THE BLOOD SUPPLY TO THE PANCREAS WITH SOME BLOOD SUPPLY TO THE PANCREAS WITH SOME PERFUSION STUDIES....

THE BLOOD SUPPLY TO THE PANCREAS WITH SOME PERFUSION STUDIES.

BY WILLIAM S. COLLENS.

(From lhe Ph~ysiologicnl I~borc~tor,tl, Cornell University Medicnt College, New York City.)

(Received for pllblication, April 4, 1925.)

I.

Ii’lootl Supply to the Pancreas.

An anatomical sf udy of the circulation of t,hc pancreas was undertaken with t,he view of determining the arteries going directly t,o the organs so t,hat an wnct knomlcdgc could be had of the direction taken by any perfused fluids.

The rnrthod employed in these studies 1va.s a modific~ation of Gross’ teohnique (1) for injecting t.he coronary vessels of t,he heart. In order to simulate the -normal condition in the living animal it was necessary to use proper temperature ancl pressure controls in injecting the vessels. The apparatus dcviscd for tbis work is shown dia.grammatically (Fig. 1 j. The animal was first cssanguinat.ed by bleeding t,hc jugular vein, t.hen the thoracic aorta was exposed and a glass cannula inserted prosimal to it.s entrance through the diaphragm. The \l’oulfc bottles U and C wcrc submerged in t.hc copper tank and the water maintained at a temperature of 4245%. Cllamps H, were opened and the saline solution was 1)ermittccl to flow at a pressure of 120 to 140 mm. \Tlwn the washings (drained from the inferior vena cava) came clear the Hi clamps were closed and the 11, clamps opened, t.hus permitting t.hc barium gelatin mass to flow through. When t,he art,eries were completely filled-det.ermined by the pressure rising above 150 mm.-t.hc cannula was removed, the aorta ligated, and the animal placed in t.he ice box to cool. It will be observed that no abdominal incision was made and t,hat t.hcre was no form of manipulation to disturb the normal relation of the abdominal

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462 Blood Supply to the Pancreas

viscera. The ent.ire injection was conducted through the t.horacic aorta. After the gelatin had hardened t.he abdominal viscera were removed in foto; then the pancreas and its blood supply were carefully dissected. A typical X-ray photograph of one of these specimens is prcacntcd in Fig. 2. The specimen was t,hen dehydrated in alcohol, st)arting with 50 per cent and going through absolut,e, and finally cleared in methyl salicylate by t,he method of Spaltcholz (2) (Fig. 3). The ent.ire pancreas and its arterial

FIG. 1. A, copper tank; B, Woulfe bottle with saline solution; C, Woulfe l)ott.le with barium gelatin mass; D, gas burner; E, manometer; F, oxygen tank; G, thcrmomctcr; H,, clamps controlling saline solution flow; Hz, cl:irnps controlling Ixxrium flow; K, cannula in thoracic aorta.

supply can be visualized in the X-ray phot,ograph. Fig. 2 shows t,he hepatic art,ery (3), arising from the celiac axis, first giving off the right gastric, then the g&roduodenal artery. Its branches continue upward as the 1.~0 krminal hcpnt,ic arteries, the sole arterial supply t>o the liver. The gastroduodenal artery turns down toward the pylorus nntl, after giving off the small right gast,rocpiploic artery, continues on as the superior pancreaticoduodenal artcry to supply the neck and a portion of the body of


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William S. Collens 463

FIG. 2. S-ray photograph of pancreas :Intl duodenum, showing arteries injected with barium gelatin mass. Hepatic artery (A) arising from the celiac axis and giving off two terminal hepatic arteries (B) upward toward the liver, then proceeding as the superior pancresticoduodenal artery (C). Also the inferior pancreaticoduodens! artery (D).


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FIG. 3. Photograph of same specimen as Fig. 2 cleared in methyl salicylate.


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FIG. 4. X-ray photograph showing rich anastomosis between superior and inferior pancreaticoduodenal artery-after injecting the superior pancreaticoduodenal artery.


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the pancreas, together with the first portion of the duodenum. The inferior pancreat,icoduodenal artery arises from the superior mesenteric and supplies the head of the pancreas and the second portion of the duodenum. A rich anastomosis can be seen in both the duodenum and pancreas between the superior and inferior pancreaticoduodenal arteries (Fig. 4). (Only the superior pancreaticoduodenal artery was injected.) The body and tail of the pancreas are seen on dissection to be supplied by several small branches arising from the splenic artery. The veins drain-

TABLE I.

Effect of Injecting Saline Solution into Portal Vein and Hepatic Artery.

Dog 51. Weight, 6.5 kilos. Amytal, 3.9 cc. Feb. 16, 1925.

I sugar.

