pancreas

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pancreas

(Carlyn Iverson)

[Greek pankreas : pan-, pan- + kreas, flesh.]

For more information on pancreas, visit Britannica.com.

A composite gland in most vertebrates, containing both exocrine cells—which produce and secrete enzymes involved in digestion—and endocrine cells, arranged in separate islets which elaborate at least two distinct hormones, insulin and glucagon, both of which play a role in the regulation of metabolism, and particularly of carbohydrate metabolism. See also Carbohydrate metabolism.

Anatomy

The pancreas of mammals shows large variations. The extremes are the unique, massive pancreas of humans, and the richly branched organ of the rabbit. Usually, the main duct, the duct of Wirsung, opens into the duodenum very close to the hepatic duct. In humans, the pancreas weighs about 2.5 oz (70 g). It can be divided into head, body, and tail. Accessory pancreases are frequently found anywhere along the small intestine, in the wall of the stomach, and in Meckel's diverticulum.

The exocrine portion of the pancreas shows tubuloalveolar glands. Each terminal alveolus is called an acinus. The various acini have central cavities, which open into intralobular ducts through narrow intercalated tubes. The interlobular ducts anastomose and ultimately form the main duct of Wirsung. The activity of the acini is stimulated by secretin as well as by pilocarpine.

The endocrine portion shows cellular masses called islands or islets of Langerhans, in which the cellular cords or masses are more or less isolated by irregular spaces filled with connective tissue and blood capillaries. The two main types of cells are the alpha and the beta cells.

Between the grapelike exocrine portion with its ducts and the islands of Langerhans, it is possible to observe connective tissue septa, numerous blood vessels, and nerves.

Physiology

The pancreatic juice carried to the duodenum is a slightly alkaline liquid containing trypsinogen, which, when activated, causes the hydrolysis of the proteins into amino acids, amylase, and maltase, which act on the glucides, and lipase, which causes the hydrolysis of fatty substances. The intense stimulation of the pancreatic secretion after ingestion of food is considered to be the result of a nervous reflex originating in the mouth, and also of direct introduction of acids and fats into the duodenum, causing the liberation of a hormone called secretin into the bloodstream to stimulate the exocrine secretion.

F. Banting and C. Best (1922) prepared pancreatic extracts which were able to prevent the lethal effects of pancreatectomy. The same effect was obtained with extracts from pancreas in which, after ligature of the duct of Wirsung, the exocrine portion of the gland had disappeared. See also Diabetes.

The alpha cells and beta cells in the islets are the sources of two hormones, insulin from the beta, and glucagon, also known as the hyperglycemic factor, from the alpha. The former is a hormone which influences carbohydrate metabolism, enabling the organism to utilize sugar. The latter accelerates the conversion of liver glycogen into glucose. Glucagon elevates the blood sugar level, and its effects are the opposite of those of insulin, so that the two hormones together maintain the sugar metabolism of the body in balance. When the level of sugar in the blood becomes too low, the secretion of glucagon is stimulated. See also Glucagon; Insulin.

The pancreas (from the Greek meaning ‘all flesh’) is a pale, rubbery gland in the upper part of the abdomen, responsible for the production of digestive juices and hormones. The juices pass into the cavity of the duodenum (an example of exocrine secretion) while the hormones pass into the circulating blood (endocrine secretion). By means of these products the pancreas is essential to the proper processing of food, through digestion to absorption, storage, and utilization of nutrients.

Early authors found great difficulty in ascribing a function to the organ, as its rather evasive name implies. The rubbery texture suggested to some that the gland might be a shock absorber preventing the stomach from damaging itself on the vertebral column. It was not until the nineteenth century that any firm ideas of its function evolved. It was known that a small tube (the ‘duct of Wirsung’, described by him in 1642) connected the gland with the duodenum; in 1664, de Graaf inserted a wild duck's quill into the duct of a dog and collected a clear fluid, which he examined and decided was acidic. He had no idea of the fluid's function — and we now know that pancreatic juice is unambiguously alkaline, because the cells lining the duct system secrete bicarbonate ions.

