Digestive Anatomy And Radiology

Peritoneum, Gut, Blood Supply and Autonomic Nervous System

 Structures of the transpyloric plane: inferior of L1 body, hilum of left kidney, pylorus of stomach, gallbladder, 9th costal cartilage and junction with rectus abdominus
 Peritoneum: a continuous slippery transparent serous membrane that lines the abdomnopelvic cavity and invests the viscera. It consists of mesothelium a layer of simple squamous epithelial cell.
- Parietal peritoneum: lines the internal surface of the abdominopelvic wall and is supply by the same blood lymphatics and somatic nerve supply as the region it covers.
- Visceral peritoneum: lines the viscera of the stomach and intestines and is served by the same blood, lymph, and visceral nerve supply as the organs it covers
 Intraperitoneal organs: organs that is completely invaginated into the peritoneal cavity and is covered by the visceral peritoneum, e.g. stomach, spleen, liver, small intestine
 Retroperitoneal organs: organs that are outside the peritoneal cavity and are only partially covered on one surface by the parietal peritoneum, e.g. kidney is between parietal peritoneum and the posterior abdominal wall along with the ascending and descending colon
 Peritoneal cavity: located within the abdominal cavity and contains a thin film of peritoneal fluid that lubricates the surface enabling the viscera to move over each other without friction during digestion.
 Embryological process of the peritoneal cavity:
- The gut is initially the same length as the developing body but undergoes exuberant growth
- Abdominal cavity is lined with the peritoneal sac and as the organs develop they invaginate to varying degrees into the peritoneal sac
- The viscera are connected to the abdominal wall by a mesentery which is composed of two layers of peritoneum within a thin layer of loose connective tissue. The mesentery is highly mobile to accommodate movement of the gut
- Though spleen and liver do not change in size, their reason for visceral peritoneum covering is due to the need to accommodate passive change imposed by the high active diaphragm
- Initially the entire primordial gut is suspended in the center of peritoneal cavity by the posterior mesentery but as the organs grow they come to lie against the posterior abdominal wall. The posterior mesentery is reduced and in the case of descending colon, the small intestine pushes it to the left against the visceral peritoneum and become fused
- Fused mesentery forms the fusion fascia, a connective tissue plane in which the nerves and vessel continue to lie. This is surgically important as it allows both ascending and descending colon to be incised (they are secondarily retroperitoneal)
 Peritoneal formations:
- Mesentery: double layer of peritoneum that occurs as the result of the invagination of an organ and maintains neurovascular communication. Its content includes connective tissue, blood, lymphatic vessels, nerves and lymph nodes and fat.
 Omentum: double layered extension of the peritoneal fold that extends from adjacent organs
- greater omentum: prominent peritoneal fold that hangs down like an apron from the greater curvature of the stomach and proximal duodenum and folds back fusing with the anterior surface of the transverse colon and its mesentery.
- lesser omentum: omentum connecting the lesser curvature of the stomach and proximal duodenum to the liver
 Peritoneal ligament: double layered peritoneum that connects the organs to one another
- Falciform ligament: liver connected to the anterior abdominal wall
- Hepatogastric ligament: liver connected to the stomach as a membranous portion of the lesser omentum
- Hepatoduodenal: thickened free edge of the lesser omentum that connects the liver and duodenum and conducts the portal triad
- Gastrophrenic ligament: connects the diaphragm to the stomach
- Gastrosplenic ligament: attaches the stomach to the spleen
- Gastrocolic ligament: apron part of the greater omentum that connects stomach to transverse colon
 Bare areas: areas of intraperitoneal organs not covered by peritoneum to allow connection of neurovascular structures.
 Peritoneal fold: reflection of the peritoneum that is raised from body wall by underlying blood vessels, ducts, and obliterated fetal vessels
 Peritoneal recess: pouch of the peritoneum formed from peritoneal fold
- Superior recess of omental bursa: tiny pouch behind the liver
- Inferior recess of omental bursa: pouch at the bottom of the greater omentum
- Subphrenic recess: superior extension of the greater sac and is separated in to right and left recesses by the falciform ligament
- Hepatorenal recess: the posterosuperior extension of the greater sac lying between the visceral surface of the liver and the right kidney
 Subdivisions of the peritoneal cavity: the transverse mesocolon divides the abdominal cavity into supracolic and infracolic compartment.
- Supracolic: contains stomach, liver and spleen
- Infracolic: contains small intestine and ascending/descending colon. Lies behind the greater omentum and divided further into left and right infracolic spaces by the mesentery of small intestine.
- Paracolic gutter: grooves on the lateral aspects of the large colon that allow communication between the supracolic and infracolic compartment
 Omental bursa: extensive saclike cavity that lies posterior to the stomach and lesser omentum. It contains a superior and an inferior recess and allows free movement of the stomach on the structures posterior to it.
 Omental foramen: the opening situated posterior to the free edge of the lesser omentum that allows communication between the omental bursa and the greater sac.
- ¬anterior boundary is the hepatoduodenal ligament (containing portal vein, hepatic artery and bile duct
- Posterior boundary is the IVC
- Superior boundary is the liver covered with visceral peritoneum
- Inferior boundary is the first part of duodenum
 Stomach: expanded part of the alimentary tract specialized for accumulation of ingested food and chemically and mechanically prepare it for digestion
- Size and shape of the stomach will be affected by body types or even result of diaphragm movement and stomach content
 Parts of the stomach:
- Cardia: part surrounding the cardial orifice
- Fundus: dilated superior part lodged into the left dome of the diaphragm. Superior reaches 5th intercoastal space and inferior the cardial orifice
- Body: the major part of the stomach between the fundus and the pyloric antrum
- Pylorus: the funnel-shaped outflow region of the stomach consisting of the pyloric antrum leading into pyloric canal
 Curvatures of stomach
- Lesser curvature: the shorter concave border of the stomach. Angular incisure is the sharp indentation that indicated the junction of body and pyloric
- Greater curvature: forms the longer convex of the stomach
 Interior of stomach:
- Gastric rugae: longitudinal folding of the gastric mucosa that disappears during gastric distention
 Blood supply of the foregut:

