!"#$%&' !")*$+' ,&-#$+. "#$% /&'0() *+,- ./0&1%2 #20 "%3456 78&0%2819 "#2:;%#6 #20 )<3%%2 7;= >= ?%&0&65& @ A&4%1/%; @*9 *+@B TOPIC OUTLINE I. Spleen A. Characteristics B. Ligaments C. Surface Features D. Borders E. Vessels F. Innervation II. Pancreas A. Characteristics B. Parts C. Vessels D. Innervations E. Ducts III. Small intestine A. Characteristics B. Parts 1. Duodenum 12Jejunum and IleumI. SPLEEN A. CHARACTERISTICS Location •In theleft hypochondriac region(left upper abdominal quadrant) closely related to the left lung, left pleural cavity, and left ostophrenic recess •Under the cover of the left 9th-11th ribsin the midaxillary line oif the left-side lower ribs and/or upper lumbar transverse processes are fractured, the spleen is also most likely damaged/ruptured Fig 1. Anterior View of the Spleen Fig 2. Lateral View of the Spleen •Usually not palpable oin case of hypertrophy/enlargement, do NOT palpate !possibility of rupture and can be fatal •Position assessed by percussion oNormal: dull area over 9th-11th ribs, should not go beyond midaxillary line oAbnormal(i.e. enlargement): dull area over 9th-10th ribs Functions •Prenatal – Hemapoetic organ •Afterbirth – identifies, removes, and destroys expende RBC’s and broken down platelets; recylces iron and globin •Largest lymphatic organ – lymphocyte proliferation and immune response •Blood reservoir •Can self-transfuse in times of hemorrhagic stress Clinical Correlation •Blunt force trauma to the abdomen (e.g. crush injury, punch/blow) •When diseased, can possibly rupture from mild mechanical stimulation (e.g. palpation) B. LIGAMENTS •Attach to the medial aspect of spleen hilum •Gastrosplenic ligament oFrom the hilum to the left part of the greater curvature oContains short gastric arteries and left gastroepiploic artery •Splenorenal ligament oFrom the front upper half of the left kidney to the hilum of spleen C. SURFACE FEATURES •Diaphragmatic Surface oConvex and smooth oBeneath left lead of diaphragm and adjacent ribs •Visceral Surface oGastric Surface "Upper part of posterior stomach "Adjacent to notch located on superior border oRenal Surface "Lateral upper part of left kidney "Near inferior border, absence of notch on this side Fig 3. Surface Impression of the Spleen •Impressions oColic Impression
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OS 206 E1 20131112 Spleen, Pancreas and Small Intestine v2
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7/17/2019 OS 206 E1 20131112 Spleen, Pancreas and Small Intestine v2
• Bodyo Triangular cross-sectiono Anteriorly covered with peritoneum
and forming part of stomach bedo Posteriorly devoid of peritoneum and
in contact with SMV, aorta, leftsuprarenal gland, left kidney
o Lateral to SMVo Overlies aorta and L2 verterbra, above
transpyloric plane and beneath omentalbursa
• Tailo Anterior to left kidneyo Close to splenic hilum and left colic
flexureo Relatively mobileo Passes between layers of splenorenal
ligament with splenic vessels
C. VESSELS Arterial Supply
• Pancreatic arteries # splenic artery –(forms)! arcades with pancreatic gastroduodenal artery and Superior Mesenteric Artery (SMA)
• Head:o Anterior and posterior
pancreaticoduodenal arteries arebranches of gastroduodenal artery
o Anterior and posterior inferiorpancreaticoduodenal arteries arebranches of SMA
o Shares same blood supply asduodenum (via two arterial arcadesembedded in anterior and posteriorsurface of pancreatic head) , requiring
removal of duodenal part duringpancreatic resection
• Body and Tail:o ~10 splenic artery brancheso Dorsal, inferior, great pancreatic arteries
Venous Drainage
• Pancreatic veins - correspond to pancreaticarteries; tributaries of splenic and superiormesenteric parts
