Stomach, Duodenum, Pancreas, and Spleen | Gross HSB A
Year 1 – Sem 1 – Finals – Week 3 (Lucas, M.D.)
Important structures (a checklist)
✓ Stomach
✓ Duodenum
✓ Pancreas
✓ Spleen
Stomach (gaster)
▪ Overview
o Location – at upper abdomen beneath the left costal margin
▪ Also, it extends to the epigastric & umbilical regions
o Shape – J-shaped
▪ Two orifices of the stomach
o Cardiac orifice – located at the superior aspect of the stomach
▪ Description – where the esophagus connects with the stomach
▪ Importance – acts as a sphincter which prevents regurgitation of stomach
contents back to the esophagus
o Pyloric orifice – located at the inferior aspect of the stomach
▪ Description – formed by the pyloric canal
▪ Importance – acts as a sphincter which opens to the duodenum
▪ Two curvatures of the stomach
o Greater curvature – located at the left border of the stomach
o Lesser curvature – located at the right border of the stomach
▪ Two surfaces of the stomach
o Anterior surface
o Posterior surface
▪ Gastric folds (rugae)
o Description – form the mucous membrane of the stomach
o When stomach is filled → may be flattened
▪ Functions of the stomach
o Temporary storage of food – 1500 mL capacity
o Acidic chyme – due to gastric secretions
o Control of chyme delivery – due to the pyloric sphincter
▪ Parts of the stomach
o Fundus of the stomach
▪ Description – dome-shaped part at the
left side of the cardiac orifice
o Body of the stomach
▪ Description – from the left side of the cardiac
orifice up to the angularis incisura
o Angularis incisura
▪ Description – constant angle of the
lesser curvature (inferiorly)
o Pylorus
▪ Description – most tubular part of the
stomach
▪ Pyloric antrum
• Description – triangular area below the body of the stomach (in other books, it
may reach until the pyloric sphincter)
▪ Pyloric canal
• Description – the space or cavity of the pyloric area
o Lesser curvature
▪ Description – forms the right border of the stomach
▪ Extent – from the cardiac orifice to the angularis incisura to the pylorus
o Greater curvature
▪ Description – forms the left border of the stomach
▪ Extend – from the cardiac orifice to the fundus, body, antrum until the pylorus
▪ Supporting structures of the stomach
o Gastrosplenic ligament
▪ Description – connects the stomach & the spleen
▪ Importance – keeps the stomach in place
• Also, carries the short gastric vessels
o Lesser omentum
▪ Description – attached to the lesser curvature
of the stomach towards the liver
▪ Parts of the lesser omentum:
• Hepatoduodenal ligament
• Hepatogastric ligament – supports the stomach
• Hepatoesophageal ligament
o Greater omentum
▪ Description – apron-like fatty layer connecting the
greater curvature to the transverse colon
▪ Muscle layers of the stomach
o Oblique muscle coat – innermost layer
o Circular muscle coat – middle layer Notes
▪ Pyloric sphincter – thickening of the circular muscle coat
o Longitudinal muscle coat – outermost layer
▪ Blood supply of the stomach
▪ Venous drainage of the stomach
▪ Lymphatic drainage of the stomach
▪ Nerve supply of the stomach
Duodenum
▪ Overview
▪ Four parts of the duodenum
▪ Mucous membrane of the duodenum
The anterior lateral wall of the first
part of the duodenum is the most common
site for duodenal ulcers since it is the part
closest to the stomach (due to acidic); may
appear as appendicitis due to location
o Left gastric artery
▪ Origin – from the celiac trunk
▪ Importance – supplies the upper right part of the stomach (lesser curvature)
o Right gastric artery
▪ Origin – from the hepatic artery
▪ Importance – supplies the lower right part of the stomach (lesser curvature)
o Short gastric artery
▪ Origin – from the spleen Notes Epiploic refers to
▪ Importance – supplies the fundus the omentum
o Left gastroepiploic artery