 Vein drainage of the stomach:

 Parasympathetic nerve innervation of stomach:
- Anterior vagal trunk derived from the left vagus nerve and enters the abdomen as a single branch that lies anteriorly to oesophagus. It runs toward the lesser curvature and gives off hepatic and duodenal branches (leaves in the hepatoduodenal ligament), and the rest gives rise to anterior gastric branches.
- Posterior vagal trunk derived from the right vagus nerve and enters the abdomen posteriorly to the oeseophagus. Vagal trunk supplies branches to the anterior and posterior surface of the stomach and gives off celiac branch and posterior gastric branches.
 Sympathetic nerve innervation of the stomach: T6-T9 segments of the spinal cord passes to the celiac plexus through the greater splenchnic nerve and is distributed around the gastric and gastro-epiploic arteries
 Small intestine: consisting of duodenum, jejunum and ileum, the primary site for absorption and nutrients (extends from the pylorus to the ileocecal junction).
 Duodenum: the first and shortest part of the small intestine (25cm) with a C-shape around the head of the pancreas. Ends at the duodenojejunal junction approximately at the level of L2.
- Superior part: short and lies anterolateral to the body of the L1 vertebra and is overlapped by the liver and gallbladder. Proximal part has the hepatoduodenal ligament attaches superiorly and greater omentum inferiorly
- Descending part: longer retroperitoneal segment descending along the right sides of the L1-L3 vertebrae and curving around the head of the pancreas. Initial lies to the right parallel to the IVC. The hepatopancreatic ampulla opens into the posteromedial wall on the summit of an eminence called the major duodenal papilla.
- Inferior part: horizontal segment that crosses the L3 vertebrate and the IVC, aorta. It is crossed by superior mesenteric artery. Superior to it is the head of the pancreas and uncinate process.
- Ascending part: short segment that rises on the left side of the L3 vertebra and the aorta to reach the inferior border for the body of the pancreas. Here it curves anteriorly to join the jejunum
 Arterial supply of duodenum: duodenum is supplied by the gastroduodenal artery with the superior pancreaticoduodenal artery serving the proximal duodenum and inferior pancreaticoduodenal artery serving the distal part. The two later arteries anastomose at the level of entry of bile duct.
 Venous drainage of duodenum: follows the arteries and drain into the portal vein and some indirectly via the splenic vein or superior mesentery vein.
 Nerve innervation of duodenum: derived from the vagus and greater and less splanchnic nerves by way of celiac and superior mesenteric plexuses
 Jejunum: second part of the small intestine around 3m in length lying mostly in the left upper quadrant of the infracolic compartment.
 Ileum: the end part of the small intestine terminating at the ileocecal junction and located mainly in the right lower quadrant (approximately 5m long).
 Mesentery of jejunum and ileum: approximately 15 cm long and is directed obliquely inferiorly to the right from the duodenojejunal junction to the ileocolic junction. The mesentery crosses the ascending and horizontal parts the duodenum, aorta, IVC etc.
 Arterial supply of jejunum and ileum: superior mesenteric artery, arising from the abdominal aorta at L1, supplies the two structures. It sends 15-18 arteries to the jejunum and ileum and unites to form loops and arches called arterial arcades. These then gives off straight arteries to the tube called vasa recta.
 Venous drainage of jejunum and ileum: the superior mesenteric vein drains the jejunum and ileum. It lies anterior and to the right of the SMA in the mesentery and unite with the splenic vein to form the portal vein
 Nerve innervation of jejunum and ileum:
- Sympathetic: reach the superior mesenteric nerve plexus through the sympathetic trunks and thoracic abdominopelvic splanchnic nerves. Sympathetic stimulation reduces motility of intestine, secretion and digestion.
- Parasympathetic: derived from the posterior vagal trunk and presynaptic fibers symapse with postsynaptic in the myenteric and submucosal plexus. Parasympathetic stimulation increase motility opf intestine and restoring digestive activity.
 Differences between jejunum and ileum:
- Color: deeper red (jejunum), paler pink (ileum)
- Wall: thick and heavy (jejunum), thin and light (ileum)
- Vasa recta: long (jejunum), short (ileum)
- Arcades: few larger loops ((jejunum), many short loops (ileum)
- Fat in mesentery: less (jejunum), more (ileum)
- Circulator folds: large, tall and closely packed (jejunum), low and sparse and absent distally (ileum)
 Large intestine: the last segment of the digestive tube consisting of cecum, appendix, colon, rectum and anal canal and is responsible for absorption of water and electrolyte from digestive residue (feces). The large intestine can be distinguished form the small intestine by:
- Omental appendices: small fatty omentum like projections
- Teniae coli: 3 thickened bands of smooth muscle representing most of the longitudinal coat beginning at the base of the appendix to the rectosigmoid junction.
- Haustra: sacculation of the wall of colon as the teniae is shorter than the large intestine
- Diameter: much greater
 Cecum: a blind intestinal pouch lying in the iliac fossa inferior to the ileocecal junction. When distended the cecum is palpable through the anterolateral abdominal wall.
 Appendix: blind intestinal diverticulum about 6-10 cm in length containing masses of lymphoid tissue. It arises from the posteromedial aspect of the cecum.
- Mesoappendix: short triangular mesentery derived from the posterior side of the terminal ileum mesentery.
 Arterial supply of midgut: all intestinal branches anastomse with adjacent branches of each other and this pattern continues with primary and secondary arch and vasa recta. All colic arteries will anastomose via the marginal artery that runs parallel to the entire colon, sending out branches supply the respective parts.

 Arterial supply of the hindgut:

 Colon:
- Ascending colon: (15 cm) passes superiorly on the right side of the abdominal cavity to the right colic flexure located at the right lobe of liver. It is separated from the anterior abdominal wall by the greater omentum.
- Transverse colon: approximately 45 cm long is the longest part of the large intestine. It crosses the abdomen from right to left colic flexure (situated anterior to the inferior left kidney and attached to the diaphragm by the phrenicocolic ligament). The transverse mesocolon is fused with the posterior wall of the omental burse and the roots lies along the inferior border of pancreas. Very mobile.
- Descending colon: (30 cm) extends from left colic flexure to the left iliac fossa and passes anterior to the lateral border of the kidney.
- Sigmoid colon: S shaped loop of about 40 cm long and extense from the iliac fossa to the S3 segment. Termination of the teniae coli indicates the rectosigmoid junction. Long mesentery allows freedom of movement.

