ANATOMY Pancreas, Duodenum, & Spleen

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Term 2, Uni 1. PPT 5

Is the duodenum intra or retroperitoneal?

duodenum is retroperitoneal (secondary)

Is the stomach intra or retro peritoneal?

stomach goes from intra to retroperitoneal

What shape does the duodenum have?

C-shaped

Is the spleen intra or retroperitoneal?

retroperitoneal

How long is the Duodenum?

about 12 finger-breadths long

What parts of the duodenum are not retroperitoneal?

duodenum is mostly retroperit., eexcept for initial part and last bit

What are the 4 parts of the duodenum?

1. SUPERIOR SEGMENT: anterior to body @ L1
2. DESCENDING SEGMENT: to the R of L1 and L3 (right of IVC)
3. HORIZONTAL SEGMENT: crosses L3 vertebra
4. ASCENDING SEGMENT: goes to superior border of L2

Which segment of the duodenum receives bile and pancreatic juices?

the descending segment.

The ASCENDING segment of the duodenum is supported by what segment that connects it to the diapgragm?

the LIGAMENT OF TREITZ

=like a sling. goes around duodenal-jejunal flexure, prevents retrograde peristalsis (prevents food from going back up from jejunum into duodenum)

What is the fx of the Ligament of Treitz?

connects the ascending segment of the duodenum to the diaphragm

prevents retrograde peristalsis (prevents food from going back up from jejunum into duodenum)

What is the stimulus for the release of bile from the gallbladder?

the SPHINCTER OF ODDI

What is the most common place for stones?

the sphincter of Oddi

Where is the sphincter of Oddi located?

at the ampulla of Vater, close to the duodenum

The duodenum receives its BS from 2 sources. What are they?

1. CELIAC TRUNK
2. SMA - Superior Mesent. Artery

Trace the BS of the duodenum that comes from the celiac trunk

Celiac trunk -> common hepatic artery -> gastroduodenal artery -> anterior and post. pancreato-duodenal arteries

Trace the BS of the duodenum that comes from the SMA

SMA -> off of aorta at L1 -> SUPERIOR and INFERIOR pancreato-duodenal arteries

Which provides more BS to the duodenum, the celiac trunk or SMA?

they're 1/2 and 1/2!

this also reflects the innervation to the gut.

This structure is the shortest, widest, and most fixed part of the SI.

duodenum

Where does the duodenum start?

at the gastroduodenal jx

Where does the duodenum end?

at duodenum-jejunal jx

CT scan. What is at the T4-T5 vertebral level?

superior and inferior mediastinum

CT scan. What is at the L1 vertebral level?

abdomen

What is another name for the L1 vertebral level?

TRANSPYLORIC PLANE, bc goes thru level of pylorus

The duodenum is fixed to the posterior abdomenal wall (via peritoneum) in all parts except what?

the superior part

Is the duodenum retroperitoneal?

mostly... is retroperitoneal everywhere except @ superior part

Which part of the duodenum has the duodenal cap?

Superior part

The HORIZONTAL part of the duodenum is retro or intraperitoneal?

HORIZONTAL duodenum is RETROPERITONEAL

ASCENDING part of duodenum is retro or intraperitoneal?

ASCENDING duodenum is intraperitoneal

In which part of the duodenum do you find the duodenaljejunal flexure?

ASCENDING duodenum

The pancreas wraps about what 2 blood vessels?

SMA, SMV

Where in relation to the duodenum is the pancreas?

in the middle of the duodenum

What are the embryological origins of the pancreas?

dorsal and ventral

The dorsal origin of the pancreas gives rise to what?

neck, body, tail (endo)
=ENDOCRINE fx --> ex. produce insulin

The ventral origin of the pancreas gives rise to what?

uncinate process, head (exo)
=EXOCRINE fx

Where is the uncinate process of the ventral part of the pancreas found?

behind SMA and SMV
in front of the aorta

The tail of the dorsal part of the pancreas point to what organ?

the spleen

What does the EXOCRINE pancreas secrete?

pancreatic juice (pH 8)

What does the ENDOCRINE pancreas secrete?

insulin, glucagon, somatostatin

Pancreatic juices are secreted into the duodenum by what structure?

ampulla of Vater

the ampulla of vater secretes pancreatic juices into what?

the duodenum

From the duodenum, where do pancreatic juices empty?

into the duodenal papilla

Pt has blockage of the sphincter of Oddi, which is in the ampulla of Vater. What are the possible harmful risks?

blockage may lead to AUTODIGESTION OF THE PANCREAS --> may lead to Pancreatitis (if pt lacks minor duodenal papilla)

some pts have minor duodenal papilla that when the major duodenal papilla is blocked, minor can still drain pancreatic juices. thus not all pts c this problem get pancreatitis

What is 1 of the most common causes of pancreatitis?

gallstones

What happens if autodigestion of pancreas -> pancreatitis is left unchecked and untreated?

infection can spread UPWARDS and cause CHOLANGITIS in the CYSTIC DUCT

Cholangitis in the cystic duct can be a secondary cause of what condition?

pancreatitis, which can be due to gallstones -- specifically blockage of the Sphincter of Oddi at the ampulla of Vater

The head and uncinate process of the pancreas receives its BS from what 2 vessels?

