Stomach, Duodenum, Spleen, Pancreas Flashcards
/What are the functions of the stomach
Acts as a storage tank for food
Site of initial food breakdown
Chemical breakdown of proteins begin
Delivers chyme to small intestine
Where does the stomach lie in the supine position?
Left and right upper quadrants
Epigastric, umbilical, left hypochondrium, and left flank regions
What are the 4 parts of the stomach?
Cardia
Fundus
Body
Pyloric part
What does the cardia of the stomach surround?
It sounds the cardial orifice
What is the cardial orifice?
The superior opening/inlet of the stomach
Where does the cardial orifice lie in the supine position?
Posterior to left 6th costal cartilage, 2-4cm from medial plane at the level of T11
What is the fundus?
The dilated superior part of the stomach related to the left dome of the diaphragm
What is the fundus limited inferiorly by?
Horizontal plane of the cardial orifice
Where does the fundus lie in the supine position?
Posterior to left 6th rib in the MCL
Where does the body of the stomach extend from?
Fundus to pyloric antrum
What is the pyloric part of the stomach?
It is the funnel-shaped outflow region of the stomach
What is the widest part of the pyloric part?
Pyloric antrum
What is the narrowest part of the pyloric part?
Pyloric canal
What is the pylorus?
It is the distal, sphincteric region of the pyloric part
What is the sphincter found in the pyloric part and what is it composed of?
Pyloric sphincter, which is a thickening of the circular muscles of the stomach
What is the pyloric orifice?
The inferior opening of the stomach leading to the duodenum
What is the level of the pylorus in the supine position?
L1
What are the curvatures of the stomach?
Greater curvature
Lesser curvature
What is the greater curvature of the stomach?
Longer, convex, left border of the stomach
What does the greater curvature of the stomach provide attachment for?
Greater omentum
What is the lesser curvature of the stomach?
Shorter, concave, right border of the stomach
Where is the cardial notch located?
Between the oesophagus and fundus
Where is the angular incisure/notch located?
Between the body and pyloric part
What does the lesser curvature provide attachment for?
Lesser omentum
What are the folds of circular muscle within the stomach that appear as longitudinal wrinkles/ridges?
Gastric folds or rugae
Which structures lie anterior to the stomach?
Diaphragm
Left lobe of liver
Left costal margin
Anterior abdominal wall
Which structures lie posterior to the stomach?
Omental bursa
Pancreas
Transverse mesocolon
Transverse colon
Left kidney and suprarenal gland
Spleen and splenic artery
Which structures lie superior to the stomach?
Left dome of the diaphragm
Which structures form the bed of the stomach, from superior to inferior?
Structures forming the posterior wall of the omental bursa
Left dome of diaphragm
Spleen
Left kidney and suprarenal gland
Splenic artery
Pancreas
Transverse mesocolon
Which arteries supply the stomach?
Left gastric artery
Right gastric artery
Left gastroepiploic (gastro-omental) artery
Right gastroepiploic (gastro-omental) artery
Short gastric arteries
Posterior gastric artery
Which veins drain the stomach?
Right and left gastric veins -> hepatic vein
Short gastric vein and left gastroepiploic vein -> splenic vein
Right gastroepiploic vein -> SMV
Prepyloric vein
Which lymph vessels drain the superior 2/3 of the stomach?
Lymph drains along the right and left gastric vessels to the gastric lymph nodes
Where does lymph from the fundus and body of the stomach drain?
Drains along the short gastric arteries and gastro-omental vessels to the pancreaticosplenic lymph nodes
Where does lymph from the right 2/3 and inferior 1/3 of the stomach drain?
Drains along the right gastro-omental vessels to the pyloric lymph nodes
Where does lymph from the left 1/3 of the greater curvature drain?
Drains into the pancreaticoduodenal lymph nodes
Where does the duodenum begin and end?
It begins at the pylorus to the right and ends at the duodenojejunal flexure/junction on the left
At what vertebral level does the duodenojejunal flexure occur?
L2
What are the parts of the duodenum?
Superior/First part
Descending/Second part
Inferior/Third part
Ascending/Fourth part
What is the vertebral level of the superior part of the duodenum?
L1 - it lies anterolateral to the body of L1
What is the ampulla of the duodenum (duodenal cap)?
The first 2cm of the superior part of the duodenum that has mesentery and is mobile
What overlaps the first part of the duodenum?
Liver and gallbladder
What attaches to the proximal part of the superior duodenum?
Hepatoduodenal ligament superiorly
Greater omentum inferiorly
What is the length of the first part of the duodenum?
5cm
What is the length of the descending duodenum?
7-10 cm
What is the vertebral level of the descending duodenum?