Abdominal contents: Liver and Biliary, Portal systems

 Liver: largest gland in the body occupy most of the right hypchondrium and epigastrium. The diaphragm separates the liver from the pleural cavity.
 Liver surfaces:
- Diaphragmatic surface: the convex-domed smooth surface of the liver in contact with the inferior surface of the diaphragm. The subphrenic recesses exist between the diaphragm and the anterior superior aspects of the diaphragmatic surface.
- Visceral surface: the inferior surface covered with peritoneum except the fossa for the gallbladder and porta hepatis (a fissure where the portal vein, hepatic artery and lymph vessel lie). The visceral surface is rough and indented with many impressions from contacting with other organs.
 Bare area of liver: an area on the diaphragmatic surface of the posterior liver not covered by visceral peritoneum, and lies in direct contact with the diaphragm.
- Boundaries: demarcated by the reflection of peritoneum from the diaphragm to it as the anterior and posterior layers of coronary ligaments.
 Fissures of the visceral surface: two fissures along with the transverse porta hepatis form the letter H on the visceral surface of the liver
- Right sagittal fissure: continuous groove formed anteriorly by the fossa for the gallbladder and posteriorly the inferior vena cava
- Left sagittal fissure: continuous groove formed by the fissure for ligamentum teres anteriorly and ligamentum venosum posteriorly
- Porta hepatis: groove for the portal triad
 Impression of the visceral surface:
- Right side of the anterior stomach
- Superior part of the duodenum
- Lesser omentum
- Gallbladder
- Right colic flexure and transverse colon
- Right kidney and suprarenal gland
 Ligaments of liver:
- Coronary ligaments: reflection of peritoneum from the diaphragm to the liver forming the superior boundary of the bare area
- Hepatorenal ligament: connection of the parietal peritoneum covering the kidney to the posterior edge of the liver as a reflection
- Right triangular ligament: the point in which the anterior and posterior layers of the coronary ligament join on the right hand side of the liver
- Left triangular ligament: the apex of the meeting point of the anterior and posterior layers of the coronary ligament on the left hand side of the liver
- Ligamentum teres: fibrous remnant of the umbilical vein that carried oygenated and nutrient rich blood from the placenta to fetus
- Ligamentum venosum: fibrous remnant of the fetal ductus venosus that shunted blood from the umbilical vein to the IVC.
 Arterial supply of the liver: dual blood supply
- Portal vein: short wide vein formed by the superior mesenteric and splenic vein, ascends anterior to the IVC in the portal triad, bring about 80% of the blood but only 40% more oxygen than those that is returning to the heart to the parenchymal cells. The blood is saturated with nutrients absorbed by the alimentary tract.
- Hepatic artery: account for 20% of the blood received by the liver and distributed to non-parenchymal structures such as the intrahepatic bile ducts.
 Venous drainage of the liver:
- Hepatic vein: 3 intersegmental sets of right, middle and left veins draining adjacent liver divisions. These are formed by the union of collecting veins that drain the central veins of the hepatic parenchyma and later empties into the IVC just inferior to the diaphragm.
 Portacaval anastomoses:
- Superior rectal with rectal
- Epigastric with paraumbilical
- Right gastric and left gastric
- Inferior pancreaticoduodenal with superior pancreaticoduodenal
 Nerve innervation of the liver: nerves of the liver are derived from the hepatic plexus, the largest derivative of the celiac plexus. It accompanies the hepatic artery and portal vein to the liver supply sympathetic fibers and parasympathetic fibers form anterior and posterior vagal trunks.
 Anatomical lobes of the liver: external division of the liver by fissures or peritoneal reflections
- Main lobes: the liver is divided into a smaller left and a larger right lobe by the attachment of the falciform ligament and left sagittal fissure.
- Accessory lobes: on the visceral surface, the porta hepatis and the two sagittal fissure forms two accessory lobes of the right lobe. These are quadrate lobe anteriorly and caudate lobe posterior.
