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Anatomy Unit III > Duodenum, Pancreas, and Spleen > Flashcards

Duodenum, Pancreas, and Spleen Flashcards

1
Q

What are some characteristics of the small intestine?

A
  • It is the longest part of the GI tract
  • It extends from the pyloric orifice of the stomach to the ileocecal valve
  • Hollow tube 6-7 meters long with the diameter narrowing from beginning to end
  • Tube is divided into 3 parts
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2
Q

What are the 3 parts of the small intestine?

A

Duodenum, jejunum, and ileum

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3
Q

Where does the duodenum begin and end?

A

It is the first part of the small intestine and begins at the pylorus and ends at the duodenojejunal junction

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4
Q

What are some characteristics of the duodenum?

A
  • C-shaped course from the pylorus around the head and neck of the pancreas
  • Eventually continuous with the jejunum
  • ~25 cm long
  • The shortest, widest, most fixed part of the small intestine
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5
Q

What is a function of the duodenum?

A

Collects bile and pancreatic fluid via their ducts so it participates in digestion

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6
Q

The duodenum is divided into 4 parts:

A
  1. Superior
  2. Descending
  3. Horizontal
  4. Ascending
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7
Q

What parts of the duodenum are retroperitoneal?

A

All parts except the initial part and the tail

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8
Q

Describe the location of the superior part of the duodenum:

A

It is anterolateral to the body of L1 at the right side. It is ~5cm long and is divided into proximal and distal regions

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9
Q

What is significant about the superior part of the duodenum?

A

It is the most movable part of the duodenum and it receives stomach contents so it is exposed to high acidity

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10
Q

Describe the proximal part of the superior part of duodenum:

A
  • Has a smooth luminal surface - ampulla or duodenal cap or bulb
  • Proximal half of duodenum has mesentery and is mobile
  • Greater omentum and hepatoduodenal ligaments are attached to this part of the duodenum (hence it moves with the stomach)
  • Most duodenal ulcers occur in this area since it receives acidic contents from stomach
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11
Q

Describe the distal part of the superior part of duodenum:

A
  • Has corrugated luminal surface
  • Has no mesentery
  • Immobile
  • Retroperitoneal and fixed to the posterior abdominal wall
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12
Q

What lies anterior to the superior part of the duodenum?

A
  1. Peritoneum
  2. Gall bladder
  3. Quadrate lobe of liver
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13
Q

What lies posterior to the superior part of the duodenum?

A
  1. Bile duct
  2. Portal vein
  3. Inferior vena cava
  4. Gastroduodenal artery
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14
Q

What lies superior to the superior part of the duodenum?

A

The neck of the gallbladder

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15
Q

What lies inferior to the superior part of the duodenum?

A

The neck of the pancreas

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16
Q

Describe the descending part of the duodenum:

A
  • About 7.5 cm long
  • Has no mesentery
  • It descends retroperitoneally along the right sides of L1-L3, passing to the right and parallel to the IVC
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17
Q

What enters the descending part of the duodenum?

A

The bile duct and main pancreatic duct enter the posteromedial wall of the descending part of the duodenum, about 2/3 along its length.

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18
Q

The bile duct and main pancreatic duct unite to form:

A

The hepatopancreatic ampulla, which opens on the major duodenal papilla

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19
Q

What is the opening of the ampulla surrounded by and what is the function?

A

Surrounded by the sphincter of the hepatopancreatic ampulla which is capable of regulating bile and pancreatic fluid flow in the duodenum (but in some people, the bile and pancreatic ducts do not join but open separately in the major duodenal papilla)

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20
Q

What is anterior to the descending part of the duodenum?

A
  1. Transverse colon
  2. Transvere mesocolon
  3. Some coils of the small intestine
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21
Q

What is posterior to the descending part of the duodenum?

A
  1. Hilus of right kidney
  2. Renal vessels
  3. Ureter
  4. Right psoas major muscle
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22
Q

What is medial to the descending part of the duodenum?

A
  1. Head of pancreas
  2. Pancreatic duct
  3. Bile duct
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23
Q

Describe the horizontal part of the duodenum:

A
  • 10cm long
  • Runs horizontally from right to left across L3
  • Passes anterior to the inferior vena cava and aorta
  • Retroperitoneal and adherent to the posterior abdominal wall
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24
Q

What is anterior to the horizontal part of the duodenum?