Exocrine function

The function of the digestive juices became known long before hormones were recognized. The advances in chemistry in the nineteenth century led the way to understanding the process of digestion. It became clear that pancreatic juice contained agents — ‘ferments’ (subsequently renamed enzymes) that were capable of breaking down the three major components of food: carbohydrates, fats, and proteins. Many of the molecules in our diet are large, having been synthesized by the plant or animal being eaten. These large molecules are then reduced in size by the enzymes from the pancreas — continuing the digestive process already begun in the stomach; only small molecules can be absorbed from the intestines. Carbohydrates are broken down to simple sugars (mono- and di-saccharides) by pancreatic amylase, fats to glycerol and fatty acids by pancreatic lipase, and proteins to amino-acids and small peptides by a variety of proteolytic enzymes. The French physiologist Claude Bernard showed in the 1840s that both pancreatic juice and bile (from the liver) were necessary for the absorption of fat. These two fluids enter the duodenum together where their main ducts converge. We know now that bile, by a detergent action, converts fats into tiny particles (micelles), and it is only when the surface area of the fat has been increased in this way that the lipase in pancreatic juice can break the fats down to fatty acids and glycerol. Probably to prevent the pancreas from digesting itself, proteolytic enzymes are secreted by the gland as ‘pro-enzymes’. These molecules are inactive at digesting protein until they reach the cavity of the duodenum, where they are rendered active by another enzyme (enterokinase). Chronic disease of the exocrine component of the pancreas often results in a deficiency of pancreatic enzymes, giving rise to poor absorption of foodstuffs: the excretion of fat in faeces (steatorrhoea) provides the most conspicuous feature of this malabsorption. Microscopically, the gland is divided up into units known as acini (acinus: Latin for ‘berry’). Each acinus is spherical, with the enzyme-secreting cells surrounding a central space (remarkably, every enzyme-secreting cell synthesizes all the pancreatic enzymes). The enzymes pass into the centre of the acini, whence they enter the narrowest ducts of the branching secretory system, and then pass by larger and larger ducts to the single pancreatic duct itself. The cells lining the duct system secrete water and bicarbonate ions and add them to the enzymes; the final juice is consequently alkaline.

The volume of juice secreted precisely neutralizes the acid contents of the stomach as they both enter the duodenum. This remarkable feat of homeostasis is brought about by acid in the duodenum causing release of the hormone secretin from cells in its wall; this secretin passes into the bloodstream and stimulates the production of water and bicarbonate ions from the duct system of the pancreas. Hence the greater the volume of acid gastric juice passing into the duodenum, the greater the volume of bicarbonate-rich juice produced by the pancreas. This tends to keep the contents of the duodenum neutral — the pH at which the pancreatic enzymes are most effective. Secretin, a protein hormone, was first demonstrated by Bayliss and Starling in London in 1902 — the earliest recognition that such ‘chemical messengers’ existed.

The pancreas and duodenum of a man (an executed criminal). Both organs have been dissected to expose their structure. The lobulated pancreas rests on the curved duodenum. The pancreatic duct runs through the centre of the gland, and divides before it enters the duodenum — an upper accessory duct runs parallel with the main duct before both ducts enter the duodenum. The main duct enters at the same point as the bile duct (glimpsed as a dark tube behind the pancreas) at a double opening known as the Ampulla of Vater. An accessory duct is common in mammals and occurs because the pancreas originates embryologically as two separate glands, which subsequently fuse. (From Claude Bernard's Memoire sur le Pancréas, 1856.)

Endocrine function

The main ‘internal’ secretions of the pancreas are the hormones insulin and glucagon. These are necessary for the regulation of storage, release, and utilization of fuels for metabolism. Insulin has a well-known association with sugar (glucose) in the body, because of its role in diabetes. Insulin lowers the blood sugar, and glucagon raises it; but these hormones are also important in the body's handling of nutrients derived from fat and protein, as well as carbohydrate.

