Duodenum general characteristics
- C or J shaped
- Shortest/widest & most fixed part of SI
- Made up by 4 parts
- Both retroperitoneal & intraperitoneal
Superior part of duodenum
- @ the level of L1
- frist part connects with pyloric of stomach
- Duodenal cap has mesentery
- Distal half retroperitoneal
Descending part of duodenum
- @ the level of L1-L3
- 2nd part right of IVC
- Bile & pancreatic ducts open here (ampulla of Vater)
Horizontal & Ascending part of duodenum
Horizontal = retroperitoneal @ the level L3 Ascending = Intraperitoneal @ the level L3, Duodenaljejunal flexure, which is supported by ligament of Trietz (connects to diaphragm & allows for widening of flexure to assist passing contents through)
Pancreas general characteristics
- Retroperitoneal
- Located @ L1
- Wraps around SMA/SMV
- 4 parts (Head,neck, body, tail)
Exocrine/Endrocrine function of Pancreas
Exocrine: Pancreatic juices @ pH 8, pancreatic enzymes-Trypsinogen (precursor of trypsin-protein), Amylase-carbohydrates (starch/glycogen), Lipase (breaks TAGs to mono/FFA)
Endocrine: Insulin, glucagon, somatostatin
Transpyloric plane (L1)
- Pylorus (stomach)
- Pancreas
- Fundus of gallbladder
- Hila of kidneys (center where vessels go in)
- Hilum of spleen
- SMA & HPV
Relations with pancreas
- Head: located post. to 2nd & 3rd part of duodenum & SMV/SMA
- Neck: Ant. to SMV/SMA & post to pyloric stomach
- Body: ant. to hilum of left kidney & post to body of stomach
- Tail: Ant. to left kidney & points left post to spleen
Vessel and pancreas
- Head/neck wrap around SMV
- Splenic vein with in pancreas and bifurcates @ body to IMV
- Splenic vein end @ spleen
- Body & tail = splenic artery
- Head & neck = sup/inf pacreatoduodenal arteris
Pancreatic duct
- Main pancreatic duct travels down tail to head where it joins with bile duct to ENTER the major duodenal papilla (Vater)
- Minor duodenal papilla = Accessory pancreatic duct
General characteristics of the Spleen
- Notched by 9,10,11 ribs
- Hilum = where veins/arteries enter/exit
- 3 major impressions (Gastric, renal, colonic)
- Splenic artery
Functions of the Spleen
- Filter: Removal of RBC & Removal of Leukocytes
- Immunological function: Removal of bacteria, antibody synthesis, protection from infection
Relations to the Spleen
- Posterior: 8-10 ribs, Left kidney
- Anterior: Stomach, greater momentum
Blood supply Duodenum
- Junction of foregut to midgut @ duodenum 4 parts lie in both areas
- Duodenum (4 parts) received part of blood supply from celiac artery & SMA
- watershed area (dual blood supply): 1/2 way along 2nd duodenum
Etiology of Haematemesis
- Brownish/red vomit
- Major 55% PUD (peptic ulcer disease)
- Minor 10% Varices & Erosive gastritis
- Bleeding: Blood color/volume, alcohol intake, previous ulcers, pervious vomiiting, NSAID use
Characteristics of Appendicitis
Pain: Upper abdomen, sharp, mild to severe, intermittent to constant, pain with meals/alcohol, pain relieved sitting forward?
-Presents w/fever, jaundice, vomiting, abdominal distention, weight loss, pale color stools
Etiology of acute pancreatitis
- G E T S M A S H E D
- Major cause: Gall stones 40%
- 2nd Major cause: Ethanol 35%
- Elevated pancreatic enzymes (lipase, trypsinogen, etc..)
Other side effects of pancreatitis
- Pyrexia (76%) aka Fever
- Tachycardia (65%)
- Distension (65%)
- Jaundice (28%)
Body wall ecchymoses
- Pancreas begins to liquify and break down into other surround tissues.
- Grey Turners = Bruising
- Cullen’s = Discoloring around umbilicus
- Both can present together
