It has 2 or 3 terminal branches not communicating in the spleen. Therefore, segmental resection of the spleen is possible. 2) Splenic vein ) receives the inferior mesenteric vein ) then unites with the superior mesenteric vein to form the portal vein. Lvm Oh Dra inaoe: To the aortic LNs around the celiac trunk.

 

1) Splenic arterv:

- lt is a branch of the celiac trunk.

- .Course:

F Tortuous course.

! Along upper border of pancreas (retro-peritoneal).

F Then reaches the spleen through lieno-renal ligament.

It has 2 or 3 terminal branches not communicating in the spleen. Therefore,

segmental resection of the spleen is possible.

2) Splenic vein ) receives the inferior mesenteric vein ) then unites with the

superior mesenteric vein to form the portal vein.

Lvm Oh Dra inaoe: To the aortic LNs around the celiac trunk.

Growth

1- The phrenico-colic Iigament is responsible for

growth of the spleen to the Rt. iliac fossa.

2- Spleen can grow towards the Lt. iliac fossa

when the phrenico-colic ligament is

infiltrated in chronic myeloid

leukemia or if the ligament is

surgically divided.

Surface anatomy:

- Draw 2 transverse lines at 9th & 11th ribs.

- Draw 2 vertical lines at midaxillary line &

scapular line from inferior angle of the

scapula.

sl

I ABDOMEN

Anatomvl

- /t,s a retroperitoneal organ.

- lt lies obliquely across the upper part of the posterior abdominal wall extending

from the duodenal curve to the hilum of the spleen.

Pa rts:

Body of

pancreas

Tail of

pancr6as

Panc16atic

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. Lies within the concavity of the duodenum.

. It has a hook-like process called uncinate process, which projects upwards & to

the left.

Relations:

Posteriori

- The CBD passes behind it close to the duodenum.

- The IVC & aorta posterior to it.

Anteriorl

- Transverse colon & jejunum.

- The uncinate process is related anteriorly to superior mesenteric artery.

Sureical Importance:

Cancer head of Pancreas may by fatal if infiltration of IVC & aorta occurs.

Cancer head of pancreas ) obstructive jaundice.

Nech

- Anterior Relations: Pyloro-duodenal junction.

- Posterior Relations: Junction between SMV & splenic v. to form the portal vein.

lnierior Abdominal

,oa carra

-Anterior: the stomach, sepa

- Posterior:

. The splenic artery runs along its

behind it.

, lt crosses in front of the left kidney.

e lesser sac.

border while the splenic vein runs

by

upper

ABDOMEN I

Sursical Importance: the splenic vein is behind pancreas, so at modified Warren

operation ligation of the vein is difficult.

Tqil

It lies in contact with the hilum of the spleen; in the lieno-renal ligament.

Surgical Imnortance:

Tail is in the splenic ligament ) at splenectomy, injury of the tail leads to burst

abdomen.

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Ducts of the Pancreas

Mqin poncteotic duct of Wirrung

- lt traverses the whole length of the gland & ends by joining the CBD at the ampulla

of Vater & discharges its contents through the major duodenal papilla.

- lt represents the duct of the ventral pancreatic bud proximally & the duct of the

dorsal pancreatic bud distally.

Accersory poncrectic duct of Scrntorini

- Usually joins the main pancreatic duct, rarely it becomes the main duct & opens

into the duodenum through the superior papilla.

-^- Blood Supolv

* - Superior pancreatico-duodenat artery: from the gastro-duodenal artery. 7v-

- lnferior pancreatico-duodenal artery.'from the superior mesenteric artery.

t Both of them supply the head & the duodenum.

- The rest is supplied by branches of splenic & superior mesenteric arteries.

N.B: The pancreatica magna artery arises from the splenic artery.

Surgical lmpoftance.' at Whipple's operation, both pancreas & duodenum are

removed.

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Lvmph Drainaqe: To the celiac & superior mesenteric LNs.

Nerve Supply:

. WFrom the vagus (secretory). .ilgpathe&: From greater splanchnic nerves (it is concerned with pain).

ABDOMEN I

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- It is the artery of forgut. It supplies the gut above the level of ampulla of Vater'

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orioin: {F . lt arises from the abdominal aorta at the level of upper border of L1.

o lt supplies the foregut above the level of ampulla of Vater.

o Related to celiac ganglion on either side.

