GHSB Abdomen, Peritoneum, PDF

S1LE16 GROSS HUMAN STRUCTURAL BIOLOGY ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, 1st STOMACH, DUODEN...

S1LE16 GROSS HUMAN STRUCTURAL BIOLOGY ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, 1st STOMACH, DUODENUM, PANCREAS & SPLEEN Dr. Flordeliza M. De Jesus| November 6, 2018 SEM OUTLINE I. THE ABDOMINAL CAVITY II. THE PERITONEUM A. Divisions of the Peritoneal Cavity B. Peritoneal organs C. Retroperitoneal organs D. Extraperitoneal organs E. Features of the Posterior Surface of Antero- lateral abdominal wal F. Peritoneal reflection III. ABDOMINAL PORTION OF ESOPHAGUS IV. THE STOMACH A. Gastric curvature B. Gastric notches C. Omenta D. Main parts of stomach E. Relations of stomach  Serous membrane lining the abdominal wall (parietal F. Blood supply peritoneum) and enclosing or partially covering the G. Venous drainage abdominal viscera (visceral peritoneum) H. Lymph drainage  Largest serous membrane in the body made up of 2 I. Nerve supply parts: V. DUODENUM A. Blood supply o Parietal – the part lining the abdominal wall B. Venous drainage o Visceral – the part covering the abdominal C. Lymph drainage viscera D. Nerve supply  The sac or space enclosed by the two layers is the VI. PANCREAS peritoneal sac or cavity, which is merely a potential A. Function space because the parietal and visceral layers are B. Parts of pancreas normally in contact with each other C. Relations D. Pancreatic ducts This is the space between the parietal and visceral E. Blood supply peritoneum is the peritoneal cavity that only contains F. Venous drainage small amount of serous fluid G. Nerve supply  The so-called peritoneal organs just project into the H. Lymph drainage cavity but not within the cavity. VII. SPLEEN  The peritoneal cavity in male is a closed sac while in A. Functions female it is NOT, since the free ends of the uterine B. Borders C. Surface of relations tubes open into the peritoneal cavity. Thus, ascending D. Blood supply infections from the vagina in the female can result to E. Venous drainage peritonitis. F. Lymphatic drainage  Peritoneal Reflections VIII. CLINICAL CORRELATION 1. Ligaments – consist of peritoneal fold that connect solid organs to abdominal wall Ex. Legend: falciform ligament 2. Omentum – connects the stomach to other Remember Lecture (Exams) Lecturer Book Guide Note viscera; greater and lesser omentum 3. Mesenteries – connect part of intestine to      posterior abdominal wall. a. Mesentery (proper) of jejunum and ileum; I. THE ABDOMINAL CAVITY transverse and sigmoid mesocolon A. Divisions of the Peritoneal Cavity  Abdominal cavity extends above at the respiratory diaphragm and below to the pelvic diaphragm  Greater Peritoneal cavity or sac – is the main part  Largest body cavity, divided into 2 parts: of the cavity that extends from the diaphragm into the o Abdomen proper – abdominal cavity pelvis proper; upper & larger part  Lesser Peritoneal cavity or sac (Omental bursa) – o Pelvic cavity – smaller and lower part a diverticulum of the greater sac, which forms a  Bounded above by the thoraco-abdominal potential space mainly behind the stomach and lesser diaphragm which extends into the bony thorax, omentum. reaching on the right side, in the mammary line, to the  The 2 sacs communicate with each other through a th upper border of the 5 rib; on the left is lower by about space called EPIPLOIC FORAMEN OF WINSLOW 1 inch  The lower boundary is formed by the pelvic diaphragm (muscle in the pelvic floor) II. THE PERITONEUM TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 1of10  ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN E. Features of the Posterior Surface of Antero-lateral abdominal wall lined by Parietal Peritoneum  Boundaries of Epiploic Foramen of Winslow: o Anteriorly: Free border of the lesser omentum, with the common bile duct, hepatic artery and portal vein o Posteriorly: Inferior vena cava  Umbilical ligaments o Superiorly: Caudate lobe of liver – Embryological remnants attached to umbilicus o Inferiorly: 1st part of the duodenum - These are vestige/remnants of embryonic structures  The peritoneal cavity contains only small amount of at the internal