Among the acini and ducts which secrete enzymes and bicarbonate there are small clumps of cells which do not connect with a duct system. These account for a small fraction of the bulk of the pancreas, but their function is vital. They were first described by Langerhans, in his MD thesis in 1869. A clue to their function came twenty years later, when Mering and Minkowski, in Strasbourg, removed the pancreas from dogs under surgical anaesthesia, and found that they developed the features of human diabetes. At the turn of the century, Opie, at Johns Hopkins University, reported degeneration of the ‘islands of Langerhans’ in the pancreas of people who had died from diabetes. In 1916, the English physiologist Sharpey-Schafer linked these observations and proposed that diabetes was due to the lack of an internal secretion — a hormone — from the ‘islets’. All this provided the background and the impetus for the accelerating and better known part of the story: the preparation in 1921 by Banting and Best, in Macleod's laboratory in Toronto, of an extract of pancreatic tissue, which reversed the rise in blood sugar in dogs whose pancreas had been removed. Next, the biochemist Collip prepared a refined extract, which was first used to treat human diabetes mellitus in 1922. Thus it was proved that the pancreas had an internal secretion — and it was named insulin from Latin insula; an island. The ‘islets’ were later shown to have two main types of endocrine cell, one producing insulin (beta cells) and the other producing glucagon (alpha cells). In the liver, the two hormones influence in opposite directions the balance between the storage of glucose (as glycogen) and its release into the blood; and they have contrary effects on new formation of glucose from amino acids. In fatty tissue they likewise have opposing effects on storage versus release of fuels. Insulin facilitates the uptake and usage of glucose by body tissues, notably muscle. In these ways the two hormones have opposite effects on the level of glucose in the blood.

The insulin: glucagon (I: G) ratio is therefore important and variable. By this balance, blood glucose level in particular is maintained for supplying the brain, nutrient supply in general is matched to the immediate needs of the body's tissues, and surplus is stored. When nutrients flood into the blood after digestion of a meal, insulin takes precedence, facilitating uptake and storage: the I: G ratio is high. When use of fuels for energy is at a peak during muscular work, glucagon promotes release of glucose and of fatty acids into the circulating blood, from liver and adipose stores: the I: G ratio is relatively low. In fasting, and its extension to starvation, glucagon is of major importance, along with others of the body's hormones.

The regulation of these counterbalancing secretions is mainly by direct response of the secretory cells to the levels of glucose and amino acids in the blood supplying the pancreas: for example, a rise in blood glucose affects cell membrane receptors on beta cells, resulting in enhancement of synthesis and extrusion of insulin.

In recent years it has become clear that the islets secrete several more hormones (apart from insulin and glucagon). These include gastrin and pancreatic polypeptide. How these interact with insulin and glucagon is the subject of much current research.

Autonomic effects

As well as the hormonal and chemical mechanisms for regulating the exocrine and endocrine functions of the pancreas, the autonomic nervous system plays a faster, and even anticipatory role — preparing the pancreas to deal with food which is on its way. Parasympathetic fibres from the vagus nerves stimulate enzyme secretion in response to eating, before ever the meal reaches the duodenum, and branches from the network of autonomic nerves in the nearby gut send signals related to events in the stomach and duodenum. The hormone-secreting cells also are supplied by nerves from both the sympathetic and the parasympathetic systems, which respectively inhibit and promote insulin release, and have the reverse action on glucagon. These actions accord with nutrient mobilization from body stores during exercise and stress, and on the other hand, the need for storage after digestion of a meal.

The pancreas is thus vital for the proper ‘feeding’ of the body tissues. Without its exocrine function, the digestion and absorption of foodstuffs is deranged. Without its endocrine function, untreated, we cannot long survive the inability to organize the use or storage of nutrients after their intake to the bloodstream.

— John Henderson, Sheila Jennett

See also alimentary system; blood sugar; insulin.

