Mesenteric_Intestines atf

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TABLE OF CONTENTS
Superior Mesenteric 1.
2.
Arteries and Blood Supply
Veins and Venous Drainage
Artery, Inferior 3.
4.
Lymphatics of the Intestines
Small Intestine, Pancreas, and Large Intestine
Mesenteric Artery, 5.
6.
Practice Questions
Clinical - Meckel's Diverticulum
Small Intestine, 7.
8.
Clinical - Appendicitis
Clinical - Volvulus
Pancreas, Large 9.
10.
Clinical - Hirschsprung's Disease
Clinical - Mesenteric Ischemia
Intestine 11. Clinical - Diseases of the Pancreas

REVIEW OUTLINE
1. Arteries 3. Organs
Mesenteric Arteries, ●
●
Superior mesenteric
Inferior mesenteric
●
●
Duodenum
Bile duct
Small Intestine, ● Middle colic ● Pancreas

● Right colic ● Main pancreatic duct
● Accessory pancreatic duct
Pancreas, Large
● Ileocolic
● Appendicular ● Hepatopancreatic sphincter
● Superior rectal ● Rugae (gastric folds)
Intestine ●
●
Sigmoidal
Left colic
●
●
Circular folds
Major and minor duodenal papilla
● Marginal ● Cecum
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● Inferior pancreaticoduodenal ●
●
Semilunar folds
Haustra
● Intestinal
● Vasa recta
● Arcades
2. Veins
● Superior mesenteric
● Inferior mesenteric
● Splenic
● Hepatic portal
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Mesenteric Arteries, Small Intestine, Pancreas, Large Intestine Bootcamp.com
SUPERIOR MESENTERIC ARTERY

ORIGIN
ABDOMINAL AORTA
I DIVISIONS
INFERIORPANCREATICODUODENALA
t INTESTINAL A
ILEOCOLICA
RIGHTCOLICA
MIDDLE COLICA
BLOODSUPPLY
PANCREAS
INFERIORDUODENUM
JEJUNUM
ILEUM
I CECUM
APPENDIX
ASCENDINGCOLON
TRANSVERSECOLON
INFERIOR
PANCREATICODUODENAL ARTERIES
ORIGIN
SUPERIOR MESENTERIC A
DIVISIONS
ANTERIORINFERIOR PANCREATICODUODENAL A
POSTERIOR INFERIOR PANCREATICODUODENAL A
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BLOODSUPPLY
It HEADOFPANCREAS
PROXIMALLOOPOF DUODENUM
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ILEOCOLIC ARTERY
ORIGIN
SUPERIORMESENTERIC A
I DIVISIONS
t APPENDICULAR A
ANTERIORCECALA
POSTERIORCECALA
E BLOODSUPPLY
CECUM
DISTALILEUM
ILEOCECAL JUNCTION
I
APPENDICULAR ARTERY
ORIGIN
I ILEOCOLIC A
BLOODSUPPLY
VERMIFORM APPENDIX
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I
I
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INTESTINAL ARTERIES
JEJUNAL E ILEAL AA
I ORIGIN
DIVISIONS
ARTERIAL ARCADES
BLOODSUPPLY
E
mum
I
ARTERIAL ARCADES
ORIGIN
I SUPERIOR MESENTERIC A
INTESTINAL AA
it
DIVISIONS
VASA RECTA
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BLOODSUPPLY
E
Yum
I
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VASA RECTA
ORIGIN
ARTERIAL ARCADES
BLOODSUPPLY
JEJUNUM
ILEUM
I
I
RIGHT COLIC ARTERY

ORIGIN
DIVISIONS
SUPERIOR DIVISION
INFERIOR DIVISION
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BLOODSUPPLY
E
ASCENDING COLON
I
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MIDDLE COLIC ARTERY