TiIllt?. Procedure.

a.m.

10.40 10.55 11.03

11.10 11.35 11.55 p.m. 12.10

12. :o 12.40

1.20

Operation started.

Injected 10 cc. saline solutic into portal vein.

Injected 10 cc. saline solrlti, into hepatic artery.

In blood. I I -

mg.

0.107 3n

0.131

0.134

on

0.188

0.121

In urine.*

0-l

0

0 0

+ +

* Retention catheter in bladder.

ing the pancreas all enter the portal system. One may observe that the arteries furnishing the most practical approach for direct perfusion of the pancreas are the superior and inferior pancreatico- duodenals.

II.

Studies of Saline Perfusion through the Arteries of the Pancreas and Liver.

Perfusion studies of these arteries were undertaken with the view of determining their effect upon the sugar excretion in the


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urine and on the blood sugar level. Dogs were employed in all the csperimenk. Amytal (a), which has been shown to have no effect upon t.hc blood sugar, was t,he ancsthet,ic of choice, using 0.6 cc. of a 10 per cent solution per kilo of body weight. The Shaffer-Hartmann method of blood sugar detcrminat’ion was employed, and the Benedict t.cst for t.hc urine. 10 cc. of normal saline solution at 40°C. were used in all t.he perfusion experiments.

Typical resrllts are seen in Tables I to \:I. Injection of saline

T.iRLE II.

Effect of Saline Solulion in Hepntic Arlery.

Dog 5.5. Weight, 7.2 kilos. Mar. 4, 192.5. ~-. .~.

0.m.

10.15 10.4Fi 11.30 11.3G

11.39 11.41

,1:00 p.m. 12.10 12.40 1.40

-

Administered 4.1 cc. arngtal. Operation started.

Injected 10 cc. saline solution into hepatic artery; superior pancreaticoduodenal artery ligated.

-

In blood. ~__

VW.

0.113

0.114

0.113

0.111 0.114

T

- -

-

In urine:

m.

0

-t

+ +

Slight.

* Retention cathet.cr in bladclcr.

solution into the hepntic artery caused an immediate glycosuria, with a slight elevation in blood sugar (Table I).

Injection of the hepstic artcry with the superior pancrcat,icoduodenal artery completely ligakd, thus causing the saline solution t,o flow only t,hrough the liver, produced a similar glycosuria (Table IIj.

Ry perfusing the superior pancreat icoduodenal artery with the terminal hepat.ic arteries tied off, so t.hat. the fluid was directed through thr pancreas and not the> liver, neither hyperglycemia nor


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glycosuria took place. When, in the same animal, the superior pancreaticoduodenal artery was ligated and the hepatics perfused, thus changing the course of the perfusing fluid through the liver, there was an immediate rise in the blood sugar and sugar appeared in the urine (Table III).

TABLE III.

Effect of Saline Solution in Superior Pancreaticoduodenal and Hepatic Arteries.

Dog 56. Weight, 4.6 kilos. Mar. 11, 1925.

Time. Procedure.

a.m.

10.00 10.30 10.40 11.00 11.07 11 09 11.15

11.20 11.25 11.40

1;: 00 p.m. 12.20 12.25

12.28 12.30 12.36

1.00

Administered 2.8 cc. amytal.

Operation started.

Injected 10 cc. saline solution into superior pancreaticoduodenal artery; hepatic artery ligated. Anemia of pancreas and marked peristalsis of duodenum.

Injected 10 cc. saline solution into hepatic artery.

Sugar.

In blood. In urine.’

mg.

0.089

0.089

0.096

0.098

0.104

0.110

* Retention catheter in bladder.

#rn.

0

0

0

Trace

+ +

Knowing that. the inferior pancreaticoduodenal artery has no relation to the arterial supply of the liver, but goes only to the pancreas and duodenum, this artery was perfused without effecting


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any change in t,he blood sugar, and no sugar appeared in the urine (Tables IV and V).

On the other hand, perfusion of saline solution t.hrough the portal vein does produce rises in blood sugar and the appearance of t,races of sugar in t,he urine. The reaction to t.hc perfusion seems, how- ever, to be delayed and ruurh less rnarkcd than similar perfusion through t.hc: arterial circulation of t.he liver (Tables I, 1-, and VI).

Epstein and 11osent ha1 (5), in an est,ensive series of cxperimcnts, found that. when they perfused t,hc arterial blood su~qdy to the

TATILL IV.

I Title. I TVWWIUW

---. -- _ _ .-. .._ n m.

10.10 I Xtllrlinistri-ed .i, w. m~ytnl. 10.55 1 Oporxtion started. 11.40

- 11.42 I 11.5.5 1 Injected 10 cc. saline solution in-

to ittfcrior ~~sricreaticoduodennl artery.