A gland in the abdomen with two functions: the endocrine pancreas (the islets of Langerhans) secretes the hormones insulin and glucagon; the exocrine pancreas secretes the pancreatic juice. Known by the butcher as sweetbread or gut sweetbread, as distinct from chest sweetbread which is thymus.

A gland that secretes digestive juices into the small intestine, and hormones (insulin and glucagon) into the bloodstream. The pancreatic digestive juices contain enzymes which break down starch, fats, and proteins. If the pancreas becomes inflamed, a condition known as pancreatitis occurs. It is often linked with a blockage of the bile duct. The inflammation it causes may lead to obstruction of the pancreatic duct and pancreatitis. Heavy drinkers of alcohol often suffer from pancreatitis. Traumatic pancreatitis can also result from an injury to the abdominal region inflicted during a contact sport such as karate. Symptoms include abdominal pain (which often radiates to the back), fever, and vomiting. Traumatic pancreatitis can be dangerous if accompanied by bleeding, and may require surgical correction. Chronic pancreatitis leads to tiredness and loss of weight because of reduced secretion of digestive enzymes.

A mixed gland located behind and slightly below the stomach. It produces hormones (insulin and glucagon) from the Islets of Langerhans. and digestive juices from small sacs known as acini. The digestive juices (also known as pancreatic juices) are released the into duodenum. They contain amylase, lipase, nucleases, peptidases, and other proteases (e.g. trypsin). Production of pancreatic juices are stimulated by hormones secreted by the duodenum (e.g. secretin).

A gland behind the stomach that functions in both the endocrine system and the digestive system. Its endocrine function involves the secretion into the bloodstream of insulin, which regulates the level of sugars in the blood. As part of the digestive system, the pancreas secretes into the small intestine a fluid containing enzymes that is used in the digestion of all foods.

A large, elongated, racemose gland located in the anterior abdomen between the liver, kidneys, stomach, spleen and duodenum.
The pancreas is composed of both exocrine and endocrine tissue. The acini secrete digestive enzymes, and small ductules leading from the acini secrete ions, mainly sodium and bicarbonate. The combined product, pancreatic juice, enters a long pancreatic duct and from there is transported duct to the duodenum. The pancreatic juice contains enzymes for the breakdown of proteins, carbohydrates and fats. The bicarbonate ions in the pancreatic secretion help neutralize the acidic chyme that is passed along from the stomach to the duodenum.
The endocrine functions of the pancreas are related to the islets of Langerhans which occur throughout the pancreas. These small islands contain three major types of cells: the alpha, beta and delta cells. The alpha cells secrete the hormone glucagon, which elevates blood sugar. The beta cells secrete insulin, which affects the metabolism of carbohydrates, proteins and fats. The delta cells secrete somatostatin, the functions of which are not fully understood, but it is known that it can inhibit the secretion of both glucagon and insulin and may act as a controller of metabolic processes. The somatostatin produced by the delta cells of the pancreas is the same as that produced by the hypothalamus as an inhibitor of the release of growth hormone from the pituitary gland.

• p. disease — pancreatic atrophy of post-smolt Atlantic salmon caused by a togavirus infection; clinical signs include anorexia, emaciation. Called also sleeping disease.
• endocrine p. — see pancreas (above).
• exocrine p. — see pancreas (above).

Pancreas
1: Head of pancreas 2: Uncinate process of pancreas 3: Pancreatic notch 4: Body of pancreas 5: Anterior surface of pancreas 6: Inferior surface of pancreas 7: Superior margin of pancreas 8: Anterior margin of pancreas 9: Inferior margin of pancreas 10: Omental tuber 11: Tail of pancreas 12: Duodenum
Gray's	subject #251 1199
Artery	inferior pancreaticoduodenal artery, superior pancreaticoduodenal artery, splenic artery
Vein	pancreaticoduodenal veins, pancreatic veins
Nerve	pancreatic plexus, celiac ganglia, vagus[1]
Precursor	pancreatic buds
MeSH	Pancreas
Dorlands/Elsevier	Pancreas

This article is about the bodily organ . For culinary use of animal pancreas, see Sweetbread.

