Stomach, Duodenum, Pancreas, and Spleen Far Eastern University Nicanor Reyes Medical Foundation

Norman V. Valera, M.D., DPSA Institute of Medicine

STOMACH Stomach Curvatures

Expanded part of the digestive system LESSER CURVATURE (inner)
between the esophagus and the small Shorter concave right border of the stomach
intestine (conduit) Angular incisure = most inferior part of the curvature
Acts as a food blender and reservoir • Lies just to the left of the midline
Chief function: enzymatic digestion • Indicates the junction of the body and the pyloric part of the stomach
Mouth = partial digestion (chewing) of GREATER CURVATURE (outer)
carbohydrates Longer convex left border of the stomach
Stomach = where more of the proteins, Passes inferiorly to the left from the junction of the 5th intercostal space and
lipids, and complex carbohydrates are MCL — curves to the right, passing deep to the 9th or10th left cartilage as —-
further digested continues medially to reach the pyloric antrum
Gastric juice gradually converts a mass of
food into a semi-liquid mixture, CHYME, Interior of the Stomach
which passes fairly quickly into duodenum Rugae
Can hold 2-3 liters of food Folds along the wall inside the stomach
Greater/wider surface area = more gastric pits (where its lining secretes
Parts of the Stomach gastric acids needed for digestion) = more digestion can occur
CARDIA
Connects the esophagus and stomach
the part surrounding the cardiac orifice, the superior opening or inlet of the
stomach
FUNDUS
Dilated superior part that is related to the left dome of the diaphragm
Limited inferiorly by the horizontal plane of the cardiac orifice
Cardiac notch is between the esophagus
and the fundus
Lies posterior to the left 5th rib in the plane
of MCL
BODY
Major and biggest part of the stomach
between the fundus and the pyloric antrum
PYLORIC PART Arterial Supply of the Stomach
Terminal end Arterial supply of the stomach arises from the celiac trunk and its branches
Funnel-shaped outflow part of the stomach Lesser curvature - anastomoses from right and left gastric arteries
2 parts: pyloric antrum (wider part) leads Greater curvature - anastomoses from right and left gastro-omental
into the pyloric canal (narrower part) (gastro-epiploic) arteries
Pylorus is the distal, sphincteric region of Fundus and upper body - short and posterior gastric arteries
the pyloric part
• It is a marked thickening of the circular Venous Drainage of the Stomach
layer of smooth muscle Veins of the stomach are parallel to the arteries in position and course
• Controls discharge of the stomach Right and left gastric veins drains into the hepatic portal vein
contents through the pyloric orifice into Short gastric veins and left gastro-omental veins drain into splenic vein
the duodenum Right gastro-omental vein empties in the SMV
Prepyloric vein ascends over the pylorus to the right gastric vein

1 - A 2021 ! of ! 4
1
tiglao
Stomach, Duodenum, Pancreas, and Spleen Far Eastern University Nicanor Reyes Medical Foundation
Norman V. Valera, M.D., DPSA Institute of Medicine