surface of anterior abdominal wall fluid to moisten the interior of the sac. All viscera are o Median umbilical ligament – fibrous cord in outside the peritoneal cavity. the midline extending from apex of urinary B. Peritoneal Organs bladder to umbilicus derived from fetal  Abdominal organs which are almost enveloped allantois (Urachus) completely by visceral peritoneum. This allows certain Remnant of the urachus. It extends from amount of mobility on the organ involved. the apex of urinary bladder to the umbilicus  Ex: stomach, jejunum, ileum, transverse colon, sigmoid colon o Lateral umbilical ligament – 2 fibrous C. Retroperitoneal Organs cords/ a paired ligament derived from  Primary retroperitoneal organs obliterated umbilical arteries o Are those which are covered with peritoneum This is a remnant of umbilical artery only on its anterior surface partly or  Umbilical folds – peritoneal folds overlying umbilical completely and which are not derived from ligaments and inferior epigastric vessels the GI tract. o Median umbilical fold – peritoneal elevation o Ex: Kidney & Ureters, suprarenal glands, overlying median umbilical ligament aorta, inferior vena cava o Medial umbilical folds – peritoneal  Secondary Retroperitoneal organs elevation overlying lateral umbilical ligaments o Are those which are derived from the gut and o Lateral umbilical folds – peritoneal during fetal life are completely covered by elevation overlying the inferior epigastric peritoneum and lose during this vessels development. F. Peritoneal Reflections o They are covered with peritoneum only on  These are extensions of the visceral peritoneum: their anterior surface, partly or completely  MESENTERY – 2 layered peritoneal membrane that o Ex: duodenum, pancreas, usually ascending envelops and supports a hollow viscus, attaching it to and descending colon the body wall or to another organ. (Ex: Mesentery of D. Extraperitoneal Organs small intestines, mesocolon of transverse colon and  Are abdominal or pelvic organs which have no sigmoid colon) peritoneal covering at all  LIGAMENT – 2 layered peritoneal membrane that  Ex: lower 1/3 of rectum usually connects a solid abdominal viscera to each other or to hollow viscus or to the body wall. (Ex: gastrosplenic, lienorenal, hepatogastric, hepatoduodenal, coronary ligaments of the liver  OMENTUM – a peritoneal fold connecting the stomach with other viscera o Greater omentum – 4 layered large apron- like peritoneal fold attached to the greater curvature of the stomach and the adjacent part of the duodenum; usually referred to as the abdominal policeman TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 2of10  ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN  Gastrocolic ligament – attached to transverse colon; usually referred to as the greater omentum  Gastrosplenic ligament (Gastrolienal) – attached to the hilus of spleen o Lesser omentum – 2 layered peritoneal fold connecting the inferior surface of the liver to the esophagus, lesser curvature of the st stomach and the 1 part of the duodenum  Hepatogastric ligament – the part of the lesser omentum between the liver and stomach  Hepatoduodenal ligament – the part between liver and duodenum  Enclosed in the right free border of the hepatoduodenal ligament are the PORTAL TRIAD namely, Hepatic artery, portal vein and bile duct IV. THE STOMACH (GASTER)  Immediately behind the right border of the  Most dilated part of the alimentary tract found Hepatoduodenal ligament is the Gastroepiploic between the esophagus and the small intestine with a Foramen of Winslow, communication between the capacity of about 1.5 liters in adults greater and lesser peritoneal sacs.  