Lecture Notes - Stomach, Spleen, Duodenum, & Pancreas
Foregut Structures (supplied by the celiac trunk): abdominal esophagus, stomach, spleen, proximal half of duodenum, pancreas, liver and biliary system.
  1. Review of the Developmental Anatomy and Peritoneal Relationships:
    1. Dorsal mesentery: greater omentum (gastrophrenic, gastrosplenic, gastrocolic ligaments and omental apron)
    2. Ventral mesentery: lesser omentum (gastrohepatic and gastroduodenal ligaments)
    3. Omental bursa (lesser sac) and epiploic foramen (of Winslow)
    4. Relationship to transverse mesocolon
  2. Abdominal Esophagus - Descends through the esophageal hiatus of the diaphragm.
  3. Stomach - fixed at T11 and L1 or L2
    1. Nerves
      1. Sympathetic: postganglionic fibers from the celiac ganglia (preganglionic fibers from the greater thoracic splanchnic nerve, T5 - T9 or 10)
      2. Parasympathetic: from the vagus (X)
        1. Anterior vagal trunk (continuation of the left vagus)
          • gastric branches
          • hepatic branch
        2. Posterior vagal trunk (continuation of the right vagus)
          • gastric branches
          • celiac branch
    2. Parts: cardia, fundus, body, and pylorus (pyloric antrum, canal, and sphincter)
    3. Blood Vessels:
      1. Arteries - Celiac trunk (axis)
        1. Left gastric artery:
          • gastric branches
          • esophageal and hepatic branches
        2. Splenic artery:
          • splenic branches
          • short gastric branches
          • left gastro-omental (gastroepiploic) a.
        3. Common hepatic artery:
          • proper hepatic a. - right gastric a.
          • gastroduodenal a. - right gastro-omental (gastroepiploic) a.
      2. Veins - Portal Vein: venous blood from the abdominal digestive organs.
        1. Directly into the portal vein:
          • left gastric v. (plus esophageal v.) and right gastric v.
        2. Via superior mesenteric vein: right gastro-omental v.
        3. Via splenic vein:
          • splenic branches
          • short gastric branches
          • left gastro-omental v.
          • inferior mesenteric v.
    4. Lymphatic Drainage: four regions drain into the celiac nodes near the celiac trunk.
  4. Spleen
    1. Projection on ribs, 9th, 10th and 11th.
    2. Visceral surface - contact stomach, kidney, pancreas, and left colic flexure.
    3. Hilum - site of entrance of the splenic vessels.
    4. Costal (diaphragmatic) surface
    5. Internal structure: no regular segmentation.
    6. Capsule: thin and easily ruptured, difficult to repair.
  1. Duodenum
    • first part of small intestine
    • fixed, mostly retroperitoneal C-loop, fusion fascia
    • four parts:
      • first (L1): no circular folds, peritoneal
      • second (L1,2,3) descending: major + minor duodenal papillae
      • third (L3) transverse: crossed by SMA and SMV
      • fourth (L3,2) ascending: duodenojejunal flexure, suspensory muscle of duodenum (lig. of Treitz)
  2. Pancreas
    • retroperitoneal
    • head with uncinate process, neck, body + tail
    • main (+ accessory) pancreatic ducts, proximity to common bile duct
  3. Arteries and Veins of Duodenum and Pancreas
    • from gastroduodenal a.:
      • supra- and retroduodenal aa.
      • ant.+post. superior pancreaticoduodenal aa.
    • from SMA: ant.+post. inferior pancreticoduodenal aa.
    • from splenic a.: dorsal -, great - and caudal pancreatic aa.
    • anastomoses, ant. + post. arcades, vasa recta to duodenum
    • venous drainage to portal vein directly or via splenic vein or SMV