A
  1. Superior mesenteric vein and artery

2. Coils of the small intestine

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25
What is posterior to the horizontal part of the duodenum?
1. Right psoas major 2. Inferior vena cava 3. Aorta 4. Right ureter
26
What is superior to the horizontal part of the duodenum?
1. Head of the pancreas | 2. Superior mesenteric vessels
27
Describe the ascending part of the duodenum:
- 2.5 cm long - Ascends on the left side of the aorta at the level of L2 - Ascending part bends anteriorly and joins the jejunum at the duodenojejunal flexure - Most is retroperitoneal - Immobile, attached to the posterior abdominal wall
28
Which part of the ascending part of the duodenum is peritoneal?
The distal end, it is movable with the jejunum
29
What supports the duodenojejunal flexure?
A fibromuscular suspensory muscle (or ligament) or the duodenum arising from the right crus of the diaphragm and attached to the ascending part of the duodenum
30
What is anterior to the ascending part of the duodenum?
1. Beginning of the root of the mesentery | 2. Coils of jejunum
31
What is posterior to the ascending part?
1. Left psoas major muscle | 2. Left margin of the aorta
32
What is medial to the ascending part?
1. Head of the pancreas
33
What is superior to the ascending part?
1. Body of pancreas
34
Several peritoneal folds and recesses are related to the duodenum, particularly near the:
Duodenojejunal junction
35
How are these folds/recesses formed?
When the retroperitoneal duodenum changes to the peritoneal jejunum
36
What are the 4 recesses formed by the peritoneal folds?
1. Superior duodenal fold 2. Inferior duodenal fold 3. Retroduodenal (between superior and inferior) 4. Paraduodenal (carriers the inferior mesentery vein in its fold)
37
The duodenum has a rich blood supply, mostly from:
The superior and inferior pancreaticoduodenal (PD) arteries
38
The superior PD is a branch of the:
Gastroduodenal a
39
The inferior PD is a branch of the:
Superior mesenteric aa
40
The superior PD arteries supply:
The proximal half of the duodenum
41
The inferior PD arteries supply:
The distal half of the duodenum
42
Where do the superior and inferior PD anastomose and what does it form?
In the head of the pancreas to form an arterial arcade and the straight arteries originating from them supply the duodenum
43
The superior part of the duodenum may receive blood from?
1. Supraduodenal a 2. Right gastric a 3. Gastro-omental (gastro-epipolic) or 4. Gastroduodenal a (these vessels often anastomose with each other)
44
The veins of the duodenum drain into the postral venous system via which veins?
Either the superior mesenteric vein or by small direct veins
45
The pre-pyloric vein at the gastroduodenal junction drains into the:
Right gastric vein
46
Where is the lymphatic drainage? 3 nodes
1. Pancreaticoduodenal nodes (along pancreaticoduodenal aa) 2. Pyloric nodes (along gastroduodenal aa) 3. Superior mesenteric nodes (along superior mesenteric aa) All of these nodes ultimately drain into the celiac nodes
47
What innervated the duodenum?
The vagus nerve and sympathetic nerves via the plexus on the pancreaticoduodenal aa
48
Which part of the duodenum is more prone to ulceration?
The first part of the duodenum. If the ulcer becomes perforated (erodes through the wall), digestive juices and gut contents escape into the peritoneal cavity and produce peritonitis (inflammation of the peritoneum)
49
Defining characteristics of the pancreas:
- It is elongated (12-15 cm), soft grayish digestive gland - Located near the transpyloric plane, across the posterior abdominal wall, posterior to the stomach - The transverse mesocolon is attached to its anterior margin - It lies posterior to the omental bursa - It is retroperitoneal, except for...
50
What does the pancreas secrete?
Pancreatic fluid that enters the duodenum by the pancreatic duct, and hormones like insulin and glucagon that enter the blood
51
The pancreas is located on the bodies of:
L1 to L3 vertebrae, and can be divided into 4 parts - head, neck, body and tail
52
The pancreas is retroperitoneal except for:
The tip of the tail
53
Describe the head of the pancreas:
It is located within the curve of the duodenum and has a prolongation called the uncinate process, which lies posterior to the superior mesenteric vessels
54
What structures are posterior to the head of the pancreas?
1. Inferior vena cava 2. Right renal vessels 3. Bile duct
55
Describe the neck of the pancreas:
- 2 cm long and located between the head and body - The neck is grooved posteriorly by the superior mesenteric vessels - Its anterior surface is covered with peritoneum and is adjacent to the pylorus of the stomach - The portal vein is formed posterior to it (merged splenic and superior mesenteric vv)
56
Describe the body of the pancreas:
- Extends across the aorta on L1-L3 - Posterior to the omental bursa - Lies between the celiac trunk and the superior mesenteric artery - Its superior part is intimately related to the splenic artery - It is retroperitoneal
57
What is anterior to the body of the pancreas?
1. Peritoneum | 2. Bed of stomach, where it provides attachment for the transverse mesocolon
58
What is posterior to the body of the pancreas?
1. Aorta 2. Superior mesenteric a 3. Left suprarenal gland 4. Left kidney
59
Describe the tail of the pancreas:
- It is thick and pointed or blunt - It passes between the two layers of the splenorenal (peritoneal) ligament - Its end usually contacts the hilum of the spleen, the tip is peritoneal
60