SUPERIOR and INFERIOR Pancreatoduodenal Arteries

Superior = from celiac trunk (T12)
Inferior = from SMA (L1)

The body and tail of the pancreas receive their BS from what vessel?

the splenic artery
the tip of the tail is supplied by the PANCREATIC branches off of the splenic arteries.

List the 7 structures found in the TRANSPYLORIC PLANE (L1)

1. Pylorus
2. Pancreas
3. Fundus of gallbladder
4. Hila of kidney
5. Hilum of spleen
6. SMA
7. Hepatic portal vein

Why is the pancreatic juice pH 8?

to neutralize stomach contents

What 3 pancreatic enzymes are found in the exocrine portion?

1. Trypsinogen
2. Amylase
3. Lipase

What organ points toward the spleen in a CT scan?

the pancreas

When looking at CT of L1, why can't we see the kidney?

bc liver pushes kidney down

Where is the pancreas in relation to the lesser sac?

pancreas is posterior to lesser sac

Where is pancreas in relation to kidney?

adjacent

In pancreatitis, inflammation of pancreas has what harmful effect?

enzymes empty into retroperitoneal sac -> leads to autodigestion

What is the most common cause of death in road traffic accidents?

ruptured SPLEEN

The spleen is associated with what ribs?

9, 10, 11 = floating ribs

The spleen indentations are due to 3 organ impressions. What are those 3 organs?

1. Gastric
2. Renal (L kidney)
3. Colonic

Blood supply to the kidney is at what anatomical part of the kidney?

the hilum

In general terms, where is the spleen found in the body?

on the LEFT side of the body, at the end of the tail of the pancreas

Is the spleen intra or retroperitoneal?

the spleen is intraperitoneal

What is the fx of the spleen?

1. remove RBCs (FILTERING FX)
2. remove WBCs (FILTERING FX)
3. other immunological fxs

What color is the spleen?

purplish

In traffic accidents, how do pts get ruptured spleens?

broken ribs easily puncture the spleen, cause internal hemorrhage

What borders the spleen ANTERIORLY?

stomach

What borders the spleen ANTERO-MEDIALLY?

stomach, pancreas

What blood vessel suplies the pancreas?

the SPLENIC ARTERY

What borders the spleen POSTERO-MEDIALLY?

L kidney

What is hematemesis?

vomiting of blood

What is the MCC of hematemesis?

Peptic Ulcer Disease

What is the 2nd MCC of hematemesis?

Mallory Weiss tears from excess vomiting

What is the 3rd MCC of hematemesis?

varices

If pt experiences hematemesis and blood is coffee-colored, what does this mean?

that blood is partially digested

How can you ddx Mallory Weiss tears from other causes of hematemesis?

will present c bright red blood

Give the symptoms of pancreatitis.

Pt presents c sharp pain in EPIGASTRIC AREA & UPPER ABDOMEN. Pain is either intermitten or consistent. Pain is alleviated by sitting forward. Pain is aggravated by meals and alcohol.

Fever, jaundice, steatorrhea, weight loss, and abdominal distension.

What are the 2 MCCs of pancreatitis?

1. Gallstones
2. Ethanol

What proteins will be elevated in the blood in pts c Pancreatitis?

1. ^ serum Lipase
2. ^ serum Amylase

What is ALD?

Alcoholic Liver Disease

Pt suffers from ALD and presents c hematemesis. Most likely dx?

varices.

What is the textbook description of stomach ulcers?

"punched out appearance"

Does pancreatitis pain radiate?

yes.

What are the causes of pancreatitis?

GET SMASHED.
80% of pancreatitis is caused by "GET"
=Gallstones, Ethanol, Trauma

What does GET SMASHED stand for?

mnemonic for causes of pancreatitis:
G= Gallstones
E = Ethanol
T = Trauma

S= steroids
M = mumps
A = autoimmune
S = scorpion venom
H = hyperilpidemia
E = RCP
D = drugs -- azathioprine, cytotoxics

What is the CAGE questionnaire?

used in Alcohol Hx
C = compulsion
A = anger
G = guilty
E = eye opener

2/4 correct, 60% chance you're alcoholic.

What is "guarding"?

a symptom. = to contraction of abdom. wall upon palpation

What is Cullen's sign?

Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.

Cullen's sign is indicative of what disease?

acute pancreatitis

What is Grey Turner's sign?

Grey Turner's sign[3] (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.

Grey Turner's sign is indicative of what dx?

pancreatitis

What diagnostic technique can you use to dx pancreatitis?

ABDOMINAL X-RAY

What sort of findings would you expect to find upon abdominal x-ray of pt c pancreatitis?

diffuse ileus, calcification of pancreas (indicates chronic --> necrosis)

What effect will pancreatitis have on lesser sac?

inflammation of pancreas will push the lesser sac FORWARD, since pancreas is behind the lesser sac.

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