Lies in the upper quadrant, in the left hypochondriac III. ABDOMINAL PORTION OF ESOPHAGUS epigastric umbilical regions of the abdomen  1.5 to 2.5cm long distal part of the esophagus  Position and shape depend upon its contents and opening into the stomach through the cardiac orifice position of the body as well as, phase of respiration  Enters the abdominal cavity through the esophageal  It has 2 openings, 2 curvatures, 2 surfaces and 2 opening of the diaphragm at level of T10 vertebra incisura or notches where right and left vagus nerve also pass together  The main parts of stomach are the fundus, body and with the left gastric vessels and lymphatics pyloric region  It extends from the esophageal hiatus (T10) to its A. Gastric curvatures junction with the stomach (T11) The abdominal part is the shortest portion of the esophagus, it is the lower 1/3 of your esophagus  Anteriorly, it is covered by liver and posteriorly rest on the diaphragm  Blood supply: Left gastric and left inferior phrenic arteries left gastric artery is a branch of your celiac trunk o Left gastric artery runs along the upper part of the lesser curvature of stomach rd o Supplies the lower 3 of esophagus o Anastomose with the esophageal branches  Greater curvature rd of thoracic aorta that supplies the middle 3 – The left or convex border of the stomach continuous of esophagus with the esophagus at the cardiac notch - Extends from the cardiac orifice above to the pyloric  Venous drainage: Left gastric veins which in turn orifice distally. It 4 to 5 times longer than the lesser drain into the portal vein curvature. o Left gastric vein, that drains into the portal - It gives attachment to the greater omentum vein; Anastomose with the tributaries of the azygos vein (R) and hemiazygos vein (L)  Lesser curvature  Nerve supply: Vagus and sympathetic trunks – The right or concave border of the stomach  Lymphatic drainage: celiac node continuous with the right border of the esophagus o Thoracic sympathetic trunk through the great - It extends from the cardiac orifice to the pyloric splanchnic nerve, containing T6 – T9 spinal orifice. nerves - It gives attachment to the lesser omentum B. Gastric Notches or Incisures  Cardiac notch (Incisura cardiaca) – depression to the left side of the distal end of esophagus as it connects with the stomach. This is the beginning of the greater curvature TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 3of10  ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN  Angular notch (Incisura angularis) – depression along o Pylorus – sphincteric region which the lesser curvature of the stomach (along the right separates stomach from the duodenum. It is border). This marks the junction of the body and pyloric marked off on the surface of the stomach by regions of the stomach. a shallow groove in which a small prepyloric vein (Mayo) maybe identified C. Omenta of stomach during surgery; the pylorus usually lies at the 1. Lesser omentum – a 2-layered peritoneal fold level of the transpyloric plane which is the attached to the lesser curvature of stomach opposite L1 vertebra. 2. Greater omentum – a 4-layered peritoneal fold E. Relations of the Stomach attached along the greater curvature of the stomach  ANTERIOR o Covered partly by the left lobe of liver o The fundus is partly overlapped by spleen o Diaphragm separates the stomach from the left lung and heart o Related with the anterior abdominal wall below the costal margin  POSTERIOR o Lesser sac (omental bursa) is found at the back of the stomach which lies on structure mainly retroperitoneal ones on the posterior wall of this sac o The structures forming the stomach bed are as follows:  Pancreas with splenic artery on its superior border  Diaphragm  Left kidney D. Main Parts of the Stomach  Left suprarenal gland  Spleen  Transverse mesocolon F. Blood Supply of the Stomach (arises from direct and indirect branches of the celiac artery)  Left gastric artery o the smallest branch of the celiac trunk o runs along the lesser curvature anastomosing with right gastric artery inside lesser omentum and supplies both surfaces of the stomach  Right gastric artery o A branch of hepatic artery proper o Runs along the lesser curvature supplying both surfaces of the stomach on its right distal part  Fundus – part of the stomach above the imaginary  Right gastroepiploic/gastro-omental artery line drawn from the cardiac orifice to greater curvature o A branch of the gastroduodenal artery (from it is above the level of a horizontal plane along the hepatic artery proper) on the right end of cardiac notch stomach along the greater curvature, runs to  Body – part of the stomach between the imaginary the left, anastomosing