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
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)
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.
The duodenum is fixed to the posterior abdomenal wall (via peritoneum) in all parts except what?
the superior part
The HORIZONTAL part of the duodenum is retro or intraperitoneal?
HORIZONTAL duodenum is RETROPERITONEAL
The dorsal origin of the pancreas gives rise to what?
neck, body, tail (endo)
=ENDOCRINE fx --> ex. produce insulin
Where is the uncinate process of the ventral part of the pancreas found?
behind SMA and SMV
in front of the aorta
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 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)
3. Fundus of gallbladder
4. Hila of kidney
5. Hilum of spleen
7. Hepatic portal vein
In pancreatitis, inflammation of pancreas has what harmful effect?
enzymes empty into retroperitoneal sac -> leads to autodigestion
The spleen indentations are due to 3 organ impressions. What are those 3 organs?
2. Renal (L kidney)
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
What is the fx of the spleen?
1. remove RBCs (FILTERING FX)
2. remove WBCs (FILTERING FX)
3. other immunological fxs
In traffic accidents, how do pts get ruptured spleens?
broken ribs easily puncture the spleen, cause internal hemorrhage
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 proteins will be elevated in the blood in pts c Pancreatitis?
1. ^ serum Lipase
2. ^ serum Amylase
What are the causes of pancreatitis?
80% of pancreatitis is caused by "GET"
=Gallstones, Ethanol, Trauma
What does GET SMASHED stand for?
mnemonic for causes of pancreatitis:
E = Ethanol
T = Trauma
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 Cullen's sign?
Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
What is Grey Turner's sign?
Grey Turner's sign (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.
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)