▪ Importance – supplies the upper part of the greater curvature
o Right gastroepiploic artery
▪ Importance – supplies the lower part of the greater curvature
o Left gastric vein
▪ Destination – drains to the portal vein
▪ Importance – drains the upper right part of the stomach (lesser curvature)
o Right gastric vein
▪ Destination – drains to the portal vein
▪ Importance – drains the lower right part of the stomach (lesser curvature)
o Short gastric & left gastroepiploic veins
▪ Destination – drains to the splenic vein
▪ Importance – drains the upper part of the greater curvature
o Right gastroepiploic vein
▪ Destination – drains to the superior mesenteric vein
▪ Importance – drains the lower part of the greater curvature
o Left & right gastric nodes ©©
o Left & right gastroepiploic nodes
Notes These lymph nodes drain their corresponding
blood vessels (based on their names)
o Clinical correlation:
▪ Gastric tumor – stomach layers have no barrier, gastric tumor easily
metastasizes or spread to different lymph nodes → hence, the origin of the
gastric cancer is hard to detect (usually diagnosed late)
o Celiac plexus
▪ Importance – sympathetic innervation of the stomach
▪ Sensory – pain-transmitting fibers
▪ Actions of the sympathetic to the stomach:
• Pyloric sphincter → activated (motor innervation)
o Left & right vagus nerves
▪ Importance – parasympathetic innervation of the stomach
▪ LARP (mnemonic of origin of the vagal trunk)
• Left vagus nerve → anterior vagal trunk
• Right vagus nerve → posterior vagal trunk
▪ Actions of the parasympathetic to the stomach:
• Secretomotor to the gastric glands
• Motor to the muscular wall of the stomach
• Pyloric sphincter → inhibited
o Description – first part of the small intestine
o Shape – C-shaped
o Length – 10 inches (25 centimeters)
o Importance – joins the stomach to the jejunum
o Location – at the epigastric & umbilical region of the abdomen
o First part of the duodenum
▪ Extent – begins with the pylorus & extends upward and backward at the L1 level
o Second part of the duodenum
▪ Orientation – vertically-oriented at a downward direction
▪ Location – anterior to the hilum of the right kidney
▪ Lumbar level – right of the L2 & L3
▪ Ampulla of Vater
• Description – dilation seen at the medial border
of the 2nd part of the duodenum
• Formation – due to the union of the common bile duct & pancreatic duct
▪ Major duodenal papilla
• Description – opening of the nipple-like projection (ampulla of Vater)
▪ Minor duct of Santorini
• Description – opens to the duodenum above the major duodenal papilla
▪ Minor duodenal papilla
• Description – opening of the minor duct of Santorini at the duodenum
o Third part of the duodenum
▪ Orientation – horizontally-oriented part of the duodenum
▪ Location – anterior to the vertebral column
o Fourth part of the duodenum
▪ Orientation – vertically-oriented at a upward direction
▪ Ligament of Treitz – supports the duodenojejunal flexure demarcating the border
between the duodenum & the jejunum
o First part of the duodenum → smooth
o Remaining parts of the duodenum → has circular folds called plicae circulares
o Importance – secretes cholecystokinin (important for fatty food digestion)
Notes Only the first part of the duodenum is motile; the remainder of the duodenum is rigidly fixed. In crush injuries,
the third part of the duodenum is frequently crushed against the L3 vertebrae of the spinal column
▪ Blood supply of the duodenum
o Upper half of the duodenum → superior pancreaticoduodenal artery
▪ Derivation – branch of the gastroduodenal artery
o Lower half of the duodenum → inferior pancreaticoduodenal artery
▪ Derivation – branch of the superior mesenteric artery
o Also, the supraduodenal & retroduodenal arteries
▪ Derivation – branches of the gastroduodenal artery
▪ Venous drainage of the duodenum
