 Good day everybody. This is Dr. Sanjeev Sanyal Professor Department Chair. This is a supine getover. We have opened up the abdomen, removed most of the contents. I'm standing on the right side. Camera person is also on the right side. So this is going to be a demonstration of the pancreas, the surrounding structures, the vascularity and a few clinical correlations. So this structure that we see in front of us, this is the entire pancreas. So let's trace the whole pancreas. This portion that you see here, this is the outline of the head of the pancreas, and down below, this is the insinuate process of the pancreas. And that is covered by the supine-mesentric vein, the supine-mesentric artery. Then we have this portion, this is the head of the pancreas, which is continuing with this narrow portion, which is the neck of the pancreas. Then we have this whole portion, this is the body of the pancreas, and right at the end is the tail of the pancreas, which aborts on the spleen, the hilum of the spleen, and the spleen is down there in the left hypochondrium. So these are the parts of the pancreas. Now in order to understand the pancreas better and look at the blood supply, we have cut out at the neck of the pancreas, and we have reflected it. So we shall come back to the pancreas just in a little while. As I'm turning it, we are looking at the under surface of the pancreas, and we can see this groove here. This groove was formed by the splenic vein, which I shall demonstrate just now. So let me put the pancreas aside. Now let's take a look at the neurovascular structures which are in relation to the deep surface of the pancreas. The main point of the pancreas is that side, the neck, and the monocentric process is on this side. So now we can see the structures here. What do we notice? First of all, this is the supine-mesentric artery, and with all its branches. The supine-mesentric artery is arising from L1 level of the aorta. Just to the right of that is this structure here. This is the supine-mesentric vein. The supine-mesentric vein is being met by this long vein here. This is the splenic vein, which is coming from the spleen. And we can see that's the spleen down there. And the two of them unite behind the neck of the pancreas. That's the reason why we cut out the neck and removed it. And normally the splenic vein is supposed to receive the inferior-mesentric vein. But in this particular canaver, this is the inferior-mesentric vein. And we can see the inferior-mesentric vein is opening into the supine-mesentric vein here. This is the inferior-mesentric vein. It is opening into the supine-mesentric vein. And after the supine-mesentric vein unites with the splenic vein, we can see this continuation here going upwards and to the right. This is the portal vein. So this is one of the constituents of the extra hepatic portal triad, which I shall mention just now. Now let's come to the other parts of the extra hepatic portal triad. We can see this structure here. This is the common hepatic artery. It is coming from this celiac trunk at the level of T12 from the aorta. The celiac trunk gives the common hepatic artery. It is giving rise to this tortuous artery. This is the splenic artery, and it is giving rise to this artery deep inside. This is the left gastric artery. So let's focus on the common hepatic artery. The common hepatic artery, as it goes up, it becomes the hepatic artery proper. This is the other structure in the extra hepatic portal triad. And the third structure in the extra hepatic portal triad is this one here. This is the common bile duct, this green colored structure. So therefore these three structures, the duct, artery, and the portal vein, these three together constitute the extra hepatic portal triad. These were all enclosed by the hepato-deodenal ligament, and they were extending from the upper surface of the deodenum first part, which is here, to the portal hepatitis of the liver. And I'm going to put my hand behind, and you can see my hand is in the epiploid foramen of Winslow, and we can see the other end of my hand has come out here. So this is the epiploid foramen of Winslow, and this extra hepatic portal triad structures constitute the anterior boundary of the epiploid foramen of Winslow. So coming back to the vascularity of the pancreas. The pancreas is supplied separately. The head of the pancreas has got a different supply. The body and the tail of the pancreas has got a slightly different supply. So let's take a look at it. This is the head and the insinid process, as I mentioned in the beginning. And we can see the blood supply to the head of the pancreas is coming from this artery here. This is the gastrodeodenal artery, which is dividing into the superior pancreatic odeodenal, anterior and posterior. The right gastropyploid has been removed when we remove the stomach. So the superior pancreatic odeodenal, it makes an arch like this, and it supplies the upper half of the