The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as an exocrine gland, secreting pancreatic juice containing digestive enzymes that pass to the small intestine. These enzymes help in the further breakdown of the carbohydrates, protein, and fat in the chyme.

Contents 1 Histology 2 Function 2.1 Endocrine 2.2 Exocrine 2.3 Regulation 3 Diseases of the pancreas 4 History 5 Embryological development 6 In non-human animals 7 Additional images 8 References

Histology

Under a microscope, stained sections of the pancreas reveal two different types of parenchymal tissue.^[2] Lightly staining clusters of cells are called islets of Langerhans, which produce hormones that underlie the endocrine functions of the pancreas. Darker staining cells form acini connected to ducts. Acinar cells belong to the exocrine pancreas and secrete digestive enzymes into the gut via a system of ducts.

Structure	Appearance	Function
Islets of Langerhans	Lightly staining, large, spherical clusters	Hormone production and secretion (endocrine pancreas)
Pancreatic acini	Darker staining, small, berry-like clusters	Digestive enzyme production and secretion (exocrine pancreas)

Function

The pancreas is a dual-function gland, having features of both endocrine and exocrine glands.

Endocrine

Main article: Endocrine pancreas

The part of the pancreas with endocrine function is made up of approximately a million^[3] cell clusters called islets of Langerhans. Four main cell types exist in the islets. They are relatively difficult to distinguish using standard staining techniques, but they can be classified by their secretion: α cells secrete glucagon(increase Glucose in blood), β cells secrete insulin (decrease Glucose in blood), δ cells secrete somatostatin (regulates/stops α and β cells), and PP cells secrete pancreatic polypeptide.^[4]

The islets are a compact collection of endocrine cells arranged in clusters and cords and are crisscrossed by a dense network of capillaries. The capillaries of the islets are lined by layers of endocrine cells in direct contact with vessels, and most endocrine cells are in direct contact with blood vessels, by either cytoplasmic processes or by direct apposition. According to the volume The Body, by Alan E. Nourse,^[5] the islets are "busily manufacturing their hormone and generally disregarding the pancreatic cells all around them, as though they were located in some completely different part of the body."

Exocrine

Main article: Exocrine pancreas

In contrast to the endocrine pancreas, which secretes hormones into the blood, the exocrine pancreas produces digestive enzymes and an alkaline fluid (referred to as pancreatic juice), and secretes them into the small intestine through a system of exocrine ducts in response to the small intestine hormones secretin and cholecystokinin. Digestive enzymes include trypsin, chymotrypsin, pancreatic lipase, and pancreatic amylase, and are produced and secreted by acinar cells of the exocrine pancreas. Specific cells that line the pancreatic ducts, called centroacinar cells, secrete a bicarbonate- and salt-rich solution into the small intestine.^[6]

Regulation

The pancreas receives regulatory innervation via hormones in the blood and through the autonomic nervous system. These two inputs regulate the secretory activity of the pancreas.

Sympathetic (adrenergic)	Parasympathetic (muscarinic)
α2: decreases secretion from beta cells, increases secretion from alpha cells	M3[7] increases stimulation of alpha cells and beta cells

Diseases of the pancreas

Main article: Pancreatic disease

Because the pancreas is a storage depot for digestive enzymes, injury to the pancreas is potentially very dangerous. A puncture of the pancreas generally requires prompt and experienced medical intervention.

Pancreatic cancer, particularly cancers of the Exocrine Pancreas remain one of the most deadly cancers, and the mortality rate is very high.