Pm l”.K! 1’2.0.5 1 L’ 30 i

1.15 I

1.20 2.35 !

--. -- * licterit~ion cstlictrr in bladder.

ml.

0.109

0.107

0. 106 0.111

pancreas, hypcrglycwnin and glycosuria occurred. They inter- preted t hrsc csperiulcmtal results as indicating that the process of perfusion in some way caused trypsin formed in the pancreas to inactivate insulin, with a ccJnse(~tlCnt production of the diabetic condition. They ro~icluderl t,hat t,his reaction between trypsin and insulin constituted an important etiological factor in the production of diabetes.

Kcpetition of these esperiments of Epst.ein by t.he perfusion of saline solution into tdle hepatic artery of the clog confirmed his


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470 Blood Supply t.o the Pancreas

origitlal oljservat ions, but when the two terminal hepatic arteries

were ligated the pancreas could t,hen bc perfused mit.hout. producing eit,hcr a hypcrglyccmia or glycosuria. On the contrary, when t.he superior pancreat icoduotlcnal artelF was ligated with the hcpatic branches pat mt, perfusion result cd in glycosuria, with an elevation

Time.

n.m.

10.15 10.30 IO.57 11.20 Il. 2.1

11.25 11.35 11.50

1~~00 *.??I.

12.10 12.27 12.32

12.34 12.40

1.00 1 10 1.30

Administered 3 cc. amytal. Operation started.

Injected 10 cc. snlinc solution in- to inferior I’nncreaticoduodellal artery with portal vein clnrnped

Injected 10 cc. dine solution in- to portal vein.

0.073 0.071

0.075

0.074

0.000

o.oso

0 0

Slight. 0

0

* Rctentioll catheter in bladder.

in t,hc Mood sugar. This clearly indicahcs that the effect is upon the liver and not upon the pancreas. Furthermore, perfusion of the inferior pancrcati~oduodcnal artery, which has no relation to the art&d supply of the liver, has no effect whatever upon the ~~100~1 sugar and products no glycosuria.

It is interesting to note that a marked glgcosuria can bc pro-


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duccd by arterial perfusion of the liver with saline solution, without causing a hyperglycemia. The blood sugar has even been found t.0 stay at t.hc same level as the conbl in some cases.

It, seems, also, that, the blood sugar balance and attending glycosuria arc much more easily disturbed hy perfusing the liver t.hrough t.hc hepat,ic artery than through the portal win,

‘I‘.~UI.E VI

a.m.

11.15 11 .:15 11.3s

11.45 11.4s p VI

12.10 12.13 1”. 1.5

12.42

12.43 12.44 12.5s

1.1X 1 40 2.00 4.30

Operntiun started.

Injected 10 cc. sslirie solution into portal vein.

Superior pancreaticotluoden:tl artery t.ied off.

Tnjccted 10 cc. dine solution into hepatic artcry.

* Retention catheter in Illadller.

ma.

0.100

0.091

0.094

0.105 0.111 0.103 0.107 0.109

leading me to believe that, the hcpatic artcry must play a very import.ant part in carbohydrate metabolism through its Llood SUppl?‘.

IV.

CONCLUSIONS.

1. Saline pcrfwion of the pancreas directly has no etfcct upon the blood sugar level and dots not cause glycosuria.


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2. X glycosuria can be produced by perfusing the liver arteries without an attending marked rise in the blood sugar above a normal level.

3. The vascular supply through the hepatic artery controls a delicat,e balance in the liberation of sugar from the liver.

The experiments cited arc typical of many performed.

I wish t,o express my deep appreciat.ion to the members of t,he Physiological Dcpart.ment of Cornell and the X-ray Depart,ment of Mlcvue Hospital for their kind assistance in this work.

V.

BIBLIOGRAPHY.

1. Gross, L., The blood supply to the heart, View York, 1921, 5-8. 3. Lee, A. B., The mirrotomist,‘s vade mecum, Philadelphia, 8th edition,

1X1, 2iO. 3. Bensley, It. R., Am. J. Ancrf., 1911-l& xii, 297. Morris, H., Human

anatomy, Philadelphia, ith edition, 191’3, 630-635. 4. Page, I. H., J. Lrzh. rind Clin. Mctl., 19’23-24, is, 194. 5. Epstein, A. A., and Rosenthal, N., Am. J. Physiol., 10X, lss, 225;

1924-35, Issi, 316.


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William S. CollensSTUDIES

PANCREAS WITH SOME PERFUSION THE BLOOD SUPPLY TO THE

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THE BLOOD SUPPLY TO THE PANCREAS WITH SOME BLOOD SUPPLY TO THE PANCREAS WITH SOME PERFUSION STUDIES....

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