SDL - Duodenum, Pancreas, Spleen

Question 1

Describe 1st part of duodenum

Answer 1

Ascends, the first part is intraperitoneal (hepatoduodenal ligament)

L1

Question 2

Describe 2nd part of duodenum

Answer 2

Descends to right part of lumbar vertebra down to L3

Question 3

Describe 3rd part of duodenum

Answer 3

Horizontal across to the left, going over the IVC, aorta and L3 vertebral body

Question 4

Describe 4th part of duodenum

Answer 4

Superiorly, to the left of the aorta, up to the pancreas.the joins jejunum at duodenaljejunal junction. Here it is supported by a thin slip of muscle – suspensory muscle of diaphragm. A piece of peritoneum (ligament of treitz) causes duodenum to ascend. When this muscle contracts the flexure widens allowing food to enter the jejunum

Question 5

Describe the difference between duodenum and jejunum

Answer 5

Duodenum is retroperitoneal (except first part)

Jejunum has mesentery

Question 6

Where is the uncinate process? Describe its relation to important vessels

Answer 6

Extension of head of pancreas

Lower part of head is prolonged to the left, behind the SMA and SMV and in front of the aorta

Question 7

What vein is formed behind the neck of the pancreas?

Answer 7

Hepatic portal vein

Question 8

What is the tail of the pancreas invested in?

Answer 8

The splenorenal / lienorenal ligament

Question 9

What is the exocrine component of the pancreas responsible for?

Answer 9

The secretion of various digestive enzymes

These are collected into a series of ducts which, in turn, open into a principal pancreatic duct

Question 10

Where does the major pancreatic duct join the common bile duct?

Answer 10

At the hepatopancreatic ampulla (of Vater). this empties into the duodenum at the major duodenal papilla.

Question 11

What is the hepatopancreatic ampulla (of Vater) controlled by?

Answer 11

Sphincter of Oddi

Question 12

What does the accessory pancreatic duct drain?

Answer 12

The uncinate process

Question 13

Where does the accessory pancreatic duct empty into?

Answer 13

Duodenum at minor duodenal papilla

Question 14

The major duodenal papilla marks the boundary between which two subdivisions of the gut?

Answer 14

Foregut and midgut

Question 15

What are the important relations of the pancreas?

Answer 15

Tail = spleen

Body = origin of transverse mesocolon

Neck = formation HPV posteriorly

Head = within concavity of duodenum

Uncinated process = SMV and SMA anteriorly

Question 16

What effects might you expect from a carcinoma of the head of the pancreas?

Why is this condition often inoperable?

Answer 16

Jaundice

Location within abdomen and its vascular relations. Also has considerable lymph associated.

Question 17

Where does the spleen lie?

Answer 17

It lies beneath the costal margin, in the left hypochondrium.

Question 18

What ribs is the spleen related to?

Answer 18

Ribs 9-11

Question 19

Where does the hilum of the spleen lie?

Answer 19

The hilum of the spleen lies at the level of L1 vertebra ie. in the transpyloric plane.

Question 20

What is the transpyloric plane?

Answer 20

An imaginary axial plane located midway between the jugular notch and superior border of pubic symphysis, at approximately the level of L1 vertebral body.

Question 21

What are the important relations of the spleen?

Answer 21

Laterally = ribs
Medially = lesser sac, stomach, pancreas
Superiorly, anteriorly and posteriorly = diaphragm
Inferiorly = splenic flexure