o Upper half of the duodenum → superior pancreaticoduodenal vein
▪ Destination – drains to the portal vein
o Lower half of the duodenum → inferior pancreaticoduodenal artery
▪ Destination – drains to the superior mesenteric vein
▪ Lymphatic drainage of the duodenum
o Upward flow → pancreaticoduodenal nodes → gastroduodenal nodes → celiac
nodes
o Downward flow → pancreaticoduodenal nodes → superior mesenteric nodes
Pancreas
▪ Overview
o Description – soft-lobulated organ seen beside the second part of the duodenum at
the level of the transpyloric plane
o Location – deep to the posterior abdominal wall
▪ Note: Can be seen upon upward deflection of the greater omentum
▪ Parts of the pancreas
o Head of the pancreas
▪ Description – part of the pancreas embraced by the duodenum
▪ Uncinate process – part of the head which further extends to the left nearly
touching the fourth part of the duodenum
o Neck of the pancreas
▪ Description – constricted part of the pancreas
o Body of the pancreas
▪ Description – horizontal part of the pancreas
o Tail of the pancreas
▪ Location – in close proximity to the hilum of the spleen
▪ Function of the pancreas
o Exocrine function Notes There may be variations
in the union of the pancreatic
▪ Definition – releases substances through ducts duct & common bile duct
▪ Two ducts of the pancreas:
• Major pancreatic duct (Wirsung) – joins with the common bile duct to form the
ampulla of Vater Tips Mini → Santorini
• Minor pancreatic duct (Santorini)
o Endocrine function
▪ Definition – releases substances directly into the bloodstream
▪ Examples – insulin, glucagon, etc.
▪ Clinical correlation regarding the pancreas
o Trauma to the pancreas
▪ Examples – sports injury, gunshot wound, stab wound etc.
▪ Result – damaged pancreatic tissues → releases activated pancreatic enzymes
causing damage to the surrounding tissues and peritoneum
▪ Presentation – acute peritonitis
o Cancer in the head pancreas
▪ Result – may cause compression of the bile ducts
▪ Presentation – jaundice (yellowing of skin)
o Splenectomy damage to the tail of pancreas
▪ Cause – due to close proximity of the tail of the pancreas to the spleen
▪ Result – releases activated pancreatic enzymes causing damage to the
surrounding tissues and peritoneum
▪ Blood supply of the pancreas
o Superior pancreaticoduodenal arteries
▪ Two branches – anterior superior & posterior superior branches
o Inferior pancreaticoduodenal arteries
▪ Two branches – anterior inferior & posterior inferior branches
Spleen
▪ Overview
Notes Splenectomy patients are prone
to infections due to its function as the
o Color – reddish organ largest lymphoid organ in the body
o Shape – oval-shaped
o Location – posterior portion of the left upper quadrant below the diaphragm and
adjacent to the 9th to 11th ribs
▪ Also, near the tail of the pancreas
o Weight – 150 grams on average
▪ Function of the spleen
o Characteristic – largest single mass of lymphoid tissue in the body
o Action – removes particulates from the blood stream (opsonized bacteria,
antibody-coated cells, etc)
▪ Also, serves as a quality control mechanism for the red cells (removing
senescent & deformed cells) from circulation
▪ Supporting structures of the spleen
o Splenocolic ligament – between the spleen & the splenic flexure of the colon
o Gastrosplenic ligament (short gastric vessels) – between the spleen & the stomach
o Phrenosplenic ligament – between the spleen & the diaphragm
o Splenorenal ligament – between the spleen & the left kidney
▪ Blood supply of the spleen
o Splenic artery
o Short gastric vessels
▪ Venous drainage of the spleen
o Splenic vein
And people can be broken, sure. But any surgeon knows, what’s broken can be mended. What’s hurt can be healed. That no matter how dark it gets, the sun’s going to rise again
Meredith Grey (Grey’s Anatomy S11E24)
AngeloBautista