 Functional division of liver: demarcated by the blood supply of the liver (e.g. each part receive independent branches of the portal triad). Altogether the liver can be subdivided into 8 surgically resectable hepatic segments
- The primary division split the liver into two half (5th to 8th lobes from 1st to 4th lobes). This is done internally along the plane of the middle hepatic vein, viscerally by the right sagittal fissure and diaphragmatically by the Cantlie line (gallbladder around to IVC)
- Left and right livers are subdivided vertically into medial and lateral section (6th and 7th from 5th and 8th, 4th from 2nd and 3rd) by the right portal and left portal fissure and each receive a secondary branching of the portal triad. Left portal is demarcated by the falciform ligament and left sagittal fissure. The right portal fissure has no external demarcation.
- Transverse plane at the level of the tertiary branching subdivides all segments except the left median (7th from 6th, 8th from 5th and 2nd from 3rd). The left median counts as the 4th segment. The caudate lobe (1st segment) is supply by branches of both left and right division and drained by its own minor hepatic vein.
 Biliary ducts: canals that convey bile from the liver to the duodenum.
- Left and right hepatic duct draining the respective parts of the liver joins to form the common hepatic duct
- Common hepatic duct unite with the cystic ducts on the right side to form the common bile duct
 Common bile duct: form the free edge of the lesser omentum and varies from 5-15 cm in length. Bile duct descends posterior to the superior duodenum and lies in a groove on the posterior surface of the pancreatic head.
 Hepatopancreatic ampulla: The bile duct unites with the main pancreatic duct on the left side of the descending duodenum forming the hepatopancreatic ampulla. The distal ampulla opens as the major duodenal papilla into the duodenum.
 Sphincter of Oddi: thickened circular muscles around the distal end of the hepatopancreatic ampulla to prevent flow of bile and pancreatic secretions during non-digestion periods. Bile reflux into the gallbladder where it is stored and concentrated.
 Arterial supply of bile duct:
- Cystic artery: supplying the proximal part
- Right hepatic artery: supplying the middle part
- Pancreaticoduodenal artery: supplying the retroduodenal part
 Venous drainage of bile duct: proximal part of the bile duct and hepatic ducts has its veins entering the liver directly while the superior pancreaticoduodenal vein drains the distal part of the bile duct and empties into the portal vein.
 Gallbladder: pear-shaped organs that lies in the fossa for gallbladder on the visceral surface of the liver. Its body is anterior to the duodenum and its neck and cystic duct are immediately superior to it. Peritoneum completely surrounds the fundus of the gallbladder and binds its body and neck to the liver.
- Fundus: end of the organs projects from the inferior border of the liver and located at the top of the 9th costal cartilage.
- Body: contacts the visceral surface of the liver and transverse colon and superior duodenum
- Neck: narrow S-shaped bend part directed toward the porta hepatis and joins the cystic duct
 Cystic duct: duct connecting the neck of the gallbladder to the common hepatic duct. The mucosa of the neck spirals into the spiral fold to keep the cystic duct open so bile can easily be diverted when the sphincter bile duct is closed.
 Arterial supply of gallbladder: the cystic artery supplies the gallbladder and cystic duct, commonly arises from the right hepatic artery in the triangle of calot between the common hepatic duct and the cystic duct.
 Venous drainage of the gallbladder: cystic vein drains the neck of the gallbladder and cystic duct, entering the liver directly or drain through portal vein.
 Nerve innervation of the gallbladder: sympathetic nerves passes from the celiac nerve plexus along the cystic artery to the gallbladder and parasympathetic are vagus nerve following the same pathway way. Parasympathetic stimulation causes contraction f the gallbladder and relaxation of the sphincter at the Ampulla of Vater.