What are the 2 pancreatic ducts?
One main duct and one accessory duct
61
Characteristics of the main duct:
- Starts at the tail of the pancreas and runs through the substance of the gland, receiving tributaries throughout the body of the pancreas - Lies near the posterior surface of the pancreas - Within the head, main duct turns inferiorly and comes close to the bile duct - The ampulla opens into the duodenum via the MAJOR DUODENAL PAPILLA - It drains digestive enzymes into the duodenum - There are 3 sphincters that regulate flow of bile and pancreatic juices to the duodenum
62
The main duct unites with the bile duct to form the:
Hepatopancreatic ampulla
63
What are the 3 sphincters that regulate flow of bile and pancreatic juices to the duodenum?
1. Pancreatic duct sphincter (around the terminal part of the main duct) 2. Hepatopancreatic sphincter (around ampulla) 3. Choledochal sphincter (around bile duct)
64
Describe the accessory duct:
- It drains part of the head of the pancreas, variable | - It usually joins the main duct (in 9% of humans it may drain directly into the minor duodenal papilla)
65
What is the arterial supply of the pancreas?
From the splenic and pancreaticoduodenal arteries. Up to 10 small branches of the splenic artery supply the body and tail of the pancreas.
66
What is the role of the anterior and posterior pancreaticoduodenal arteries?
They form an arcade in the head of the pancreas and supply the head and neck of the pancreas
67
The pancreatic veins drain into the:
Portal, splenic, and superior mesenteric veins
68
The majority of pancreatic veins drain into the:
Splenic vein
69
The pancreaticosplenic nodes lies along the:
Splenic artery
70
The pyloric lymph nodes lie near the:
Pylorus
71
Where do all pancreatic lymph nodes drain into?
The celiac, hepatic, and superior mesenteric lymph nodes
72
Innervation of the pancreas comes from:
Vagus and splanchnic nerves
73
The pain fibers are carried by:
The splanchnic nerves
74
The sympathetic and parasympathetic fibers travel along the arteries from the:
Celiac and superior mesenteric plexuses
75
Defining characteristics of the spleen:
- Large, soft vascular lymphatic organ located in the left upper quadrant of the abdomen - Largest single mass of lymphoid tissue - It is in contact with the posterior wall of the stomach - It is anterior to the superior pole of the left kidney - Its capsule and trabeculae contain smooth muscle - The hilum is usually intimately related to the tail of the pancreas
76
Is the spleen peritoneal or retroperitoneal?
Peritoneal
77
What is attached to the hilum of the spleen?
The gastrosplenic and splenorenal ligaments are attached to the hilum of the spleen on its medial aspect where branches of the splenic artery enter and branch. The splenic veins exit at the hilum
78
Describe the diaphragmatic surface:
- Convex and smooth - Contacts diaphragm at 9-11 ribs - Superior border is sharp - Posterior and inferior borders are rounded
79
Describe the visceral surface:
It is in contact with the posterior wall of the stomach and is connected to the greater curvature of the stomach by the GASTROSPLENIC LIGAMENT and left kidney by the splenorenal ligament
80
The 3 surfaces of the visceral spleen include:
Colic, gastric, and renal
81
What is the gastrosplenic ligament?
The peritoneal covering of the greater curvature of the stomach enclose the spleen. Ther peritoneum between the stomach and the spleen is called the gastrosplenic ligament
82
What is the splenorenal ligament?
This peritoneal layer encloses the pole of the left kidney, the splenic vessels and the tail of the pancreas
83
What is the largest branch of the celiac trunk?
The splenic artery - follows a torturous course along the superior border of the pancreas. Between the layers of the splenorenal ligament, the artery divides into 5 or more branches, which enter the hilum of the spleen
84
What are the branches of the splenic artery in the spleen considered to be?
End arteries - there are no anastomoses between the small branches of the splenic arteries so obstruction of one of them could result in death of splenic tissue of that area
85
Describe the venous drainage of the spleen:
The splenic vein is formed by several tributaries that emerge from the hilum of the spleen. It is joined by the INFERIOR MESENTERIC vein and runs posterior to the body and tail of the pancreas.
86
Near the neck of the pancreas, the splenic vein joins the _________ to form the portal vein.
Superior mesenteric vein
87
Where do splenic lymph vessels drain?
Into the pancreaticosplenic lymph nodes which are present in the posterior surface of the superior border of the pancreas
88
What is the innervation to the spleen?
Nerves to the spleen are derived from the celiac plexus. They are mostly vasomotor - control how much blood flows in
89
What happens when the spleen is ruptured?
Severe intraperitoneal hemorrhage and shock (the spleen is the most frequently ruptured abdominal organ)
90
What is the problem with splenomegaly?
Some disease result in the enlargement of the spleen (splenomegaly) --> an enlarged spleen crowds other abdominal viscera
91
Why are the splenic arteries important?
They are end arteries and of surgical important - ligation of a branch will result in necrosis of that splenic segment it supplies.
92
Is the spleen essential for life?
No, like the appendix, it is proposed that removal of the spleen may not cause major problems to adult human health

Anatomy Unit III (13 decks)

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