Everything will eventually drain into the hepatic portal system C-shaped, about 10 inches long (25 cm)
Why should the venous blood from visceral organs of abdominal cavity need Begins at the pylorus on the R side and ends at the duodenojejunal
to pass through hepatic portal system, instead of going straight to the junction on the left side (L2 vertebra)
systemic circulation?
Divisions
Lymphatic Drainage of the Stomach Superior (1st) part – 5cm & lies anterolateral to the body of L1
Lymph from the superior two thirds of the Descending (2nd) – 7 to 10cm & descends along the R sides of L1 through L3
stomach drains along the right and left Most important part: houses common bile & ampulla of Vater (major papillary
gastric vessel to the gastric lymph node opening coming from the main pancreatic duct — Duct of Wirsung)
Lymph from the fundus and superior part of Secretions coming from pancreas and gallbladder will all drain to this part of
the body of the stomach also drains along the duodenum for further digestion of proteins (via bile & proteolytic
the short gastric arteries and left gastro- enzymes)
omental vessels to the pancreaticosplenic Horizontal (3rd) – 6 to 8cm & crosses L3
lymph node Ascending (4th) – 5cm & begins at the L of L3 and rises superiorly as far as
Lymph from the right two thirds of the superior border of L2
inferior third of the stomach drains along the
right gastro-omental vessels to the pyloric Superior Part of Duodenum
lymph nodes Ascends from the pylorus and is overlapped by the liver and gallbladder
Lymph from the left one third of the greater Peritoneum covers its anterior aspect, bare of peritoneum posteriorly
curvature drains to the Proximal part has the hepatoduodenal ligament attached superiorly, and the
pancreaticoduodenal lymph nodes, greater omentum attached to inferiorly (this is why it is relatively fixed)
which are located along the short gastric
and splenic vessels Descending Part of the Duodenum
Runs inferiorly, curving around the head of the pancreas.
Parasympathetic Nerve Supply of the Stomach Bile and main pancreatic ducts enter its posteromedial wall. This ducts usually
Anterior vagal trunk, derived mainly from the left vagus nerve (CN X) unite to form the hepatopancreatic ampulla, which opens on an eminence,
It runs toward the lesser curvature of the stomach, where it gives off hepatic called major duodenal papilla
and duodenal branches Entirely retroperitoneal
The rest of the anterior vagal trunk continues along the lesser curvature, Houses the head of the pancreas (direct contact; hence the hepatopancreatic
giving rise to anterior gastric branches ampulla)
Posterior vagal trunk, derived mainly from the right vagus
It supplies branches to the anterior and posterior surfaces of the stomach Inferior (Horizontal) Part of the Duodenum
It gives off a celiac branch, which passes to the celiac plexus, and then Runs transversely to the left, passing over the IVC, aorta and L3 vertebra
continues along the lesser curvature, giving rise to posterior gastric Injuries to these parts may also affect the duodenum which can cause
branches mechanical obstruction, intrinsic to lumen of this part of duodenum (take note
of landmarks)
Sympathetic Nerve Supply of the Stomach Crosses superior mesenteric artery and vein and the root of the mesentery of
From the T6- T9 segments of the spinal cord passes to the celiac plexus the jejunum and ileum
through the greater splanchnic nerve and is distributed through the plexuses
around the gastric and gastro-omental arteries Ascending Part of Duodenum
Runs superiorly and along the left side of the aorta to reach the inferior border
DUODENUM of the body of the pancreas.
First & shortest part of the small intestine Supported by the attachment of the suspensory muscle of the duodenum
Widest and relatively fixed part (ligament of Treitz)

1 - A 2021 ! of ! 4
2
tiglao
Stomach, Duodenum, Pancreas, and Spleen Far Eastern University Nicanor Reyes Medical Foundation
Norman V. Valera, M.D., DPSA Institute of Medicine

They are next conveyed to the duodenum via periarterial plexuses extending to
the pancreaticoduodenal arteries

PANCREAS
Lies transversely and slightly oblique at the level of the 1st and 2nd lumbar
vertebra
Retroperitoneal organ
Transverse mesocolon attached to the anterior margin
Functions:
Exocrine: production of pancreatic
enzyme
Endocrine:
• Glucagon – produced by the
alpha cells located on the body
at the periphery of the islets of
Blood Supply of the Duodenum Langerhans
Upper part – superior pancreaticoduodenal from gastroduodenal • Insulin production – produced by
Lower part – inferior pancreaticoduodenal from superior mesenteric the beta cells on the central
portions islets of Langerhans
Venous Drainage of the Duodenum • Somatostatin – delta cells
Superior pancreaticoduodenal vein drains into portal vein located on the peripheral portion
Inferior pancreaticoduodenal vein joins the superior mesenteric vein of the islets of Langerhans
Superior mesenteric vein which lies anterior and to the right of the SMA in the Somatostatin will function to balance
root of mesentery; ends posterior to the neck of pancreas where it unites with the insulin and glucagon secretion
splenic vein to form the portal vein
Parts of Pancreas
Lymphatic Drainage of the Duodenum HEAD – lies in the curvature of the duodenum
ANTERIOR LYMPHATIC VESSELS — drain Anterior to the IVC, aorta, right renal vessels and left renal vein
into pancreaticoduodenal lymph nodes, Uncinate process projects posteriorly and to the left and lies posterior to
located along the superior and inferior superior mesenteric vessels
pancreatoduodenal arteries, and into the Common Bile Duct passes posteriorly in a grove or embedded within – will
pyloric lymph node deliver of the bile on the second part of the duodenum via the ampulla of
POSTERIOR LYMPHATIC VESSEL — pass Vater
posterior to the head of the pancreas and NECK – anterior to the union of splenic vein and Superior Mesenteric Vein to
drain into the superior mesenteric lymph form the portal vein
nodes, and then into the splenic lymph Landmark for splenic vein before becoming the portal vein
nodes BODY – curves over the vertebrae and great vessels
EFFERENT LYMPHATIC VESSELS from the Anterior to the aorta and lies between the celiac trunk and the superior
duodenal lymph nodes drain into the celiac mesenteric artery
lymph nodes Splenic vein passes posteriorly to the body of the pancreas
TAIL – lies in the splenorenal ligament – connects the spleen and the left
Nerve Supply of Duodenum ligament
Derive from the VAGUS and GREATER and LESSER (ABDOMINOPELVIC) Usually contacts the hilum of the spleen
SPLANCHNIC NERVES by way of the celiac and superior mesenteric plexuses

