PANCREAS, DUODENUM, JEJUNUM & ILEUM
the regulation of carbohydrate the head & empties independently into the 2nd
PANCREAS
• Large, flat, lobulated gland associated with the
duodenum
• Long & irregular primatic in shape
• Location: upper part of the abdomen
• NOT accessible by physical examination
• Lies RETROPERITONEAL – mostly behind the lesser
sac
• Extends from the
o RIGHT SIDE of the L1,L2 & L3 vertebra to the
o LEFT of the hilum of the spleen
• Notes:
o Exocrine & endocrine gland
o Stomach, Pancreas, colon, & renal  touches
the spleen
PARTS OF PANCREAS
• HEAD
o Broad & flat, fits snugly into the curve of the
duodenum
o Left & upper part – continuous with the neck
o Left & lower part – projects the uncinate
process
o UNCINATE PROCESS – is inferior to the neck
of the pancreas & lies behind the superior
mesenteric vessels
• NECK
o Constricted by the superior mesenteric
vessels
o Lie in the pancreatic incisure
o A deep groove on the posterior surface of the
neck
• BODY
o Lies above the duodenal flexure & on the left
kidney
• TAIL
o The tapering right extremity extending into
the lienorenal ligament & to hilus of spleen
o FUNCTIONS:
 Produces BOTH exocrine & endocrine
secretion
 EXOCRINE secretion – contains
enzyme for digestion
 ENDOCRINE secretion – essential for
metabolism
RELATIONS
• ANTERIOR surface
o Transverse mesocolon – across the head &
lower part of the neck & body
o Stomach – through omental bursa
o Above
 lesser curvature,
 lesser omentum
 liver &
 1st part of the duodenum
• POSTERIOR surface
o Head – lies on the hilum of right kidney &
vessels
o Neck & Uncinate process – lies in front of
the aorta
o Body – crosses left kidney & left
suprarenal gland & right crus of
diagphram
• Confluence of the splenic & superior mesenteric veins
o  forms the portal vein on the posterior
surface of the neck
• Tip of the tail  makes contact with the spleen at the
hilum
PANCREATIC DUCTS
• 2 pancreatic ducts
o Main/ Chief pancreatic ducts (WIRSUNG)
o Accessory pancreatic duct (SANTORINI)
• Duct of WIRSUNG
o Runs the length of pancreas from the entire
tail & body
o From the postero-inferior part of the head,
including the uncinate process
o Formed by the junction of small ducts of
lobules from the tail through the body to the
neck
o Leaves the head piercing the duodenum &
ends by an orifice common to it & the
common bile duct at the summit of the major
duodenal papilla (Papilla of Vater)
• Duct of SANTORINI
o If present – drains the anterosuperior part of
part of the duodenum, at the minor duodenal
papilla
BLOOD SUPPLY
• Pancreatic branches of SPLENIC ARTERY
o Which run along the superior border of the
pancreas
• PANCREATICODUODENAL ARTERY
o Superior branch of gastroduodenal
o Inferior branch of mesenteric artery
VENOUS DRAINAGE
• Tributaries of:
o Splenic &
o Superior mesenteric veins
NERVE SUPPLY
• Derived from the CELIAC & SUPERIOR MESENTERIC
plexus
o Enter the posterior surface of the pancreas
• SECRETIN – hormone from the duodenum w/c control
the pancreatic enzyme secretion
• Spinal cord segments T6-T10 – the pain fiber of the
pancreas w/c run in the thoracic splanchnic nerves
LYMPHATIC DRAINAGE
• CELIAC & SUPERIOR MESENTERIC LN & some in
Lumbar LN
o Drains From the HEAD of the pancreas
• PANCREATICOLIENAL nodes along splenic vessels
o Drains From the body & tail of pancreas
o It send their efferent to the celiac nodes
DUODENUM
• 1st part of the small intestine
• Shortest, widest, most fixed, & most vascular portion
of the small intestine
• Has NO mesentery, only partially covered with
peritoneum
• Mainly RETROPERITONEAL
• Commences at the pylorus & ends to the left of the
midline opposite the 2nd lumbar vertebra in the
jejunum
• As it joins the jejunum, it turns abruptly forward,
forming the DUODENOJEJUNAL FLEXURE
• Together with the pancreas, it is the most deeply • Renal vessels
lying portion of the alimentary tract & the least • Inferior vena cava VENOUS DRAINAGE
accessible to physical examination • Psoas muscle – inferiorly • Veins if the duodenum w/c ends in the SPLENIC & S.