Branches {*

1. Left gastric afteru..

', lts branches include:

a- Esophageal branches.

b-Gastric branches.

2. Splenic arterv:

a-To pancreas: pancreatic branches to supply its body & tail.

b-To stomach:

- Short gastric arteries: pass in gastro-splenic liEjament.

- Lt. gastro-epiploic: supply Lt. part of greater curvature.

- Posterior gastric in 50%.

c-Terminal branches: to spleen.

3. Hepatic arteru: lts branches include:

a- Rt. gastric along the lesser curvature of the stomach.

-^-b- Gastro-duodenal artery which gives:

{f i- Rt. Gastro-epiploic:along greater curvature of the stomach.

ii- Superior pancreatico-duodenal: anastomoses with inferior pancreaticoduodenal between the head of pancreas & 2nd part of duodenum.

c- Supra-duodenal artery.

d- Left hepatic artery.

{f "- Right hepatic artery: gives .c.y-s.!!9..A.ftey-to the gall bladder.

ABDOMEN I

Points of Suroical Imoortance

. Gastro-duodenal artery may cause fatal bleeding in perforated DU.

. Blood supply of duodenum & pancreas is the same (pancreatico-duodenal a.), so,

with removal of the head of pancreas we have to remove the duodenum

(Whipple's operation).

Orioin:

. Arises from the front of abdominal aorta at the level of lower border of L1.

,rt lt supplies the midgut from the level of ampulla of Vater till the Rt. % of the

* transverse colon.

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I ABDOMEN

Branches

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Posbriffscd fl'tory *ppildcdar afiery

1. lnferior pancreaticoduodenal arterv

It anastomoses v,vith the superior pancreatico-duodenal artery between the head

of pancreas & 2no part of the duodenum.

2. Jeiunal & ileal branches (12- 151

- lt forms the arterial arcades in the mesentery.

- The arcades are simple in jejunum & complex in ileum.

3. lleo-colic Arterv: it is the continuation of the SMA.

- Branches:

1. lleal branches.

2. Appendicular branches (the continuation of the ileo-colic a.).

3, Anterior caecal & posterior caecal branches to the caecum.

4. Ascending branches anastomose with the descending branches of the Rt.

colic.

4. Riqht Golic Arterv: Its branches include:

1. Descending branches anastomose with ascending branch of ileocolic.

2. Ascending branches anastomose with the Rt. branches of the middle colic a.

5. Middle Colic Afterv: lts branches include:

1. Rt. branch anastomoses with ascending branches of Rt. colic.

2. Ll. branch anastomoses with ascending branches of superior Lt. colic artery.

IILB; Superiar mesenteric artery lies on the Lt. ode of superiar mesenteric u,ein

ABDOMEN I

Surgical fmoortance

During colectomy, we ligate arteries arising from Rt. side of SMA; which are the

middle colic, Rt. colic & ileocolic, while those arising from Lt. side; which are jejunal &

ileal branches are kept; to avoid ischemia of jejunum & ileum.

Orioin:

Arise from the front of abdominal aorta at the level of lower border of L3.

It supplies the hindgut from lateral Ts of the transverse colon to the upper lz of the

anal canal.

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1- Left Colic arterv: lts branches include:

a- Ascending branches anastomose with the Lt. branches of the middle colic.

b- Descending branches anastomose with sigmoid branches.

2- Siqmoid branches.

I AEDOMEN

3- Superior Rectal arterv:

middle & inferior rectal arteries.

O rio in : SMV + splenic vein. # Cou rse

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fro nt of th e rVC

. lt ascends in the free margin of the hepato-duodenal ligament (lesser omentum)

behind CBD to the right & the proper hepatic artery to the left.

. lt ends at the porta hepatis.

Lenqth: 3 inches.

Diameter: 0.8- 1.2cm

Direct tributaries:

Portalvein drains the whole intra-abdominal alimentary tract + ant. abdominal wall

o Lt. and Rt. gastric veins.

. Small pancreatic & duodenal veins.

o Para-umbilical veins into left branch of portal vein.

. Splenic v.

. SMV.

. Cystic vein.

Pressu re: 10 - 20 cmHzO (7 - 11 mmHg).

Surqical Importance:

Collateral Circulation ic Shunts

Lower end of & hemi

Around the umbilicus Anterior abdominal wall

veins

Anal canal Middle & inferior rectal veins

Lumbar veins

Bare area of the liver

Adhesions Abdominalwall

ABDOMEN I

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