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92 terms

ANATOMY Pancreas, Duodenum, & Spleen

Term 2, Uni 1. PPT 5
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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.