The Pancreas and Spleen Flashcards
Where is the pancreas located?
Posterior to the stomach
Is the pancreas intraperitoneal or retroperitoneal?
Retroperitoneal
Where does the pancreas extend from?
From duodenum on the right across the posterior abdominal wall to the spleen on the left.
Which part of the pancreas is intraperitoneal?
The tail
What level is used to identify the pancreas?
L1
What is the pancreas divided into/
- Head
- Body
- Neck
- Tail
- Uncinate process
Where does the head of the pancreas lie?
Within the curve of the duodenum
What vessels cross the head of the pancreas?
The superior mesenteric artery and vein.
Where does the uncinate process lie and wrap?
Lies adjacent to the ascending part of the duodenum and wraps behind the SMA and SMV
What does the tail of the pancreas extend into?
Extends into the Splenorenal ligament and abuts the spleen.
What are the three anterior branches of the aorta that supply the GI tract and related structures?
- Coeliac Trunk
- Superior Mesenteric Artery
- Inferior Mesenteric Artery
What organs are supplied by the Coeliac trunk?
Ab. eosophagus Stomach Duodenum Liver Pancreas Gall bladder Spleen
What is supplied by the Superior Mesenteric Artery?
ACARDS Duodenum Small Intestine Caecum Appendix Ascending colon Right 2/3 of transverse colon
What is supplied by the inferior mesenteric artery?
LARDS Left 1/3 of transverse colon Descending colon Sigmoid colon Rectum Anal canal
Where does the 20-25% of the livers blood supply come from?
From the hepatic branch of the coeliac artery.
Where does blood flow through in the liver before being returned to the heart by the Inferior vena cava.
liver sinusoids
What is the arterial supply of the body and tail of the pancreas?
The Splenic artery from celiac trunk
What is the arterial supply of the head of the pancreas?
Superior pancreatico-duodenal (common hepatic) and inferior Pancreatico-duodenal arteries (superior mesenteric)
Why is ischemia to the pancreas from vascular obstruction is uncommon?
Due to the dual supply
What is venous drainage of pancreas? x 2
Pancreatoduodenal veins (to SMV) and splenic vein to the portal vein
PG
15
Lymph nodes of the pancreas
Superior/inferior pancreatic lymph nodes
Where does the pancreatic duct begin?
In the tail of the pancreas
What is the region that the pancreatic duct joins the bile duct?
Hepatopancreatic ampulla (of Vater)
Where does the Hepatopancreatic ampulla open into?
The posterio-medial wall of part 2 of the duodenum at a point called the Major duodenal papilla.
Where does the accessory pancreatic duct empty into duodenum? and what does it drain?
At the minor duodenal papilla. This drains the
head and ucinate process.
What does the lower part of the head and uncinate process drain via?
Via an accessory pancreatic duct
What do papillas in pancreas contain? and function
Sphincteric muscle which controls the flow from the ducts
What does the hypertrophy of the head cause?
Portal or bile duct obstruction (eg Gall stone blocking ampulla of Vater)
What does the hypertrophy of the head cause?
Portal or bile duct obstruction (eg Gall stone blocking ampulla of Vater)
Pancreatitis types
Acute (serious) (Alcoholism, bile reflux) or chronic (Calcifications, Pseudocyst)
What is annular pancreas?
Ring of pancreatic tissue blocks part 2 of duodenum. New born disease (1 in 13, 000) Blocks food to GIT. Not all cases show symptoms
What does the type of adenocarcinoma of the pancreas depend on?
Location
Are adenocarincomas of the pancreas usually endocrine or exocrine?
90% are exocrine
What procedure is performed for tumours in tail and head of pancreas?
Radical distal pancreatectomy
What will you need after pancreatectomy?
Lifelong insulin and enzyme replacement.
Why is the spleen described with the pancreas?
As it drains into the portal venous system.
Where does the spleen lie? (relation to diaphragm) and quadrant/region
Its lies below the diaphragm in the upper left Quadrant → left hypochondrium
What ribs is the spleen found at?
Found underneath the 9th, 10th and 11th ribs on the left side.
Attachments of the spleen by ligaments x 2
Strong attachments to the stomach and left kidney;
- Gastrosplenic ligament
- Splenorenal ligament
What is the entry and exit point for splenic vessels
Splenic hilum
• Splenic artery -from celiac trunk
• Splenic vein – to portal vein
What does lymphatic drainage of the spleen occur via?
Via retropancreatic nodes at hilum to coeliac nodes
Innervation of the spleen
Coeliac plexus by sympathetic fibres
What does the hileum of the spleen make contact with ?
With the tail of the pancreas
Splenic artery branches
- Pancreatic branches
- Short gastric arteries
- Left gastroepiploic artery
- Posterior gastric
What is the anterior border notch of the spleen a relic of?
Of the fusion of the several lobules from which the organ arises in the embryo.
What is the red pulp of the spleen?
Sinusoids and vascular sinuses filled with blood
Function of red pulp of spleen
Purifies blood and removes dead or old blood cells
Composition of red pulp of spleen x 3
- A loose connective tissue network of reticulin fibres (collagen) and stellate fibroblasts;
- Capillaries.
- Numerous sinusoids with associated macrophages
What is the white pulp of spleen?
Aggregates of lymphoid tissue adjacent to central arteries
White pulp of spleen function
Produces white blood cells
x 5 clinical conditions of the spleen
- Enlarged Spleen (Splenomegaly)
- Ruptured spleen
- Sickle cell disease
- Thrombocytopenia
- Accessory spleen