• Mostly empty into splenic vein –(joins)! SMA –(forms)! hepatic portal vein
Fig 9. Venous Drainage of the Pancreas
Lymphatics
• Follow blood vessels
• Most terminate at the pancreaticosplenic lymphnodes lie along splenic artery
• Some terminate at the pyloric lymph nodes
• Drain into superior mesenteric lymph nodes orcoeliac lymph nodes (via hepatic lymph nodes)
D. INNERVATION
• From CN X and abdominopelvic splanchnic
nerves
• Parasympathetic and sympathetic fibers reach
pancreas by passing along the arteries fromceliac plexus and superior mesenteric plexus;also distributed to pancreatic acinar cells andislets
• Parasympathetic fibers: secretomotor, butpancreatic secretion is primarily mediated bysecretin and cholecystokinin (formed by epithelialcells of duodenum and upper intestinal mucosa;stimulated by acid contents
E. DUCTS
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• Duct of Wirsung (Main Pancreatic Duct)o Runs the length of the pancreas
collecting radicles from the entire bodyand tail from the posteroinferior part of
the head including the uncinate process
o Begins in the tail and runs through theparenchyma of the gland to thepancreatic head where it turns inferiorlyand is closely related to the commonbile duct
o Ampulla of Vater# duct of Wirsung +common bile duct
• Duct of Santorini (Minor Pancreatic Duct)o 2 cm superior to main ducto Drains anterosuperior part of the heado Opens into the descending (or 2
nd ) part
of the duodenum at the summit of minorduodenal papilla
o Usually communicates with the mainpancreatic duct (60% of the time)
o Sometimes larger than the mainpancreatic duct and not connected to it
" fusion or lack thereof duringpancreatic developmentexplains variations of the ducts
Clinical Correlations
• Carcinoma of the head of the pancreas usuallyshows itself by painless progressive jaundice anddistention of the gallbladder due to compressionof the common biliary duct
o Compresses and obstructs bile ductand/or hepatopancreatic ampulla
o Effects: Causes: Obstruction,enlargement of gallbladder, and
jaundice (obstructive jaundice)
• 90% of people with pancreatic cancer haveductular adenocarcinoma
•
Carcinoma involving the neck and body involvesportal or IVC obstruction
III. SMALL INTESTINES
A. CHARACTERISTICS
• Site of digestion and food absorption
• 6-7 m long
• From pylorus to ileocecal valve
• Jejunum and ileum: long greatly coiled partsattached to the posterior abdominal wall bymesentery
o jejunum: proximal 2/5o ileum: distal 3/5
B. PARTS
Fig 11. Parts of Duodenum
1. Duodenum
• 20-25 cm long
• First part of the small intestine
•
Shortest, widest, and most sessile part of thesmall intestine
• No mesentery; partially covered by the
peritoneum
• Curves in a “C” around the head of the pancreas
4 PARTS
1st Part/Superior Duodenum
• 5 cm long; extends from the pylorus to the neck
• Most movable of all parts
• Anteriorly covered by peritoneum but bareposteriorly (except near pylorus)
• Relations:
o Anteriorly: quadrate lobe of liver andgallbladder
o Posteriorly: lesser sac, gastroduodenalartery, bile duct, portal vein, IVC
o Superiorly: epiploic forameno Inferiorly: head of pancreas
2nd Part/Descending Duodenum
• 8-10 cm long
• from the neck of the gallbladder to the lowerborder of L3 vertebra
• Relations:o Anteriorly: gall bladder, fundus, right
lobe of liver, tranverse colon, coils ofsmall intestine
o Posteriorly: hilum of right kidney andright ureter
o Laterally: ascending colon, right colicflexure, right lobe of liver
o Medially: head of pancreas, bile ductand main pancreatic duct
3rd Part/Horizontal Duodenum
• 10 cm long
• crossed by SMV
• runs horizontally to the left of the subcostal plane
• begins at the lower border of the L3 vertebra and
ascends at the 4th part in front of the abdominal
aorta
