416 CLINICAL APPLIED ANATOMY. 



of other infective diseases, such as typhoid fever, may really 

 gain access to the gland in this manner. 



Extension of inflammation from closely related structures 

 sometimes produces a localised pancreatitis. Gastric and 

 duodenal ulcers, tumours of the pylorus and other organs, 

 disease of the lumbar vertebrae and aneurysms of the aorta or 

 cceliac axis may in this way set up an inflammation. 



The depth at which the pancreas lies in the abdomen and the 



cystic duct 

 for. ofWinslow 

 supra-renal 

 1st stage dttod 

 rt. kidney 

 com. bile duct 

 2nd stage 



hepatic duct 



com. bile duct 

 hep. art. 



port vein 

 pancreas 



duct of Santorini: 



colon 



pancr. duct (Wirs.) 

 opening 



jejunum 



3rd stage duod. 



FIG. 52. THE HEAD OF THE PANCREAS, DUODENUM, AND COMMON 

 BILE DUCT. (Hughes and Keith.} 



presence in front of it of the stomach, render it difficult or 

 impossible to recognise moderate degrees of enlargement of the 

 gland. Indeed, it is usually impossible to feel the gland at all. 

 Acute pancreatitis usually shows itself as an acute peritonitis in 

 the upper part of the abdomen, involving the lesser sac, which 

 covers the front of the gland, or that part of the greater sac which 

 is in contact with its lower border. The pancreas is in close 

 relation with the great nerve plexuses of the abdomen, which may 

 explain the extreme pain and collapse which is so characteristic 

 of acute inflammation. 



