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Pancreas – Hermit of the Abdomen

Pancreas – Hermit of the Abdomen

Ashley Davidoff MD

O’ Dear pancreas

You have been called the hermit of the abdomen
By whom I do not know
But in your dark and hidden way, you have
spoken without a word
from the gurgling depths of the abdomen
Yes – you have earned this lonely title
and a coin should be tossed
to the person who coined the phrase


But it took a long time to understand who this hermit was – and what he was doing in the darkness of the abdomen

From the day of antiquity
You have been looked upon by many
Herophilus, the father of anatomy had the first incisive insights into you
As he was one of very few who had the guts to explore the guts in open fashion

Aristotle at the same time seemed to have known something about you
But then you lay unharmed and unexplored for almost 500 years
Until Rufus mistook you for a piece of meat –
You must have laughed at the “pan kreas” thing
How wrong he was – you evasive little trickster

And then the Talmud – always seeming to be right
Thought you were the finger of the liver –
Little did they know how independant you were

While Vesalius was up to your “hide and seek” game
The magical eyes of da Vinci missed you completely
Even though he saw the serpiginous splenic artery snake right above you

Your ducts seemed to have intrigued the next generation, Wharton, Wirsung, and de Graaf
As you sustained the pain of the quill penetrating your inner gut
(I forget you were already dead but it must of hurt just watching!)

A little later it was that man called Vater and the little Italian Santorini found your minor duct and your nipple
And so by this time we had a good understanding of you in your nakedness
But of course, as said – you were dead

And so young Bernard explored your factories, and got a sense of your canine workings,
But you were able to hold on to your sweet secret for just a little longer
Until the Langerhans found the family jewels in the famous 2% of your population-
The islets – those beautiful eyelits – governess of all things sweet in the body

Eberle Bernard Danilevsky, and Kuhne joined up across the world to expose your antacid and enigmatic enzymatic brew
And once again your wonderful workings for a better world were exposed –
And we knew then, that you were the quiet and effective type –
A hermit who did good
But did not want the limelight

To see you as you lived and breathed in the flesh
was the mission of Wilhelm the X-Ray man
who crusaded the path to visualise 40,000 Angstroms under the skin


abdomen, pancreas, liver, gallbladder, kidneys, CT scan, Art in Anatomy, Ashley Davidoff MD


And then there was a slew of heroes who learned to slew your sickened parts – including the famous Whipple who was able to Whipple you in an inimitable way

And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
Exposed the insular chemistry of you 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 borne

And so we try to understand your form as our scans explore you as you live and breathe
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
And we are happy – so happy for you that you are well nourished by a double blood supply
And we wonder why you have no skin – we thought all the organs had a skin
Except for your tail – almost a foreskin

And you are off axis on two planes – what is that all about? – kinda crooked

And your twin origins and the intimacy with the duodenum, of the ventral twin
And the strange fusion of the Wirsung guy excluding the little Italian Santorini
It seems to me that your matrimonial fusion with Wirsung and the bile duct has led to more problems than the merger was worth
It does not seem in the long run, to have been a marriage made in heaven
What was that all about? Is there a grand plan to come?


And so we try to understand your diseases
And in some way we understand that the guy glugging down the bottle
Could be punished by your reaction
But why Oh why are you so nasty to those whose misfortune it is to have stones roll down and get no satisfaction.. down the green vile bile route
Have you not learned to live with the green secretion by now
And did you not know that by reacting the way you do, that you are cutting off your nose to spite you head?

While type 2 seems remote from you
We don’t know about this Type 1 business
Why are you made to suffer so much at the hands of your own body on your own body?
We feel sorry for you – to have your own buddies reject you – must be awful
And then to see so many young ones suffer because you don’t work
And we once again see and understand what power you control from that deep dark hermit home of yours

And the cancer thing … so silently it creeps on you causing your collagen to counter
And only making things worse as it strangles nerve, blood vessel, and your spouse duct – the green one, – without regard

And then I think of you in your prime and in your happiness
When you are with you 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



Copyright 2017 Revised from previous publication in The Common Vein

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Heart Shapes in Nature

Heart shapes in nature abound.  The shape of the heart has a deep meaning in almost every culture and whenever one finds a shape reminiscent of the classical shape of heart shape, it provides a little extra beat of excitement.

I have collected such gems over the years and present some in the following blog.

History of the Heart Shape and Implications in our Culture

heart, history, symbol, Jesus Christ, anatomy, heraldry, Valentine's day, sacred heart, heraldry, mood, emotion, Christianity, symbol, icon

History of the Shape of the Heart Icon

 The collage reveals the symbols that contributed to the shape of the heart icon as we know it.  Elements from anatomy of animals that were exposed during sacrifice, from botany with leaves and seeds that reflected similar emotional connections as the heart, and elements of human anatomy associated with attraction, love and romance combined to result in the shape of the icon of the heart as we know it.

