SPLEEN and PANCREAS
Spleen:
* largest single mass of lymphoid tissue in the body.
* It is in contact with post. wall of stomach and connect to its greater curvature by gastrosplenic ligament which transmit short grastric vessels and left gastroepipolic vessels . it is attach to left kidney by lienorenal ligament which contain splenic vessels and tail of pancreas. It is entinely surrounded by peritoneum except at hilum .
* In lift it is soft,purpish,freely movable located in the left hypocondrium . post. to stomach and anterior to superior part of Lt. kidney.
Relation of spleen:-
Anteriorly ------ stomach
Posteriorly ----- left part of diaphragum that separated it from pleura ,lung and rips 9 through 11.
Inferiorly ----- left colic flexure .
Medially ----- left kidney.
* spleen varies in size, weight, and shapes, it is usually 12 cm long 7cm wids, roughly size and shape clenched fist average weight 150 gm.
* spleen has 2 surface :
1- diaphragmatic
2- visceral: - gastric
- renal
- colic.
* spleen has 3 border:-
1- anterior
2- superior
3- posterior
4- inferior
* the thin capsule of the spleen is composed of dense, connective tissue, there is trabeculae from capsule carry blood from and to paraanchyma or splenic pulp.normally contain larg amount of blood.
Surface anatomy of spleen:
* lies deep to 9th , 10th , 11th ribs.
* long axis lies in the line of 10th ribs where it rest on left colic flexure.
* normally does not extend inferior to left castal cartilage so normal spleen is seldom palpable through abdomen wall.
Arterial supply:
Splenic artery:
1- largest branch of colic.
2- tortous course.
3- post. to omental bursa.
4- along superior border of pancrease.
5- ant. To left kidney
6- between layers of lienorenal ligament.
7- divided into 5 or more branches inter hilum supply individual element of spleen as end artery.
**NOTE:
* There is no anastomosis between small branches of splenic arteries consequently obstruction of them result in death of splenic tissue ( splenic infarction).
* splenic vein join I.M.V. , and unite with S.M.V. posterior to neck of pancrease to from portal vein.
* spelnic lymphatic vessels passes to the pancreatic splenic L.N.
* the nerve spleen derive from celiac plexus.
Clinical point:
1- splenomegaly.
2- splenoectomy .
3- rupture of spleen.
4- acessory spleen.
Pancrease
* an elongated accessory digestive gland.
* lies retroperitoneally , transversly across the post. abd. wall post. to stomach , between duodenum on Rt and spleen on Lt,
* transverse mesolon attaches to its ant. margin .
* pancrease produces:-
1- an exocrine secretion( pancreatic juice) that enter duodenum through main and accessory pancreatic ducts .
2- endocrins secretion ( glucogon and insulin from pancreatic islet ( of longerhans) enter the blood.
For descriptive purposes it divideal into 4 parts:-
1- Head of pancrease:
- expanded part , embraced by C-shaped curve of duodenum to right of superior mesentery vessels.
- the uncinate process, projection from inferior part of head , extend medially to left, posterior to the S.M.A. the head rest posteriorly on the:-
- I.V.C. Rt renal a. and v. , left renal vein.
- bile duct, lies in a groove on the postero superior or embedded in its substance of head of pancrease.
2- Neck of pancrease:-
- is short (1.5-2 cm), over lies superior mesenteric vessels which form groove in to post. aspeet.
- ant. Surface covered by peritoneum , is adjacent to pylorus of stomach .
- the S.M.V. join splenic vein post. to neck to form portal vein.
3- Body of pancrease:-
- continues from neck , lies to left of S.M vessels. passing over Aorta and L2 vertebra.
- ant. Surface covered with peritoneum lies in the floor of omental bursa .
- posterior surface , devaid of peritoneum is in contect with , Aorta , S.M.A. , left supera renal gland, left kidney and renal vessels.
4- Tail of pancrease:-
- lies ant. to Lt kidney.
- closely related to hilum of spleen and Lt colic flexure.
- tail relatively mobile passes between layer of spleno renal ligament with splenic vessels.
Surface anatomy of pancrease:-
* the neck, overlie 1st and 2nd lumbar vert. in the transbyloric plane .
* its head is to right , and inferior to transbyloric plane.
* its body and tail are to left and superior to this level.
* pancrease is not palpable , because it lies deep.
Main pancrease duct:-
- begin in the tail of pancrease to its head when it turn inferiorly , unit with bile duct to form short, dilated hepatopancreatic ampulla. Open in 2nd part of duodenum at summit of major duodenal papilla , around the hepato-pancreatic amulla we have hepatopancreatic sphinetor ( sphinetor of Oddi).
Blood supply of pancrease :-
* splenic artery up to 10 branches supply body and tail.
* superior pancreatic duodenal artery, branches of gastroduodenal a.
* inferior pancreatic duodenal artery branch of S.M.V. supply head.
Lymphatic drainage:-
- follow blood vessels , most end in pancreaticosplenic nodes , that lies along splenic artery .
- some vessels end in pyloric L.N.
- both L.N. drain to celiac , hepatic , and superior mesenteric L.N.
Nerves of pancrease:-
- from vagus and thoracic splamchnic nerves.