• Secretes secretin & pancreozymin o Medially MESENTERIC
• Head of pancreas + common bile duct
• Receive bile & pancreatic juice through the
o Laterally NERVE SUPPLY – Celiac plexus
common bile duct & pancreatic duct
• Right colic flexure
LYMPHATIC DRAINAGE
DIVISIONS of DUODENUM • The common bile duct & pancreatic duct
• Pancreaticoduodenal nodes
• Superior – 1st portion
o Together perforate the medial side of the 2nd o Drains superiorly – HEPATIC GLANDS
portion o Inferiorly – PREAORTIC NODES
• Descending – 2nd portion
• Transverse/ horizontal – 3rd portion HORIZONTAL/ TRANSVERSE PORTION MAJOR DUODENAL PAPILLA (PAPILLA of VATER)
• 5-7.5 cm long
• th
Ascending – 4 portion • Elevation at the medial portion of the inner surface of
• Begins at the right side of the upper border of L4 the descending part of duodenum
vertebra
SUPERIOR PORTION • At the summit of which is the common opening for
• 5 cm long • Crosses the midline in front of the great blood vessels the common bile duct & main pancreatic duct
• Begins at the pylorus & ends at the level of neck of & crura of the diaphragm, ends in the ascending
gallbladder portion, infront of abdominal aorta MINOR DUODENAL PAPILLA
• Most movable of the 4 divisions • RELATIONS • Elevation at medial portion of the internal surface of
• Covered completely with peritoneum o Crossed by – superior mesenteric vessels + the duodenum about 2.5 cm above the opening of the
the mesentery major duodenal papilla
• Upper border of the 1st half has the attachment of
o Covered in front by peritoneum, except where
hepatoduodenal ligament • At the summit of this elevation is the opening of the
it is crossed by the superior mesenteric accessory pancreatic duct
• Inferior border of same segment has the attachment vessels
of greater omentum o Posterior surface rest upon the
• Visible in Xray, after barium meal as a triangular
JEJUNUM & ILEUM
 right cruz of the diagphram, • The remainder of small intestine from the end of
shadow termed as duodenal cap  the inferior vena cava & duodenum
• RELATIONS  aorta
o Above&Infront – Quadrate lobe of LIVER & • Jejunum – the proximal 2/5 commencing at the
o Upper portion – in relation with the head of duodeno-jejunal flexure to the left side of L2 vertebra
GALLBLADDER pancreas
o Behind – gastroduodenal a. + common bile • Ileum – distal 3/5, w/c terminates into the cecum
duct + portal vein • NO morphological demarcation between the 2
ASCENDING PORTION segments
o Below & behind – Head & Neck of pancreas • 2.5 cm long
• Ascends on the left side of aorta up to the level of L2
• Both are attached to the posterior abdominal wall by
DESCENDING PORTION an extensive fold of peritoneum – the mesentery
vertebra
• 7-10 cm long
• Ends at the duodenojejunal flexure – where it joins
• Extends from the level of the neck of the gallbladder DIFFERENCES B/W JEJUNUM & ILEUM
with the jejunum
(L1 vertebra) along the right side of vertebral column JEJUNUM ILEUM
• RELATIONS
to as low as the L4 vertebra Occupies Umbilical & Left Occupies Umbilical,
o Anteriorly – covered with peritoneum,
• Receives the openings of common bile duct & Iliac regions hypogastric & Right Iliac
continuous with left portion of mesentery
pancreatic ducts region
o Posteriorly – left psoas major + left renal
• RELATIONS Wider diameter – 4 cm Narrower – 3.5 cm
vessels
o In front from above downwards Circular mucosal folds are Few circular mucosal folds,
• Right lobe of the liver large & thickly set disappear distally
BLOOD SUPPLY of DUODENUM
• Transverse colon Peyer’s patches are absent Large & numerous all
• Branches of the inferior & superior
• Small intestine in the upper part throughout its length
pancreaticoduodenal arteries
o Posteriorly
• Anastomose & supply the 2nd, 3rd & 4th part of FUNCTION