with the left line drawn along the cardiac orifice and another plane gastroepiploic artery from splenic artery passing from angular notch to greater curvature. o It supplies to the right part of the stomach,  Pyloric – region is the distal part of the stomach superior part of duodenum and greater extending from the plane of angular notch to its omentum opening into the duodenum (Pyloric orifice)  Left gastroepiploic/gastro-omental artery o A branch of the splenic artery (the largest - The part of stomach distal to the angular notch up to branch of celiac artery) which runs between the junction of stomach with the duodenum, marked layers of the gastrolienal ligament to the externally by a slight depression. greater curvature of the stomach o It supplies both stomach and greater o Pyloric antrum – dilated proximal portion, omentum and anastomosis with the right secreting gastrin which stimulates more gastroepiploic artery gastric gland secretion.  Short gastric arteries o Pyloric canal – constricted tubular portion to o Branches of the splenic artery the right side of the antrum TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 4of10  ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN o Pass between layers of gastrolienal ligament G. Venous drainage to the fundus of the stomach where they  the veins accompany the arteries and end in the anastomose with the branches of the left Portal vein gastric and left gastroepiploic arteries H. Lymphatic drainage  lymph vessels of the stomach accompany the arteries supplying it and terminate into the following: o Left gastric nodes o Pyloric lymph nodes o Gastroepiploic lymph node o Pancreaticoduodenal lymph node I. Nerve supply  Celiac sympathetic plexus – contains efferent and afferent nerves derived from T6-T9 spinal segments and are transmitted by the greater thoracic splanchnic nerve.  Parasympathetic nerve supply comes from anterior and posterior vagal trunks -has both secretory and motor effects on the stomach; vagal stimulation evokes a secretion rich in pepsin STOMACH BED and increases gastric motility  The stomach bed refers to the organs on which the  Sympathetic nerve supply (vasomotor to the stomach rests in the supine position gastric blood vessels and visceral sensory fibers) These organs are: comes mainly from the celiac plexus through the  Left dome of the diaphragm nerves around the gastric and gastroepiploic arteries.  Spleen and splenic artery The efferent sympathetic to the stomach arise from  Left kidney and suprarenal gland the 6th-9th thoracic segments of the spinal cord  Pancreas  Tansverse colon and its mesentery Sympathetic nerve supply is the one responsible for the gastric pain V. THE DUODENUM Small Intestine  The longest part of the alimentary canal. It extends from the pylorus of the stomach to the ileocecal junction.  It is the segment of the alimentary canal where the greater part of digestion and food absorption takes place.  It consist of 3 segments – the duodenum, the jejunum and the ileum Duodenum  1st part of the small intestine  The C-shaped first portion of the small intestines MNEMONIC: Don’t Try Sex Koz its Super Painful the c shaped duodenum is the one that encloses Diaphragm- Transverse colon- Spleen/splenic artery- Kidney- the head of the pancreas Suprarenal gland- Pancreas  10 inches long  Shortest and widest, most fixed and thickest of the small intestine almost retroperitoneal EXCEPT the 1st inch of the 1st portion  It is more vascular Uyyy, Med yan!  It is the distal continuation of the stomach; distally continuous with the jejunum  Begins at the pylorus and ends to the left midline opposite the lumbar vertebra in the jejunum  As it joins the jejunum it turns abruptly forward forming the duodenojejunal flexure and is attached to the right crus of the diaphragm through Ligament of Treitz  Together with the pancreas it is most deeply lying portion of the alimentary tract  FUNCTIONS: o Secretions: Secretin and Pancreozymin o Receives bile and pancreatic juice through common bile duct and pancreatic ducts TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 5of10 ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN  DIVISIONS OF THE