Right sides from L1-L3
What does the second part of the duodenum curve around?
The head of the pancreas
What opens into the posteromedial wall of the descending duodenum?
Bile and pancreatic ducts into the major duodenal papilla
Is the descending part of the duodenum intraperitoneal or retroperitoneal?
Retroperitoneal
What is the length of the inferior part of the duodenum?
6-8cm
At which vertebral level does the inferior part of the duodenum lie?
It crosses L3
What does the third part of the duodenum cross on its path?
Aorta, IVC and L3
What crosses the inferior part of the duodenum?
Superior mesenteric artery and vein
Root of mesentery
What lies superior to the third part of the duodenum?
Head of the pancreas and uncinate process
What separated the inferior part of the duodenum from the vertebral column?
Right psoas major
Aorta
IVC
Right gonadal vessels
What is the length of the ascending duodenum?
5cm
What vertebral level does the ascending part of the duodenum lie?
It begins to the left of L3 and runs superiorly to the superior border of L2
What supports the duodenum at the duodenojejunal junction?
Suspensory muscle of the duodenum or Ligament of Treitz
Where does the ligament of Treitz originate from?
Right crus of the diaphragm
Which arteries supply the duodenum?
Anterior and posterior superior pancreaticoduodenal arteries
Anterior and posterior inferior pancreaticoduodenal arteries
Which veins drain the duodenum?
Veins follow the arteries to drain into the hepatic portal vein directly, or the SMV or splenic vein indirectly
Where do the anterior lymphatic vessels of the duodenum drain?
Pancreaticoduodenal lymph nodes into the pyloric lymph nodes
Where do the posterior lymphatic vessels of the duodenum drain?
Pass posterior to the head of the pancreas to drain into the superior mesenteric lymph nodes
Where do efferent vessels from the duodenal lymph nodes drain?
Celiac lymph nodes
Where is the spleen located?
Superolateral part of the left upper quadrant or left hypochondrium
What are the functions of the spleen?
It is the largest lymphatic organ and participates in the body’s defence system as a site of lymphocyte proliferation and of immune surveillance and response
Prenatally, it is a haematopoietic organ.
After birth it is involved in identifying, removing and destroying expanded RBCs and broken down platelets
Recycling iron and globin
Blood-reservoir, storing RBCs and platelets
Which part of the spleen is not covered by peritoneum?
The splenic hilum
What are the surfaces of the spleen?
Diaphragmatic surface
Visceral surface
What is the difference between the anterior and superior borders of the spleen to the posterior and inferior borders of the spleen?
Anterior and superior = notched
Posterior and inferior = rounded
What is the thin fibrous capsule of the spleen composed of?
Dense, irregular, fibroelastic connective tissue that is thickened at the splenic hilum
Which ligaments attach the spleen to the stomach and kidney?
Gastrosplenic ligament
Splenorenal ligament
What lies anteriorly to the spleen?
Stomach
What lies posteriorly to the spleen?
Left hemidiaphragm, which separates it from the pleura, lungs and ribs 9-11
What lies inferiorly to the spleen?
Left colic flexure
What lies medially to the spleen?
Left kidney
What are the impressions found on the spleen?
Gastric impression
Renal impression
Colic impression
What does the pancreas produce?
Exocrine secretions from the acinar cells
Endocrine secretions from the pancreatic islets
What are the parts of the pancreas?
Head, neck, body and tail
What does the head of the pancreas attach to?
Medial aspect of the descending and horizontal parts of the duodenum
What is the uncinate process?
This is a projection from the inferior part of the pancreatic head, which extends medially to the left, posterior to the SMA
What is located posterior to the pancreatic head?
IVC
Right renal artery and vein
Left renal vein
Which vessels are overlied by the pancreatic neck?
Superior mesenteric vessels
What union occurs posterior to the pancreatic neck?
The union of the splenic vein and SMV to form the portal vein
What is the posterior surface of the body of the pancreas in contact with?
Aorta
SMA
Left suprarenal gland
Left kidney
Left renal vessels
What is the tail of the pancreas related to?
Splenic hilum and splenic flexure
Which ligament does the tail of the pancreas lie in?
Splenorenal ligament
Where does the main pancreatic duct being and run through?
It begins in the tail of the pancreas and runs through the parenchyma of the gland to the head
What does the union of the main pancreatic duct and bile duct form?
Hepatopancreatic ampulla
Where does the hepatopancreatic ampulla open into?
It opens into the second part of the duodenum into the major duodenal papilla
What is the sphincter located around the ampulla of Vater?
The sphincter of Oddi
Where does the accessory pancreatic duct open into?
Minor duodenal papilla
