268 THE DIGESTIVE SYSTEM 



The head of the pancreas lies in the C -shaped bend of the 

 duodenum and consequently extends to the right of the median 

 plane. Its anterior surface is related to the transverse colon 

 (p. 280) and to the origin and first part of the portal vein. 

 Posteriorly, the head of the pancreas is in relation to the 

 inferior vena cava and to the bile duct, which descends 

 obliquely behind its upper part (Fig. 99). 



This portion of the gland may be the seat of malignant 

 disease and the symptoms produced are, for the most 

 part, referable to the relations which have been enumerated. 

 The bile duct lies in a deep groove in the head of the 

 pancreas and it is very liable to be compressed, giving rise to 

 jaundice which is gradual in its onset but which steadily 

 increases in intensity. The inferior vena cava may be com- 

 pressed, leading to oedema of the lower limbs, ascites, etc., 

 and the circulation through the portal vein may be interfered 

 with (p. 274). 



The neck and body of the pancreas extend to the left in front 

 of the abdominal aorta. The body is somewhat triangular on 

 section, possessing anterior, posterior and inferior surfaces, 

 separated from one another by corresponding borders. The 

 anterior border gives attachment to the transverse mesocolon, 

 so that the anterior surface lies in the posterior wall of the 

 omental bursa, where it takes part in the formation of the 

 stomach-bed (p. 245), while the inferior surface looks down- 

 wards into the infra-colic compartments. 



Tumours in connexion with the body of the pancreas may, 

 when they are of large size, be palpated through the anterior 

 abdominal wall, and they not uncommonly transmit the pulsa- 

 tions of the abdominal aorta. Pancreatic cysts usually enlarge 

 on the anterior surface of the gland, so that they project into 

 the omental bursa. If they grow in an upward direction, they 

 may thrust the lesser omentum before them and reach the 

 anterior abdominal wall above the lesser curvature of the 

 stomach, which is displaced downwards and to the left. In 

 this case, percussion indicates an increase in the liver dulness, 