Radiology: Imaging of the abdomen 1

 Liver:
- CT and MRI shows vascular supply, can distinguish hepatocellular cancer from a benign tumor
- Liver should be always examined with CT
 Gallbladder
- Gallstone should use absolutely only ultrasound for detection
- Abnormal gallbladder is tender and thick walls, possibly signs of inflammation and presence of gallstones
- Dilated ducts of common bile duct are detected with ultrasounds and no need for contrast. Loosened area may indicate gallstone.
 Intestine:
- Fluid in the small bowel
- Bubbly appearance distinguishes colon
- With barium enema, small and large bowel can also be distinguish due to their location (colon more peripheral and have context – poop factor)
- Free air in the bowel means bowel penetration
- Haustra marking identify colon
- Air fluid in the small bowel obstruction
 Spleen
- Located at the left upper quadrant, right of the vertebrate from inferior
- Splenic artery located behind the pancreas
- Anything bigger than 10cm is an enlarged spleen. This is most likely due to trauma or invasion by lymphoma
- Spots on the liver and spleen are due to metastatic cancer
- Gray area are areas of hemorrhage

Abdomen CT 2

 Intestine:
- Faecal loading – gas all the way through the colon so no obstruction
- Narrowed thickness of the colon is typical colon cancer
- Caecovolvitis, dilated colon can twist on itself. Air fluid in colon is abnormal
- Colon cancer in colon due to infection (over use of antibiotics and pseudomembrane colitis – loss of good bacteria) and CD.
- CT scan can easily show cancer and their metastasis
 Pancreas:
- Pancreas is retroperitoneal but sometimes tail is intraperitoneal
- Pancreatitis, where all its enzyme is released at once to cause pain in inflammation
- Initially use ultrasound then blood test and then CT scan
- Diabetes – islet cells fails
 Peritoneum:
- Ascites can be shown with ultrasound or inject contrast into peritoneum. Peritoneum pockets are sites of infection
 Kidney:
- Located right next to the pancreas and 2nd part of the duodenum
- Obstruction to the ureters due to cancer or vascular structure
- Kidney stone causes extreme pain
- IVU – allergy reaction rate
- Kidney looks dull with intravenous contract