4th Part/Ascending Duodenum
• 2.5 cm long
• ascends to the level of upper border of the leftsuspensory ligament of Treizt (which is attachedto the right crus of diaphragm)
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• marked peritoneal fold from the diaphragm toduodenal termination
Relations:
• Anteriorly: beginning of mesentery root and coilsof jejunum
• Posteriorly: left margin of aorta and medial borderof psoas muscle
CLINICAL
• Radiologically, after a barium meal, the superiorpart appears as a triangular homogenousshadow, known as the duodenal cap
• Plicae circulares (valves of Kerkring) orcircular folds appear about 2.5 to 5 cm from thepylorus, which are large crescentic folds whichproject into the intestinal lumen
ARTERIAL SUPPLY
• 1st
par t: Supraduodenal, retroduodenal, andduodenal branches from the right gastric, rightgastroepiploic, andgastroduodenal/pancreaticoduodenal arteries
• Sympathetic and vagus nerves from celiac andsuperior mesenteric plexuses
2. JEJUNUM AND ILEUM
• Attached to the posterior abdominal wall by a fan-shaped fold of peritoneum called the mesenteryof the small intestine
• Root of the mesentery permits the entrance andexit of the branches of the superior mesentericartery and vein, lymph vessels, and nerves intothe space between the two layers
DIFFERENCES:
Proximal Jejunum (2/5) Distal Ileum (3/5)
In upper part ofperitoneal cavity, below
left side of thetransverse mesocolon
In lower part ofperitoneal cavity
and in pelvis
Wider, thicker, heavier(because of morenumerous plicaecircularis), redder
intestinal wall
Narrower, thinner,lighter (because of
very small or absentplicae circularis), paler
intestinal wall
Mesentery attachmentin posterior abdominalwall above and to the
left of the aorta
Mesentery attachmentin posterior abdominalwall below and to the
right of the aorta
Form only 1 or 2
arcades of mesentericarteries
3 or more arcades ofmesenteric arteries
Less fat in mesenteryPresence of
translucent areasFat deposited near theroot and scanty near
the intestinal wall
Abundant mesenteryfat
Laden and opaqueUniform deposition of
fat, extending from rootto wall
No Peyer’s PatchesPresence of Peyer’s
Patches
More folds Less folds
More vascular (redder) Less vascular (paler)
• Caliber of the small intestine diminishes as does
the thickness of its muscular wall from theproximal jejunum to the distal ileum
• Peyer’s patches are visible and often palpableon the antimesenteric border of the ileum
• The mesentery of the proximal small bowel isthinner and contains less fat between its leavesand is more translucent than the mesentery ofthe distal small bowel
• There is more of a marked tendency towardarborization and anastomosis of arterial andvenous arcades in the mesentery of the distalileum than in the mesentery of the proximal
jejunum
ARTERIAL SUPPLY
• Branches of SMA
• Intestinal branches ! gut (anastomose to formarcades)
• Ileocolic artery! lowest part of ileumVENOUS DRAINAGE
• Sympathetic and vagus nerves from superiormesenteric plexus
CLINICAL
• Although trauma to the jejunum and ileum iscommon, the injury is less serious compared totrauma in the duodenum. This is because theyare able to move freely, reducing crushing impactfrom blunt trauma. Penetrating injuries may self-seal through mucosal plugging.
• Mesenteric arterial occlusion – the superiormesenteric artery supplies an extensive portionof the gut. An occlusion as the result of embolus,thrombus, aortic dissection, or abdominalaneurysm results in death of all or part of the gutfrom the duodenum to the left colic flexure.
End of Transcription
Aldwin: Hello sa mga anatomates ko, sa Sigma Row 7 & 8
at sa A-Band! :D
Almira: Sorry di ako nakalagay ng message sa initial copy.=]] Umm!hello? Also, advanced happy birthday to