head of the pancreas, and then below we can see this artery here. This came from the superior mesentric artery, and you can see the opening where it came from. This is the opening where it came from. We have cut it to separate it out. This is the inferior pancreatic odeodenal, which goes from below up, and this supplies the head and the insinid process of the pancreas along with the odeodenum, the C loop of the odeodenum. And incidentally we can see a branch here. This is something equivalent to the supra odeodenal artery of Wilkie, which supplies the first part of the odeodenum. So this is the supply of the head and the insinid process of the pancreas. The body and the tail of the pancreas are all supplied by the splenic artery. And we can see the splenic artery is very tortuous because it forms part of the bed of the stomach, and it is giving out these branches. We can see two big branches. These are the dorsal and the greater pancreatic arteries. These run on the posterior surface of the pancreas. The dorsal one divides into a transverse and a descending branch, inferior, and they form an anastomosis with the greater pancreatic, and finally there is a small branch called the caudal pancreatic branch, which also comes from the splenic artery. And these three arteries, the dorsal, greater, and the caudal, they supply the body and the tail of the pancreas. Now let's come to a few clinical correlations. We can see that this pancreas has got a slightly different appearance compared to what we normally see. It has got this orangish, yellowish covered structures. These are actually what are known as seponification. This is a case of alcoholic pancreatitis. In alcoholic pancreatitis, the pancreatic enzymes they leak out, especially the lipase, and it digests the peripancreatic, the retroperitoneal fat, miscentric fat, omental fat. And after they have been digested, they are broken up into the triglycerides are broken up into acids and ethylene glycol. The acids, they react with the calcium in the body and they form these calcified deposits which are called seponification. The process is similar to the formation of soap. That's why it is called seponification. So we can see these deep deposits here. These are all seponification of pancreatitis. Two weeks after an attack of pancreatitis, fluid can leak into the portion, a space in front of the pancreas, which is actually the portion behind the stomach. That is called the lesser cycle, the omental bursa, and can lead to a swelling called pseudo-pancreatic cyst. That's another important point. So these are related to this particular cadaver where we can see alcoholic pancreatitis. Carcinoma of the head of the pancreas is not very uncommon. So is periambulary carcinoma, where the common bile duct unites with the pancreatic duct and opens in the diodenum in the second part here. In such cases, we have to do a very major surgery which is called Wipple's pancreatic diodenectomy because of the common blood supply. That is another point. Really, the ulcerate process of the pancreas, when it is developing from the ventral pancreatic bud, it can form a piece from in the front and it can form another piece behind. And the two of them can encircle the second part of the diodenum to produce what is known as annular pancreas. That will be seen in newborn and next day we will see a gas bubble on the stomach and a gas bubble in the proximal part of the diodenum, which is called the double bubble sign of annular pancreas. So these are some abnormalities or the clinical correlations pertaining to the pancreas. Before I conclude, I want to draw your attention to the full extent of the splinic artery. And for that, I have lifted up the spleen here. And we can see very clearly this is the splinic vein. It is breaking up into branches at the hyalum and this is the splinic artery. And we can see coming out from the splinic artery these branches. These are the arteries which I mentioned. This splinic artery is the largest branch of the celiac trunk and it gives the dorsal greater and the caudal pancreatic arteries and it also gives the posterior gastric arteries apart from ramifying inside the spleen. And here also it gives the vasobrivia and the left gastroepiploid artery, which we cannot see in this particular dissection. So this is the full extent of the splinic vein and the splinic artery. The point to be remembered is the splinic vein runs posterior to the pancreas while the splinic artery runs along the superior part of the pancreas. So therefore the splinic vein does not form part of the bed of the stomach but the splinic artery does form part of the bed of the stomach. So these are the points which I wanted to show you in this particular dissection. Thank you very much for watching. Dr. Sanjay Sanyal Sanyal, Sherwin Weeks is the camera person. If you have any questions or comments, please put them in the comment section below. Have a nice day. Please like and subscribe.