1 - A 2021 ! of ! 4
3
tiglao
Stomach, Duodenum, Pancreas, and Spleen Far Eastern University Nicanor Reyes Medical Foundation
Norman V. Valera, M.D., DPSA Institute of Medicine

Pancreatic Ducts Function of the Spleen

Main or chief pancreatic duct of Wirsung Multiple supporting roles in the body
Runs the length of the pancreas dorm the entire Filter for blood as part of the immune
tail and body and from the postero-inferior part of system
the head including the uncinate process Old red blood cells are recycled in
Formed by the junction of small ducts and lobules the spleen, and platelets and white blood
from the tail through the body to the neck cells are stored there
Leaves the head piercing the duodenum and ends Helps fight certain kinds of bacteria that
by an orifice common to it and the common bile cause pneumonia and meningitis
duct at the summit of the major duodenal papilla Splenectomy — when done, the
(of Vater) patient should be given medication for
Accessory pancreatic duct of Santorini (if pneumonia (prevention of bacteria
present drains the anterosuperior part of the since the spleen is being taken out)
head)
Borders of the Spleen
Arterial Supply of the Pacreas (*know the impressions for practicals)
Head – superior pancreaticoduodenal artery Anterior and superior – sharp and often
(from the Gastroduodenal artery) and the notched
inferior pancreaticoduodenal artery (from the Separate the diaphragmatic surface from the gastric surface
superior mesenteric artery) Posterior - more rounded and blunter than the anterior
Body and Tail – branches of the splenic artery Separate the renal from the diaphragmatic surface

Venous Drainage of the Pancreas Relations of the Spleen

Mostly via splenic vein, but also by the portal Posterior to the stomach connected to the
vein and the superior mesenteric vein greater curvature by gastrosplenic ligament
Anterior to superior part of the left kidney,
Lymphatic Drainage of the Pancreas connected by the splenorenal ligament
Lymph nodes of the stomach are partly the Laterally to diaphragm along the 9-11th left
lymph nodes os stomach as they share the ribs
same group of LN in the area (closely related to Tail of pancreas – lies at the splenic hilum
one another)
Arterial Supply of the Spleen
Nerve Supply of the Pancreas Splenic artery divides into end arteries as it
The nervous supply of the pancreas is comprised of three different nerve enters the spleen
bundles including the vagus nerve (CN X), the thoracic splanchnic nerve No anastomoses, hence obstruction of one end
fibers from the superior mesenteric and celiac plexuses artery results in are of splenic infarction

SPLEEN Venous Drainage of the Spleen

Large soft vascular lymphatic organ located in the left upper quadrant Splenic vein
Up to 12 cm with long axis in line with 10th rib
Arises from mass of mesenchymal cells located between layers of dorsal Lymphatic Drainage of the Spleen
mesogastrium Pancreaticosplenic lymph nodes
Right lateral decubitus position – position for palpation

1 - A 2021 ! of ! 4
4
tiglao