• Hilum of the right kidney
duodenum
• Jejunum & Ileum are specialized for the absorption of
digested foodstuff, vitamins & electrolytes
The MESENTERY proper
• Fan shaped, 2 layers of peritoneum that suspends the
jejunum & ileum from the posterior abdominal wall
• Its attached border of posterior border or root is
about 15 cm.long & intestinal border is 40 times
longer
• It extends between its layers, the intestinal branches
of superior mesenteric artery, with their
accompanying veins & plexuses of nerves, the lacteal
vessels & mesenteric lymph nodes
VENOUS DRAINAGE
• Veins follow the course of the arteries & terminate
into the superior mesenteric vein
NERVE SUPPLY
• Plexuses of nerves around the superior mesenteric
vessels
• Parasympathetic fibers from vagus &
• Sympathetic fibers from the celiac plexus
LYMPHATIC DRAINAGE
• Superior mesenteric LN
• Subsidiary nodes of Superior Group are well over 100
mesenteric nodes in the mesentery of small intestine
along the arcades & branches of superior mesenteric
artery
LIVER & BILIARY APPARATUS
THE LIVER
Surface Anatomy
• Upper limit of the RIGHT LOBE
o Highest point of the liver
o Lies beneath the right dome of the diaphragm
o Level of the 5th rib
o About 2.5 cm medial to mammary line &
o About 1 cm below the nipple
• Upper limit of the LEFT LOBE
o Level of 6th rib in the mammary line
o About 2.5 cm below the left nipple
• LOWER BORDER
o Can be traced from right to left, following the
costal arch as far as the tip of 9th costal
cartilage
o Descending about 2.5 cm below the rib in
erect position
o From the 9th costal cartilage  crosses
obliquely until it reaches the tip of the 8th
costal cartilage on the left side  & from it
continues laterally until it meets the upper &
lateral limits of the LEFT LOBE
• In the MIDLINE, the lower border of the liver lies
MIDWAY bw the:
o XIPHOID
o UMBILICUS
The Liver Proper
• Largest gland in the body
• Extremely vascular
• Shape resembles a pyramid, the base being the right
& the apex to the left
• In adults, it constitutes approximately 1/50th of the
body weight
• Occupies the uppermost part of the abdomen
• Covered by the ribs – which afford some protection
FUNCTIONS
• Chief site of intermediary metabolism
• Secretes bile & hormones
• Synthesizes serum proteins & lipids
• Processes the products of digestion & most
endogenous & exogenous substances – like toxins &
drugs that enter the circulation
• Participants in the elimination of senescent cells &
particulate matter from the blood stream
• Produces hematopoietic cells of all type
POSITION of the Liver
• Under cover of the costal cartilages
• Occupies much of the upper abdomen
• Fills the Right Hypochondium completely
• Crosses the epigastrium to the left hypochondrium as
far as the anterior axillary line
Surfaces of the Liver
• Diaphragmatic surface (superior surface)
• Anterior Surface
• Posterior Surface
• Visceral Surface (inferior surface)
DIAPHRAGMATIC SURFACE
• With smooth peritoneal areas + bare area – area
devoid of peritoneum facing posteriorly
• Notable features are:
o Inferior vena cava
o Peritoneal ligaments (connecting the liver to
diaphragm)
• Peritoneal ligaments includes:
o Falciform ligament
o Left & right coronary ligaments
o Triangular ligaments
ANTERIOR SURFACE
• Readily accessible for examination as far as 10th
costal cartilage on the right side
• MEDIAN portion – lies against the anterior abdominal
wall
• INFERIOR portion – can be palpated during forced
inspiration
POSTERIOR SURFACE
• Can be seen only after the removal of the liver from
the body
• Covered with peritoneum of the greater sac
• Caudate lobe – is its median plane – lies between
the
o fossa for inferior vena cava &
o fossa for the ligamentum venosum
INFERIOR SURFACE
• also called the visceral surface