Adapted and modified from public domain photograph by Frank Eugene, taken 1898, called Adam and Eve and published in Camera Work no. 30,1910

The Heart Shape in the Skies

heart, clouds, sky, heaven, heart shape, Valentine's day

Heaven’s Heart 

Found a cloud in the sky that said it all… or at least some of it…heaven’s heart.  The art piece is a photograph that reflects all good things about the heart; its place in the heavens, prayer, love, truth, beauty, honesty, and compassion.  The artistic element reflects a window for two way of love and admiration; from the heavens to humankind and mankind to the heavens.

Heart Shapes in the Leaves


Heart Shaped Leaves of the Linden Tree

The heart shaped leaf of the Linden tree is derived from a photograph taken in Bergen Norway.  The leaf had fallen on a transparent roof and a few drops of water were trapped on its surface.  It reminded me of a tearful end of a romance with tears caught in the heart of the saddened lover.

heart, heart shape, ivy, leaf, heart shape, Valentine's day, romance, love,

Heart Shaped Leaf of the Ivy

The heart shaped Canarian ivy leaf is from a vine. In the art piece the dark green has been lightened to give a freshness to the leaf which is surrounded by a heart shape colored in purple

heart, heart shape, leaf, heart shape, Valentine's day, romance, love,

Heart Shaped Leaf of the Caladium 

The art piece shows a heart-shaped leaf with two beautiful variations of green.  The dark green veins of the leaf are in distinct contrast to the paler green background, creating both complexity to the appearance, and giving us insight into its transport systems. The caladium plant in its many forms has a intensely colored heart shaped and colorful varieties leaf. It belongs to a genus of flowering plants in the family Araceae originating in South America. Almost 1000 variations of the original plant now exist.  Other names include “Angel Wings”, “Heart of Jesus”, and “elephant ear”

heart, heart shape, leaf, heart shape, Valentine's day, romance, love, sweet potato vine

Heart Shaped Leaf of Sweet Potato Vine

The art piece shows the heart-shaped leaf partially illuminated, with an almost mysterious feel of a dark background.  The  leaf of the sweet potato vine arises from a versatile plants around, which grows in sun the sun or shade, in containers, or garden beds. The plant shown here is a bright green or chartreuse. The  beauty of the plant derives not only from the color of the foliage, its flowing nature but also of course  the shape of its leaf

heart, heart shape, leaf, heart shape, Valentine's day, romance, love,

Heart Shaped Leaf of the Black Coral Elephant Ear Plant 

The art piece shows the heart-shaped leaf with unusual black color.  The purple veins of the leaf are difficult to see since they are of a similarly dark color.  The leaf of the Colocasia “Black Coral” Elephant Ear plant is  similar to leaf of the Coladium plant whose members  are also named elephant ears because of the shape.  The leaves can be very large, and are between 8 and 60 inches long.


Yin Yang Heart Shaped Hosta Leaf 

The heart shaped leaf of the Hosta plant is surrounded by a yin yang swirl of green.  The Hosta plant (aka plantain lilies (Britain) giboshi (Japan) is known for its hardiness and the fact that it thrives in the shade.  There are as many as 45 species with foliage of varying sized leaves and shades of green. Yin Yang relates to a Chinese philosophy that uses opposite forces to bring unity and solidarity.  These opposite forces abound. In the context of love it reflects opposite sexes that come together in reproduction of a new single being. Other examples include night and day, dark and light, fire and water, or positive and negative forces.

Heart Shapes in Flowers Fruits and Seeds


Chinese Lantern Flower

The Chinese Lantern flower depending on perspective is also heart shaped – . The dried flower reveals a delicate capillary like infrastructure and therefore even more fitting for Valentine’s day.  The delicate flower enfolds and defends a barely appreciated, delicate fruit buried within its husk. The need to protect the fruit of its loins manifests motherly and fatherly love!The herbaceous perennial plant physalis alkekengi enfold and defend the small, delicate fruit buried within their husks, they may be the perfect symbol for protection. Their fiery orange red hue denotes a passion for life, amiability, endurance and vitality.


Black Walnut Husk

The male and female components occur on the same tree. Imagine the two seeds born out of love between the male and female flowers that occur on the same tree (monoecious species) in a pod that is heart shaped. The image reflects the heart shaped husk with seeds likely removed by squirrels who tore into the heart out of the heart shaped pod – how cruel nature can sometimes be? –  But squirrels will  travel miles, will dig dig deep to retrieve the glorious tasty reward for their tenacious effort. (Acknowledgement Dr Edward Fisher MD Cardiologist)


Heart Shaped Pod of the Goldenrain Tree

 The pod is lantern shaped reminiscent of the the Chinese lantern flower, and Cape Gooseberry and is about 5cms long and 3cm wide and starts as a green to yellow color and becomes orange to pink in the fall.  The black seeds are 5-8mms in diameter. (Acknowledgement Dr Edward Fisher MD Cardiologist)


Heart Shaped Pod of the Amour en Cage

The art piece shows the inverted pod surrounded by the more rotund yellow shape of a heart.  The orange fruit peeks out through a defect in the husk.  The French name Amour en Cage (love in a cage) is the most appropriate and romantic term for the fruit!