History

The pancreas was first identified for western civilization by Herophilus (335-280 BC), a Greek anatomist and surgeon. Only a few hundred years later, Ruphos, another Greek anatomist, gave the pancreas its name. The term "pancreas" is derived from the Greek πᾶν ("all", "whole"), and κρέας ("flesh").^[8]

Embryological development

Schematic illustrating the development of the pancreas from a dorsal and a ventral bud. During maturation the ventral bud flips to the other side of the gut tube (arrow) where it typically fuses with the dorsal lobe. An additional ventral lobe which usually regress during development is omitted.

The pancreas forms from the embryonic foregut and is therefore of endodermal origin. Pancreatic development begins the formation of a ventral and dorsal anlage (or buds). Each structure communicates with the foregut through a duct. The ventral pancreatic bud becomes the head and uncinate process, and comes from the hepatic diverticulum.

Differential rotation and fusion of the ventral and dorsal pancreatic buds results in the formation of the definitive pancreas.^[9] As the duodenum rotates to the right, it carries with it the ventral pancreatic bud and common bile duct. Upon reaching its final destination, the ventral pancreatic bud fuses with the much larger dorsal pancreatic bud. At this point of fusion, the main ducts of the ventral and dorsal pancreatic buds fuse, forming the duct of Wirsung, the main pancreatic duct.

Differentiation of cells of the pancreas proceeds through two different pathways, corresponding to the dual endocrine and exocrine functions of the pancreas. In progenitor cells of the exocrine pancreas, important molecules that induce differentiation include follistatin, fibroblast growth factors, and activation of the Notch receptor system.^[9] Development of the exocrine acini progresses through three successive stages. These include the predifferentiated, protodifferentiated, and differentiated stages, which correspond to undetectable, low, and high levels of digestive enzyme activity, respectively.

Progenitor cells of the endocrine pancreas arise from cells of the protodifferentiated stage of the exocrine pancreas.^[9] Under the influence of neurogenin-3 and Isl-1, but in the absence of Notch receptor signaling, these cells differentiate to form two lines of committed endocrine precursor cells. The first line, under the direction of Pax-0, forms α- and γ- cells, which produce the peptides glucagon and pancreatic polypeptide, respectively. The second line, influenced by Pax-6, produces β- and δ-cells, which secrete insulin and somatostatin, respectively.

Insulin and glucagon can be detected in the fetal circulation by the fourth or fifth month of fetal development.^[9]

In non-human animals

Pancreatic tissue is present in all vertebrate species, but its precise form and arrangement varies widely. There may be up to three separate pancreases, two of which arise from ventral buds, and the other dorsally. In most species (including humans), these fuse in the adult, but there are several exceptions. Even when a single pancreas is present, two or three pancreatic ducts may persist, each draining separately into the duodenum (or equivalent part of the hindgut). Birds, for example, typically have three such ducts.^[10]

In teleosts, and a few other species (such as rabbits), there is no discrete pancreas at all, with pancreatic tissue being distributed diffusely across the mesentery and even within other nearby organs, such as the liver or spleen. In a few teleost species, the endocrine tissue has fused to form a distinct gland within the abdominal cavity, but otherwise it is distributed amongst the exocrine components. The most primitive arrangement, however, appears to be that of lampreys and lungfish, in which pancreatic tissue is found as a number of discrete nodules within the wall of the gut itself, with the exocrine portions being little different from other glandular structures of the intestine.^[10]

Additional images

Accessory digestive system.	Digestive organs.	The celiac artery and its branches; the stomach has been raised and the peritoneum removed.	Lymphatics of stomach, etc. The stomach has been turned upward.
Transverse section through the middle of the first lumbar vertebra, showing the relations of the pancreas.	The duodenum and pancreas.	The pancreatic duct.	Pancreas of a human embryo of five weeks.
Pancreas of a human embryo at end of sixth week.	Front of abdomen, showing surface markings for duodenum, pancreas, and kidneys.		Dog Pancreas magnified 100 times.

