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The Common Vein: Anatomy of Structure – Units and Connections

Structure – The First Step

Structure is a material unit or object, composed of smaller parts that are connected and organized so that it can stand alone but also  be part of a larger and more complex whole

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The Units That Make the Whole – The Brick and the Brick Principle

The brick is the unit that is the basis of the brick building.

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The Brick – An Individual Unit That Needs to Connect In Order to Function and Be Valuable

The brick by itself has no function and no value to the world.  In order to have value it needs to connect with other bricks.  When the brick, a structural unit,  connects with other bricks and they organize, a wall is built. The wall as a structural unit, connects with other walls and they organize to form a room, and eventually a building is built.  Although the brick is nothing by itself – a weak brick can bring the whole wall and the whole building down.

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The Power of the Brick

It is Nothing by Itself  

However the Whole is Only as Strong as the Weakest Brick

The Units That Make the Body – The Cell and the Brick Principle

I am like a brick. Amrish Puri

The cell is the unit that is the basis of biology.

cell, cells, liver, process, physiology, function, receive, process, produce, export, principles, nucleus, cytoplasm, cytology, anatomy, art, the common vein, art in anatomy, Ashley Davidoff MD

The cell by itself has no function nor value, unless it is a unicellular organism.  In order to have value it needs to connect with other cells.  When the cell, a structural unit,  connects with other cells and they organize, a tissue is built. The tissue as a structural unit, connects with other tissues and they organize to form an organ, and eventually a body is built.  Although the cell is nothing by itself – a weak cell can bring the tissue and the whole body down.

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When the 37.2 trillion cells in the human body connect and organize, they create a spark of life housed in the body and gifted with a mind.

The difference between the brick building and the person is really the life that biology brings.  It is truly a miracle and the secret of how this happens still eludes human endeavour.  This secret may never be unlocked.

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Subtract The Bricks From the Cells.  What is the Result?

What is very clear, is that as human biologic units build, the  result is larger and more powerful than the individual parts.  At a critical number a spark of life emerges within the body, and a mind emerges from both of them.  When and how that happens remains a mystery.

Our first project is not to delve into the yet unanswerable “hows” of life, but rather into the “hows” of structure.  Structure is complex, but the pattern of units connecting and organizing is universal and permeates structure from the  subcellular level to the whole body and even beyond into our communities.

Some Quotes About the Brick Principle

 “A great building will never stand if you neglect the small bricks.”

Ifeanyi Enoch Onuoha

“Love is like a brick. You can build a house, or you can sink a dead body.” Lady Gaga

Brick and blood built Astapor, and brick and blood her people.”
George R R Martin – A Storm of Swords

14. “Genius too does nothing but learn first how to lay bricks then how to build, and continually seek for material and continually form itself around it.Every activity of man is amazingly complicated, not only that of the genius: but none is a ‘miracle.”
Friedrich Nietzsche

“I fear that in this thing many rich people deceive themselves. They go on accumulating the means but never using them; making bricks, but never building.”
George Eliot

“Faith. Trust. They don’t come naturally, but as we lay those first bricks, we notice that little by little, a foundation is forming. Eventually we can end up building the most beautiful things with faith and trust.”
José N. Harris

Bricks without straw are more easily made than imagination without memories.”
Author: Lord Dunsany

“It takes a thousand bricks to build a wall, but only one to tear it down.”
Markus W. Lunner

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Art of Anatomy of the Pancreas

Art of Anatomy of the Pancreas

Introduction

Ashley Davidoff MD Copyright 2015

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Pancreas in the Sky

is a photograph that shows a cloud formation embodying the shape of a pancreas

The anatomy of the pancreas is unusual and the physiology is multifaceted.  It is  a gland and is part of both the digestive and hormonal systems of the body.  Structurally it is characterised by its unusual shape and position and the absence of a capsule.  Functionally it is involved in the digestion of food as well as in the metabolism of glucose.  The most common diseases include pancreatitis, pancreatic carcinoma and diabetes. Serum tests, ultrasound, CT scan, MRI and endoscopy are most commonly used in diagnosis of pancreatic disease.  Treatment options include medical treatment (eg insulin in type 1 diabetes) minimally invasive procedures, and surgery.

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“Pancreas in Pink” 

is artwork derived from a CT scan and shows the upper abdominal cavity with the pancreas in bright pink surrounded by the liver, gallbladder, and kidneys. The aorta and inferior vena cava are the major transport vessels and serve to connect the organs.

Structure

Unusual Shape

“…and we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue”  

from  “Hermit of the Abdomen” 

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Shapes of the Pancreas

The pancreas has been compared to many objects including an elongated comma on its side, an elongated number 9 on its side, a prism, a banana, an inverted and curved upside down tobacco pipe, and even an old fashioned revolver. Placing a seahorse or a woodpecker with head down and tail up probably brings us closest to the complex shape of the pancreas. The objects used for description are so varied and disparate, that one wonders if we truly have a grasp of the shape of this organ. A more practical way to look at the shape of the organ is to define the shape of its component parts.

Structure – Position

Deep in the Abdomen in the Retroperitoneum

The pancreas lies in the anterior pararenal space of the retroperitoneum surrounded by a vertebral body and kidneys posteriorly, the liver and gall bladder to its right, the spleen to its left, and the stomach and left lobe of the liver in front.  This AiA rendering shows the pancreas cycling through the seasons.  In the  spring it is in shades of  pink, the summer in blue, the fall in  red, and in the winter in ice blue and white. 