Heart Shapes that Tell a Story Through the Natural Elements


Bleeding Heart 

The bleeding heart (aka Lamprocapnos spectabilis, Asian bleeding-heart, Dutchman’s breeches, lyre flower and lady-in-a-bath) belongs to the poppy family Papaveraceae, and is found in China, Japan, Korea and Siberia. It flowers in the early spring with a pink or white flower and is one of the earlier joys of the spring.  It tells a sad story as it opens its heart and pours out its white tears.  The shape is quite unique.


Heart Shape – Tamarind Seeds at Sunset

The heart shape of the Tamarind  seed is the subject of this art piece. The shape of the seed is heterogeneous.  With Valentine’s day in mind, I searched the many seeds of the leguminous edible fruit at the dinner table, and came up with two heart shaped seeds.


Rock Lovers Rock

 Rock Lovers Rock shows a pair of heart shaped rocks in a background of sensuous and gentle curves of surrounding rock formation.  Despite the solid and hard nature of the stone and the almost heartless assigned character, the art piece provides a soft and romantic side to the usually lifeless stone.


Valentine’s Day Walk – a Walnut and a Rock

The male and female components occur on the same tree. Imagine the two seeds born out of love between the male and female flowers that occur on the same tree (monoecious species) in a pod that is heart shaped. The image reflects the heart shaped husk with seeds likely removed by squirrels who tore into the heart out of the heart shaped pod – how cruel nature can sometimes be? –  But squirrels will  travel miles, will dig dig deep to retrieve the glorious tasty reward for their tenacious effort.


Damaged Heart Shaped Leaf

The art portrays that part of the heart has been lost – but also infers that that all is not lost and there is still a lot of love to give.  The color is sombre, and results in a melancholic mood.


Heart Shaped Leaves of Love Lost

The art piece shows two heart-shaped leaves (left) of a Linden tree in Norway at lovers’ odds, with tears streaming down their bodies, a bleeding heart (say no more) and the worst – a black leaf – who has totally given up on love. The whole image reminds me of a “Sergeant Pepper’s Lonely Hearts Club Band”.  The thing about romance is that more often than not, it does not reflect basic love.  Love of a child, parent, spouse friend, or animal has a deeper, more meaningful and more basic element of humanity and compassion that is open to all.  Romance is sometimes a closed club.


Heart Shaped Anthurium at the End of Valentine’s Day

The heart shaped anthurium flower (aka flamingo flower, and laceleaf)  originates in the Americas including northern Mexico and northern Argentina but also in the Caribbean.  In this art piece the flower looks droopy and exhausted after a long day of romance



heart, lungs, ribs, chest, chest cavity, red pepper, grapes, banana, banana peel, X-ray, radiology, anatomy

Chest of Fruit – Heart Lungs and Ribs

The chest with ribs, heart and lungs are created using fruit. The lungs are grapes, the pulmonary arteries – carrots, the ribs a banana peel and the heart is a red pepper.


Dogs Have Hearts Too 

It may take a moment to see the face of  labrador with the heart of the chest projected as his mouth and his two black eyes on either side of his cervical spine!  Once you appreciate the eyes – the rest will fall into place

And so ends our story.


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Art, Hand Movement, And Season’s Lights

Christmas, lights, Channukah, menorah, nativity scene,

The Nativity Scene, Menorah and Surrounding Lights with still hands

Winter brings a dark chill.  Humans respond to this discomfort by creating ways to alleviate the stress. This post focuses on one way to counter the gloom.  Across the Judeo-Christian world, light is used to brighten and warm the spirits.

Art in Anatomy found a family home in Westwood, Massachusetts who illuminated their home and garden with Judeo-Christian scenes.  They combined a nativity scene with a Chanukah menorah among colorful lights that adorned their house, trees, and barn.

By sleight of hand, Davidoff altered this scene by moving the camera in various directions to create different effects:


Up and Down Motion of the hands on the camera


Wave Like Motion of the hands on the camera


Looping Motion of the hands on the camera


Horizontal Motion of the hands on the camera


A Single Slow Back and Forth Sweep of the hands on the camera

The lesson: The same scene can be viewed from many perspectives.  Similarly, the same God can be viewed by many different religions.  The difference between the monotheistic religions is merely a difference in pathway; they all arrive at the same end point.  Why kill each other if we’re all headed to the same final destination?

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Art of Anatomy of the Pancreas

Art of Anatomy of the Pancreas


Ashley Davidoff MD Copyright 2015


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.


“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.


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” 

anatomy of pancreas

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. 


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.


“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.


“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.


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)



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


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

acinar cells.8b0115310.8

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.

feet--0003-catalogue-signedfeet-diabetes magnified.8

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. 


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

shows the pancreas in black in front of the splenic vein


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

Jawahar Swaminathan and MSD staff at the European Bioinformatics Institute b

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


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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