References

1. ^ Physiology at MCG 6/6ch2/s6ch2_30
2. ^ Histology at BU 10404loa
3. ^ Hellman B, Gylfe E, Grapengiesser E, Dansk H, Salehi A (2007). "[Insulin oscillations--clinically important rhythm. Anti-diabetics should increase the pulsative component of the insulin release]" (in Swedish). Lakartidningen 104 (32-33): 2236–9. PMID 17822201. 
4. ^ BRS physiology 4th edition ,page 255-256, Linda S. Constanzo, Lippincott publishing
5. ^ The Body, by Alan E. Nourse, in the Time-Life Science Library Series (op. cit., p. 171.)
6. ^ Maton, Anthea; Jean Hopkins, Charles William McLaughlin, Susan Johnson, Maryanna Quon Warner, David LaHart, Jill D. Wright (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1. OCLC 32308337. 
7. ^ Verspohl EJ, Tacke R, Mutschler E, Lambrecht G (1990). "Muscarinic receptor subtypes in rat pancreatic islets: binding and functional studies". Eur. J. Pharmacol. 178 (3): 303–11. doi:10.1016/0014-2999(90)90109-J+. PMID 2187704. 
8. ^ Harper, Douglas. "Pancreas". Online Etymology Dictionary. http://www.etymonline.com/index.php?term=pancreas. Retrieved 2007-04-04. 
9. ^ ^{a b c d} Carlson, Bruce M. (2004). Human embryology and developmental biology. St. Louis: Mosby. pp. 372–4. ISBN 0-323-01487-9. 
10. ^ ^{a b} Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. pp. 357-359. ISBN 0-03-910284-X. 

v • d • e Anatomy of torso, digestive system: accessory digestive glands (TA A05.8-9, GA 11.1188) Liver by region: Left lobe  • Right lobe (Caudate lobe, Quadrate lobe) • Transverse fissure of liver • Bare area of the liver by function: Fibrous capsule of Glisson • Hepatocyte • Space of Disse • Space of Mall • Kupffer cell • Liver sinusoid • Hepatic stellate cell • Hepatic lobule Biliary tract Bile ducts intrahepatic: Bile canaliculus • Canals of Hering • Interlobular bile ducts • Intrahepatic bile ducts • Left and Right hepatic ducts extrahepatic: Common hepatic duct • Cystic duct • Common bile duct Gallbladder by region: Body • Fundus • Neck Pancreas by region: Tail • Body • Neck • Head • Uncinate process by function: Islets of Langerhans • Exocrine pancreas ducts: Pancreatic duct • Accessory pancreatic duct Common Hepatopancreatic ampulla • Sphincter of Oddi digestive system navs: anat of tract,glands,perit,diaphragm/physio/dev, noncongen/congen/congen of d+w/neoplasia, symptoms+signs/eponymous, proc

v • d • e Endocrine system > Pancreas – Islets of Langerhans A/B alpha cell (glucagon) • beta cell (insulin) Other delta cell (somatostatin) • PP cell (pancreatic polypeptide) • epsilon cell (ghrelin) • pancreatic stellate cell

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Dansk (Danish)
n. - bugspytkirtel

Nederlands (Dutch)
alvleesklier, pancreas

Français (French)
n. - pancréas

Deutsch (German)
n. - Bauchspeicheldrüse, Pankreas

Ελληνική (Greek)
n. - (ανατ.) πάγκρεας

Italiano (Italian)
pancreas

Português (Portuguese)
n. - pâncreas (m) (Anat.)

Русский (Russian)
поджелудочная железа

Español (Spanish)
n. - páncreas

Svenska (Swedish)
n. - bukspottkörtel

中文（简体）(Chinese (Simplified))
胰腺

中文（繁體）(Chinese (Traditional))
n. - 胰腺

한국어 (Korean)
n. - 췌장

日本語 (Japanese)
n. - 膵臓

العربيه (Arabic)
‏(الاسم) البنكرياس, , هاصرة, هصارة, الغدة التي تفرز عصارة تساعد على الهضم‏

עברית (Hebrew)
n. - ‮לבלב, בלוטת הכרס‬

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