Abdominal content 2: Spleen and pancreas

 Spleen: an ovoid purplish pulpy mass about the size of a fist and is located in the left hypochondrium where is receives the protection of the lower thoracic cage. It functions as the largest lymphatic organs serving as the site for proliferation of lymphocyte and response. It is completely covered with peritoneum except the hilum which is the attachment of splenic vessels.
- Dimensions: 1 inch thick, 3 inch wide and 5 inches long
- Surfaces: diaphragmatic surface of spleen is convexly curved to fit the convexity of the diaphragm which the anterior and superior borders of spleen are notched and whereas posterior and inferior border is rounded.
 Relations of the spleen:
- Stomach situated anteriorly
- Left part of the diaphragm lies posteriorly
- Left colic flexure place inferiorly
- The left kidney medially
- Tail of the pancreas medially
 Areas of the spleen: located around the hilum of the spleen
- Gastric area: posterior superiorly located on the hilum
- Renal area: posterior inferiorly situated on the hilum
- Colic area: anterior inferiorly placed on the hilum
 Ligaments of the spleen: ligaments contains splenic vessels and attached to the hilum of the spleen
- Splenorenal ligament: ligament to the left kidney
- Gastrosplenic ligament: ligament to the greater curvature of the stomach
 Arterial supply to the spleen: the splenic artery, largest branch of the celiac trunk, follows a wavy course posterior to the omental bursa and along the superior border of the pancreas to reach the spleen. At the hilum it divides into five or more branches that enter the hilum. The lack of anastomoses in the spleen results in the formation vascular segments allowing splenectomy.
 Venous drainage of the vein: the splenic vein that formed from collection of tributaries emerging from the hilum. It is joined by the IMV posterior to the pancreas and continues posteriorly along the body and tail of the pancreas. Later unites with the SMV to form the portal vein.
 Pancreas: an elongated accessory digestive gland that lies retroperitoneally across the posterior abdominal wall posterior to the stomach and between the duodenum and spleen.
 Sections of the pancreas:
- Head of pancreas: expanded parts of the head firmly attached to the medial aspect of the descending and horizontal parts of the duodenum. The head rest posteriorly on the IVC and the bile duct lies in a groove on the posterosuperior surface of the head.
- Neck of pancreas: short part and overlies the superior mesenteric vessels that forms a groove in its posterior aspect. The anterior surface of neck is covered with peritoneum and adjacent to the pylorus of the stomach.
- Body of pancreas: continuation from neck to tail and lies to the left of the superior mesenteric vessels, passing over the aorta and L2 vertebra. Its anterior surface is covered with peritoneum while its posterior surface is bare and is in contact with the aorta. SMA left kidney and renal vessels.
- Tail of pancreas: the ending superiorly-orientated tip of the pancreas that lies anterior to the left kidney, where it is closely related to the splenic hilum and the left colic flexure.
 Uncinate process: a projection from the inferior part of the pancreatic head, extends medially to the left and posterior to the SMA.
 Pancreatic ducts: begins at the tail and runs through the parenchyma of the gland to the pancreatic head where it turns inferiorly. Most of the time, the main pancreatic duct and the bile duct unite to form the hepatopancreatic ampulla that opens into the duodenum.
- Accessory pancreatic duct: a secondary duct in communication with the main pancreatic duct and opens into the duodenum at the summit of the minor duodenal papilla.
 Sphincter of pancreatic duct: located at the terminal part of the pancreatic duct
 Arterial supply of the pancreas: pancreatic arteries derived from the branches of splenic artery along with branches from the gastroduodenal and SMA supply the pancreas. While the splenic artery supply the body and tail, the anterior and posterior branches of the superior pancreaticoduodenal artery (gastroduodenal) and inferior pancreaticoduodenal artery (SMA) provide the head.
 Venous supply of the pancreas: corresponding pancreatic veins to the arteries drain mostly into the splenic vein and partly into SMV.
 Nerve innervation of the pancreas: parasympathetic and sympathetic fibers reach the pancreas by passing along the arteries from celiac plexus and superior mesenteric plexus and distributed to the pancreatic acinar cells and islets.

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