Function

The pancreas has dual functions in the the metabolism of the body.  It acts as an as both an exocrine gland (secretes into ducts) and an endocrine gland (secretes into the circulation).

As an exocrine gland it secretes enzymes into ducts that lead to the duodenum.  These enzymes aid in the digestion of fat, proteins, and carbohydrates. As an endocrine gland it is a key player in the control of glucose metabolism which it accomplishes by secreting insulin into the circulation.

The acini are the microscopic glands making up 98% of the parenchyma and they function as the exocrine component.

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“Blueberries of the Glands of the Pancreas”

is a rendering of the histological appearance of the pancreatic acinar glands. The artpiece  illustrates the ductules that subtends the acini  which are the exocrine glandular cells. The shape of the acinar cells and ductules are reminiscent of grapes or berries on a stalk.

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“Histology of the Glands of the Pancreas”  

The exocrine hormones of the pancreas that aid in the digestion of fats, proteins and carbohydrates are produced in the acinar cells in the glandular unit called the acinus.  The art piece shows the acinus with acinar cells and the duct that transports the secretions to the pancreatic duct and eventually to the duodenum where they aid in the digestion of proteins fats and carbohydrates.

The islets of Langerhans secrete insulin into the blood stream, very soon after ingestion of a meal in order to control blood sugar and intracellular glucose concentrations. The endocrine cells called the islets of Langerhans represent only 1-2% of the tissue volume of the pancreas, but play a vital role in body function and well being. They are most numerous in the tail of the pancreas.

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Islets of Langerhans

Immunohistochemistry on mouse pancreas for insulin shows the brown stained Islets of Langerhans that secrete insulin among the acinar cells.  They represent only 2% of the population of pancreatic cells. 

(Modified  Image –  Courtesy  Billyboy Wikipedia Public Domain)

Diseases

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Acute Necrotic Pancreatitis

This is a CT of an elderly man who had severe pancreatitis.  Within the retroperitoneum there is necrotic pancreas (asterisk).  It is enlarged and consists mostly of air (arrow), fluid, and high density hemorrhagic components.  The findings are consistent with a gangrenous pancreatic abscess.  The surgeon noted that the pancreas looked and smelled like a “dead fish…. that had been dead for quite a long time.”  Other structures including the gallbladder(gb), liver, kidneys, spleen and stomach surround the pancreas

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Pancreatic Cancer with Spread to the Liver

The CT scan shows a primary pancreatic cancer (red asterisk) with metastases to the liver.  Four of many metastases are identified with white asterisks

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Normal Pancreatic Cells and Pancreatic Cancer Cells

In the upper image the cellular makeup of the acinar cells of the pancreas manifest with a normal nuclear to cytoplasmic ratio reflecting the relative size of the nucleus to the cytoplasm.   The 2nd image show cancerous cells of the exocrine pancreas.  The blue nuclii are far too large for the amount of the cytoplasm of the cell (abnormal nuclear to cytoplasm ratio).  The malignant cells are also too dark (hyperchromatic) and lack uniformity and organization.  These are all features of malignant cells .  Cancerous cells do not obey the rules of the body and  have no regard for the body at large. Malignant cells are equivalent to rebels in the community. They destroy and do not contribute to the wellbeing of the society.  They also invade the territory of neighboring structures.

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Ravages of Diabetes 

The foot of a person with diabetes following amputation of the 2nd, 3rd, and 4th digits as a result of poor circulation of the tissues.  The magnified view shows the calcification and hardening of the arteries. 

Diagnosis

“Doppler Ultrasound of the Pancreas-Hermit of the Abdomen”

shows the pancreas in black in front of the splenic vein

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“ERCP – Ductal Skeleton of the Pancreas”

is from an ERCP with an injection into normal the dorsal pancreatic duct of Wirsung with contrast also noted in the distal common bile duct

“Arteries of the Pancreas”

is from an angiogram of the celiac axis and shows the multiple arteries that supply the pancreas.  The head of the pancreas is supplied by the  superior pancreatico-duodenal vessels which arises from the gastroduodenal artery,  and inferior pancreatico-duodenal artery which arises from the SMA.  The body is supplied by the splenic artery and the superior mesenteric artery.

Treatment

Treatment options include medical treatment (eg insulin in type 1 diabetes) minimally invasive procedures for drainage and relief of obstruction, and surgery.

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3D Nuclear Magnetic Resonance Structure  of Insulin Dimer

(Modified from public domain image from Wikipedia and Courtesy Jawahar Swaminathan Jawahar Swaminathan and MSD staff at the European Bioinformatics Institute) 

“And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
exposed the insular chemistry of your insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was born 

from “Hermit of the Abdomen” Davidoff

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Pancreas and Buddies

This aquatic scene shows the relationship of the pancreas to its neighbours particularly the splenic vein and left renal vein which run a parallel course, almost like a bunch of buddies romping in the water.  The arching bodies with heads all in the same direction is quite beautiful

And then I think of you in your prime and in your happiness
When you are with your two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever”

from “Hermit of the Abdomen” Davidoff

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