DUODENUM: the right side of the vertebral column to as low as the L4 vertebra  Receives the opening of the common bile duct and pancreatic ducts (Main pancreatic duct of Wirsung and accessory pancreatic duct of Santorini) Therefore, it receives the termination of your common bile duct and pancreatic ducts  Termination of common bile duct and main pancreatic duct is marked by an elevation at the medial border of internal surface called the greater duodenal papilla or papilla of Vater st  Termination of an accessory o Superior – 1 portion pancreatic duct (if present) is  Also called duodenal bulb or marked by a smaller elevation duodenal cap (triangular shadow called the lesser duodenal papilla, on x-ray) located above the papilla of Vater  About 5cm long it is the first 2  Passes vertically downward in front inches of hilus of right kidney, to the right  Lies in the transpyloric plane to the side L2 and L3 vertebrae right side of the L1 vertebra  Relations:  Begins at the pylorus, ends at the o Anterior – fundus of gallbladder, level of neck of gall bladder right lobe of liver, transverse colon,  1st half is with lesser and greater coils of small intestine omenta and therefore movable o Posterior – hilus of right kidney,  Covered with peritoneum anteriorly right ureter and on the sides o Lateral – ascending colon, right  Internal Surface of the duodenum colic flexure and right lobe of the o The internal surface of the liver duodenum is characterized by o Medial – head of pancreas, bile the presence of thick circular duct and pancreatic duct mucosal folds – the valves of  Major duodenal papillae (Papilla Kerckring/ Plica circulares of Vater) – a mucosal elevation at o Greater duodenal papilla the medial portion of the internal (Vater) surface of the descending part of o Lesser duodenal papilla the duodenum. At the summit of which is the common opening for  Relations: the common bile duct and main - Superoanteriorly: with pancreatic duct of Wirsung quadrate lobe of the liver  Minor duodenal papilla – a and gall bladder mucosal elevation at the medial - Posteriorly: gastroduodenal portion of the intestinal surface of artery, Common bile duct, the duodenum about 2.5cm above Portal vein the opening the major duodenal - Inferoposteriorly: Head and papilla. At the summit of which is neck of pancreas the opening of the accessory  Relations (Snell 9th, pg 172) pancreatic duct of Santorini o Anteriorly – quadrate lobe of o Transverse/Horizontal – 3rd portion liver and gallbladder  5 to 7.5 cm long (8cm) o Posteriorly – lesser sac,  Begins at the right side of the upper gastrodudenal artery, bile duct border of L4 vertebra (lec guide) and inferior vena cava  Runs horizontally along the o Superiorly – entrance into the subcostal plane (L3 vertebra) along lesser sac (epilpoic foramen the lower border of the pancreas o Inferiorly – head of pancreas (doc’s outline) o Descending – 2nd portion  Crosses the midline in front of the  7-10 cm long (3 inches) inferior vena cava and crura of the  Extends from the level of neck of diaphragm, ends in the ascending the gall bladder (L1 vertebra) along portion in front of the abdominal aorta TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 6of10 ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN  Relations: - Crossed by Superior mesenteric artery and vein - Posterior surface: rests upon the right crus of the diaphragm, IVC and aorta (and L3 vertebra)- according to the outline of doc - Anterior: crossed by superior mesenteric vessels and root of the mesentery of jejunum and ileum. - Superior: related with the head of pancreas - Inferior: coils of jejunum th o Ascending – 4 portion  Above 2.5 cm long A. Blood Supply of Duodenum  Ascends on the left side of aorta up  Supraduodenal and Retroduodenal branches of to the level of L2 vertebra the Gastroduodenal artery to the 1st part  Ends at the duodenojejunal flexure,  Branches of the Superior and inferior where it joins the jejunum pancreaticoduodenal arteries anastomose and  Distal continuation of the supply the 2nd,3rd and 4th part of the duodenum horizontal/transverse segment  Runs upward to the left of aorta up to the inferior border of pancreas The upper