom.

Front surface, facies anterior, facing anteriorly and slightly upward; limits her front edge, margo anterior, and from above – upper edge, margo superior. Posterior surface, facies posterior, facing posteriorly; she is limited upper and lower edges, margins superior et inferior. Narrow lower surface, facies inferior, facing downwards and limited by the anterior and lower edges.

The mesentery of the transverse colon and the layers fused with it are attached to the anterior edge greater omentum omentum majus. The upper of the layers along the anterior edge passes at the top into the parietal peritoneum, which covers the anterior surface of the pancreas.

The anterior surface of the gland body faces the posterior wall of the stomach. The right part of the body adjacent to the head is located in front of the spine (II lumbar vertebra), protrudes forward and upward, forming omental tubercle, tuber omentale. This tubercle lies at the level of the lesser curvature of the stomach, faces the lesser omentum and here comes into contact with the same tubercle of the left lobe of the liver, tuber omentale hepatis.

The posterior surface of the body of the gland is adjacent to the abdominal aorta, the celiac plexus, and the left renal vein; to the left - to the left adrenal gland and left kidney. On this surface, in special grooves, pass the splenic artery, and below, immediately under the upper edge, near the middle of the posterior surface, the splenic vein.

The inferior surface of the body of the pancreas is located below the mesentery of the transverse colon. In the middle of its length, the duodenojejunal flexure, flexura duodenojejunalis, is adjacent to it. To the left of the lower surface there are loops of the small intestine and a section of the transverse colon. The lower surface is separated from the posterior surface by a blunt lower edge. The anterior surface is separated from the posterior by a sharp upper edge, along which the splenic artery runs. In the area of ​​the omental tubercle from the upper edge towards the lesser curvature stomach goes peritoneal fold in which the left gastric artery passes.

Tail of the pancreas, cauda pancreatis, goes up and to the left and, moving away from back wall abdomen, enters between the leaves gastrosplenic ligament, lig. gastroliennale; the splenic vessels bypass the upper edge of the gland here and go in front of it. The tail of the gland reaches the visceral surface of the spleen and adjoins it with its end below and behind the gate. Below it is adjacent to the left bend of the colon.

Pancreatic duct, ductus pancreaticus(see Fig.) runs from the tail to the head, located in the thickness of the substance of the gland in the middle of the distance between the upper and anterior edges, closer to the posterior than to the anterior surface. Along the path of the duct, ducts from the surrounding lobules of the gland flow into it. At the right edge of the head, the duct connects to the common bile duct V hepatopancreatic ampulla, ampulla hepatopancreatica, on the top major duodenal papilla, papilla duodeni major.

Before connecting to the common bile duct, the layer of circular muscle bundles of the pancreatic duct thickens, forming pancreatic duct sphincter, m. sphincter ductus pancreatici, which, as noted, is actually part of the sphincter of the hepatopancreatic ampulla.

In the area of ​​the upper part of the head there is often accessory duct of the pancreas, ductus pancreaticus accessorius, which opens with a separate mouth above the main one at the top minor duodenal papilla, papilla duodeni minor.

Rarely found accessory pancreas, pancreas accessorium, which are individual nodules, most often located in the wall of the stomach or the initial part of the small intestine and have no connection with the main pancreas.

The tail of the pancreas is in contact with spleen, lien (splen), – a circulatory organ and lymphatic system(see m. 3).

Innervation: plexus coeliacus and n. vagus

Blood supply: a. pancreaticoduodenalis superior (from a. gastroduodenalis), a. pancreaticoduodenalis inferior (from a. mesenterica superior) and rr. pancreatici (from A. lienalis). Deoxygenated blood flows through vv. mesentericae superior et inferior, v. lienalis and v. gastrica sinistra in v. portae. Lymphatic vessels carry lymph to the nodi lymphatici pancreatici, pancreatoduodenales, lienales, pylorici, lumbales.



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