Accessory Organs II Flashcards
What are the targets of the pancreas exocrine and endocrine functions?
- exocrine
- digestive
- endocrine
- insulin and glucagon
Where is the pancreas located?
Is it intraperitoneal or retroperitoneal?
- posterior abdominal wall
- right side of L1-L3
- midline
- hilum of spleen to the left
- secondarily retroperitoneal
- tail is within the rhinoligament
Identify the parts of the pancreas and then the associated spatial relationships with those parts
- head
- close to C shape of duodenum
- Uncinite process (inferior projection)
- posterior to superior mesenteric vessels
- neck
- anterior ot the superior mesenteric vessels
- body
- at L2, posterior to stomach
- tail
- in contact with spleen and left kidney
Left/Right relationship with the pancreas?
- right
- duodenum
- left
- spleen
- anterior
- stomach
- anterior inferior
- transverse mesocolon
- loops of bowel
- posterior
- kidney
- aorta
- inferior vena cava
- rental artery and vein
- portal vein
Describe the route of the main pancreatic duct?
What other duct merges with the main pancreatic duct? Why is this clinically relevant?
starts on tail side, takes oblique trajectory towrd the duodenum
it will be in the middle of the gland & deep
merges with the bile duct to form hepatopancreatic ampulla (of Vater), which is a dilation of the lumen that can be a commonl location for impacted gallstones
How is flow through the bile duct and the main pancreatic duct controlled?
Sphincter of the bile duct (choledochus)
Sphincter of pancreatic duct
Hepatopancreaticsphincter (of Oddi) – most important
Identify the arterial branches found on the posterior pancreas
Name the arterial branches that supply the pancreas and where they arise from
- Superior pancreaticoduodenal arteries (anterior & posterior)
- arise from gastroduodenal — (celiac)
- Inferior pancreaticoduodenal arteries (anterior & posterior)
- arise from superior mesenteric artery
- dorsal pancreatic artery
- arise from splenic– (celiac)
- great pancreatic artery (Magna)
- arise from splenic — (celiac)
Where are the 3 destinations for pancreatic veins to drain?
- splenic vein
- superior meseneteric vein
- portal vein
What are the 2 lymph nodes that pancreatic lymphatic vessels drain into?
What is the defining border?
- superior to attahment to transverse meso colon
- celiac nodes
- inferior to attachment to transverse mesocolo
- superior mesenteric nodes
What can occur if pancreatic cancer occurs in the head?
What can occur if pancreatic cancer occurs in the neck?
Why is pancreatic cancer often diagnosed late?
head: it may obstruct bile, which can result in jaundice
neck: portal vein can be impacted
it is located so deep, because the symptoms may be confused with other stomach/intestine pain
What are the functions of the spleen?
Is it intraperitoneal or retroperitoneal?
Unique features?
- functions
- largest lymphoid organ
- white pulp (immune responses)
- red pulp (phagocytosis)
- intraperitoneal
- unique features
- capable of marked expansion adn contraction
- normally not palpable
- fragile
Where is the spleen located?
left hypochondrium
ribs 9-11
What structures are found directly surrounding the spleen?
- anterior
- stomach
- gastrosplenic ligament
- diaphragm
- left kidney
- left colic flexure
- tail of pancreas
Identify the parts and surfaces of the spleen
What vessels are found within the spenorenal ligament?
What vessels are found within the gastrosplenic ligament?
What is the name of the ligament that anchose to spleen to the diaphragm?
- spenorenal ligament (spleen to left kidney)
- splenic artery and vein
- gastrosplenic (speen to stomach)
- the short gastric vessels adn left gastro-omental vessels
- speen to diaphragm
- phrenicosplenic ligament
Identify the arteial branches that supply the spleen
- splenic artery (largest branch of celiac trunk)
- left gastro-omental (epiploic)
- short gastric
- splenic
- pancreatic
What is the spatial relationship between the splenic artery and the splenic vein?
The splenic vein then merges wich what other vein to form which structure?
- realtionship
- splenic vein is inferior to the splenic artery
- posterior to the tail of the pancreas
- not tortuous
- merges with superior mesenteric vein to form the hepatic portal vein
- this happens posterior to the neck of the pancreas
Sympathetic innervation of the spleen comes from which nerve roots?
Lymphatic drainage?
T6-T8 for sympathetics
lymph nodes, pancreaticosplenic nodes– ultimately drain into celiac nodes
What is it called when the spleen is enlarged?
What is Kehr’s sign? What does it indicate?
splenomegaly
when a person is lying down and their legs are elevated– referred pain to the left shoulder; this is a symptom of a ruptured spleen
Where are kidneys located?
Are they intraperitoneal or retroperitoneal?
T12-L3 (right is slightly lower) in the paravertebral gutters
retroperitoneal
What is the hilum of the kidney?
What is the name of the inferior and superior portion of the kidneys?
A busy area where there are a lot of vessels entering and exiting the kidney– no hard boundaries
superior pole and inferior pole
What is the spatial arrangement of the vessels within the hilum from anterior to posterior?
Anterior to posterior: renal vein, renal artery, and renal pelvis
What is the name of the fat that forms around the kidneys and entes the hilum to fill the sinus?
What is the peelable structue around the kidney?
perirenal fat
renal capsule
Identify the features of the kidney
Describe the progression from renal papilla to ureter
- Renal papilla
- minor calyx
- major calyx
- renal pelvis
- ureter
What type of gland is the suprarenal (adrenal) gland?
What is the difference in secretion produduct from the cortext compared to the medulla?
Are they intraperitoneal or retroperitoneal?
endocrine gland
cortex: glucocorticoid steroids
medulla: epinephrine/neuro
retroperitoneal
Where are the adrenal glands located?
What is the spatial relationship between the adrenal glands and the kidneys/diaphragm?
How are the shapes of the two glands different?
T11-L1
base toward kidney, tip toward diaphragm
superomedial aspect of the kidney and diaphragm
right: pyramidal; left: flat/semilunar
Do the adrenal glands directly connect to the kidneys?
no, there is a septum (renal fascia) separating them, which is important in kidney transplant surgeries
What are the 3 arteries that supply the adrenal glands? From which arteries do they arise?
- superior suprarenal artery
- from inferior phrenic artery
- middle suprarenal artery
- abdominal aorta
- inferior suprarenal arterly
- from renal artery
Describe the difference in venous drainage from the left and right adrenal glands.
Where do the adrenal lympatics drain?
- left
- suprarenal vein drains into left renal vein
- right
- suprarenal vein drains into the IVC
- lymphatics
- lumbar lymph nodes
Why is there no parasympathetic innervation to the adrenal glands/
the chromuffin cells themselves act as parasympathetic ganglions