half is supplied by the superior  Joins/continuous with the jejunum, pancreaticoduodenal artery, a branch of the gastroduodenal duodenojejunal flexure, supported artery by attach-ment of suspensory The lower half is supplied by the inferior muscle of duodenum (ligament of pancreaticoduodenal artery, a branch of the superior Treitz) mesenteric artery. (Snell 9th, pg 177)  Ligament of Treitz  It is a fibromuscular structure that B. Venous drainage connects the duodenojejunal  The veins of the duodenum ends in the Splenic and flexure to the posterior abdominal Superior mesenteric veins and ultimately to the wall. Muscle fibers are derived Portal vein from the right crus of the The superior pancreaticoduodenal vein drains into the diaphragm portal vein; the inferior vein joins the superior mesenteric vein  the importance of this is, it (Snell 9th, 177) serves as landmark between C. Nerve Supply upper and lower GIT.  Sympathetic from celiac and superior mesenteric  Relations: (Snell 9th, 176-177) plexuses - Anteriorly: The beginning of  Parasympathetic fibers from the vagus nerves the root of the mesentery and D. Lymphatic drainage coils of jejunum  Pancreaticoduodenal nodes which drain superiorly - Posteriorly: Left psoas major and left margin of aorta to the hepatic nodes inferiorly to the celiac lymph nodes VI. THE PANCREAS  a long flat pistol shaped gland, the head part of which is enclosed by the duodenum and the main parts posterior to the stomach  It is soft , lobulated, greyish pink gland  It lies almost transversely across the posterior abdominal wall, posterior to the stomach  Its parts are head, neck body and tail  It has an endocrine as well as exocrine function  The pancreas lies across the posterior abdominal wall behind the peritoneum  Its head is enclosed by the duodenum  Its body crosses the anterior surface of the left kidney  Its tail reaches as far left as the hilus of the spleen TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 7of10  ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN A. Functions D. Pancreatic Ducts  Produces both exocrine and endocrine secretions  The exocrine secretions contain important enzymes for digestion – amylase, lipase, trypsin  The endocrine secretions are essential for the regulation of carbohydrate metabolism like insulin B. Parts of the pancreas  The pancreatic duct/s drain the exocrine secretion of the pancreas, pancreatic juice  The pancreatic ducts are the main pancreatic duct  Head and there may be an accessory duct o Broad and flat, enclosed by the curve of the duodenum  The main pancreatic duct drains the whole pancreas o To the left and upper part, continuous with from the tail to the head the neck  If present, the accessory pancreatic duct drains the o To the left and lower part, projects the head uncinated process – the uncinated process is inferior to the neck of the pancreas and lies  Main Pancreatic Duct of Wirsung largely behind the superior mesenteric o Runs the length of the pancreas from the vessels entire tail and body and from the  Neck posteroinferior part of the head, including the o Constricted by the superior mesenteric uncinate process vessels which lie in a deep groove of the o Ends by opening into the 2nd portion of the posterior surface and the neck duodenum  Body o In 2/3 of the cases, however, joins with the o Lies above the duodenal flexure and lies common bile duct to form a dilatation called behind the stomach AMPULLA OF VATER which opens in the descending portion of the duodenum  Tail o This opening is guarded by a smooth muscle o The tapering left extremity extending into the called SPHINCTER OF ODDI and found in lienorenal ligament and to the hilus of spleen an elevation in the duodenal mucosa called C. Relations MAJOR DUODENAL PAPILLA  Anterior surface  Accessory Pancreatic Duct of Santorini o Transverse mesocolon across the head and o If present drain the antero-superior part of lower part of the neck and body the head only and empties independently o The stomach is found anteriorly into the 2nd part of the duodenum, at the o Above the lesser curvature, the lesser MINOR DUODENAL PAPILLA just above st omentum and through it the liver and the 1 the major duodenal papilla part of the duodenum  Termination of Pancreatic ducts  Posterior surface o Main pancreatic duct (Wirsung) terminates into o The head lies on the hilum of the right kidney nd the 2 part of duodenum at the summit of o The neck and uncinated process lie in front greater duodenal papilla (Vater), which is also of the abdominal aorta the termination of the common bile duct o The body crosses the left kidney and suprarenal gland and the right crus of o Accessory pancreatic duct (Santorini) also diaphragm terminates into the 2nd part of duodenum a little o The union of the splenic and superior above the termination of the main duct at the mesenteric veins forms the PORTAL VEIN minor duodenal papilla on the posterior surface of the neck o The tip of the tail is in contact with the SPLEEN at its hilum E. Blood Supply of Pancreas  Pancreatic branches of the Splenic artery coursing along the superior border of the pancreas TRANSCRIBERS Rianne Malabanan, RMT Jessa Mae Manibog, RMT 8of10  ABDOMEN, PERITONEUM, ABDOMINAL PORTION OF ESOPHAGUS, STOMACH, GHSB DUODENUM, PANCREAS & SPLEEN  Pancreaticoduodenal arteries, the superior being a A. Functions branch of the gastroduodenal and the inferior, a  Lymphatic organ filtering blood eliminating old and branch of the superior mesenteric artery damaged cells from the circulation, filtering antigens F. Venous drainage and other particulate matter from the blood  Tributaries of the splenic and superior mesenteric B. Borders of the Spleen veins and eventually to the PORTAL VEIN  Anterior and superior borders G. Nerve supply o Sharp and often notched  Derived from the celiac and superior mesenteric o Separate the diaphragmatic surface from the plexus which enter the posterior surface of the gastric surface pancreas  Posterior border  The pancreatic enzymes secretion is controlled o More rounded and blunter than the anterior largely by hormone from the duodenum, the secretin o Separates renal from diaphragmatic surface  The pain fibers from the pancreas run in the thoracic  Inferior border splanchnic nerves and are conveyed to spinal cord o Separates the diaphragmatic surface from segments T6-T10 colic surface H. Lymphatic drainage C. Surface and Relations  The lymphatics from the head of the pancreas drain in  Diaphragmatic surface part, into celiac and superior mesenteric lymph o Convex, smooth and is directed upward, nodes backward and to the left o Relate with the undersurface of the  The lymphatics from the body and tail of the pancreas diaphragm separating it from the 9th, 10th and drain into the pancreaticolienal nodes along the 11th ribs on the left and intervening lower splenic vessels, which send their efferents to the border of the left lung and pleura celiac nodes  Anterior surface VII. THE SPLEEN o Directed forward, upward and medial ward  Largest lymphatic organ in the body o Broad and concave in contact with the  Encapsulated, Irregular, roughly wedge-shaped, soft posterior wall of the stomach and tail of the and vascular lymphatic organ in the upper left pancreas quadrant of the abdomen (just beneath the o It presents the hilum diaphragm) covered by 9th and 11th ribs on the left  Posterior/Renal surface side o Directed medial ward and downward  Two major functions o Somewhat flattened a. Removal of particulate matter including ageing o In relation with upper part of anterior surface erythrocytes from the circulation of left kidney and occasionally with left b. Provision of lymphocytes and antibodies as part of suprarenal gland the body’s system of secondary lymphoid tissue D. Blood Supply  Related with posterior wall of the stomach and is  Splenic artery from celiac trunk connected to its greater curvature by gastrolienal E. Venous drainage ligament and to the left kidney by lienorenal  Splenic vein which unite with the upper part of the ligament superior mesenteric vein forming PORTAL VEIN  Relations: o Posterosuperior (-lateral) diaphragm o Medial – stomach, tail of pancreas o Inferolateral – left kidney Note: She ended her outline here while the lecture ended at the last part of duodenum. The rest of the information were gathered from the lecture guide, enjoy studying