ORIGIN
I
DIVISIONS
LEFT RIGHTBRANCHES
E BLOODSUPPLY
TRANSVERSE COLON
I
INFERIOR MESENTERIC ARTERY

ORIGIN
ABDOMINALAORTA
I DIVISIONS
II
LEFTCOLIC A
SIGMOIDAL AA
SUPERIORRECTAL A
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I BLOOD SUPPLY
DESCENDINGCOLON
SIGMOIDCOLON
RECTUM
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LEFT COLIC ARTERY

ORIGIN
INFERIORMESENTERIC A
DIVISIONS
t ASCENDINGBRANCH
DESCENDING BRANCH
BLOODSUPPLY
E DESCENDING COLON
SIGMOID AC ARTERIES
ORIGIN
I INFERIORMESENTERIC A
BLOODSUPPLY
DESCENDINGCOLON
SIGMOIDCOLON
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SUPERIOR RECTAL ARTERY

ORIGIN
I INFERIOR MESENTERIC A
BLOODSUPPLY
SUPERIORRECTUM
I
MARGINAL ARTERY
ORIGIN
I
it
BLOODSUPPLY
LARGEINTESTINE
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THE MARGINAL A CONNECTSTHE SUPERIOR
AND INFERIOR MESENTERIC AA
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ANASTAMOSES
SUPERIORPOSTERIOR
ODUODENALA
PANCREATIC T PÉNYÉÉÉÉYÉOPGIÉÉNI
A
INFERIOR
SUPERIORANTERIOR
T PANINCÉÉRAFICOADYEBELAL
ODUODENAL A
PANCREATIC A
ARTERIAL ARCADE
I
MOSESOFTHEJEJUNALE ILEAL INTESTINAL AA
ANASTA
I
ANASTAMOSES
A It MARGINAL a
I
g RIGHTcoma
LEFTCOLICA
I
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I ILEOCOLICA
SIGMOIDALA
SUPERIORRECTALA
I
MIDDLE INFERIOR
RECTALA RECTALA
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SUPERIOR MESENTERIC VEIN

HEPATICPORTALU
x
LeetportALV
RIGHTGASTROOMENTALU
RIGHTPORTALV LARGEINTESTINE STOMACH
INFERIOR
HEPATICPortner RIGHTCOLICU mm
a
LARGEINTESTINE PANCREAS
SPLENICV
ILEOCOLICU m n
VARIATION OFTHE K
smallINTESTINE
iMac
ÉÉÉNÉÉÉÉnÉ
SUPERIOR
m VUFROMILEUM
SMALLINTESTINE
INFERIOR
V
MESENTERIC
SPLENIEV
LeetportALV
RIGHTPORTALV
ÉÉÉE In
AfraTafreeh.comRECTOSIGMOIDW
mmmm T
SIGMOIDCOLON e seamoepur
RECTUM SIGMOIDCOLON
T men
RECTUM
MESENTERICU
É v
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TRABECULAR V
SHORTGASTRICU OF SPLEEN
LEFTGASTROOMENTALU SPLEEN
LeetportALV
jjjjj
RIGHTPORTALU
t T
HEPATIC
HEPATICPORTALV
m MESENTERICV
Inferior attract
SPLENICV PANCREAS
SUPERIOR
MESENTERICU
INFERIOR
U
MESENTERIC
PORTALUVT
iii
LeetportALV
t.o.in T
PANCREATIC V
PANCREAS
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HEPATICPORTALV
INFERIOR
MESENTERICU
SUPERIOR
MESENTERICU GITRACT
SUPERIOR
INFERIOR MESENTERICU
V
MESENTERIC
GITRACT
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REVIEW OUTLINE
1. Lymph Nodes of the Large Intestines

Lymphatics of ● Paracolic
the Intestines ● Superior mesenteric
● Intermediate colic
● Ileocolic
● Lateral aortic
● Epicolic
● Appendicular
2. Lymph Nodes of the Small Intestines

● Superior central
● Pancreaticoduodenal
● Mesenteric
● Juxta-intestinal
● Celiac
Intestines Bootcamp.com
Large Intestine Lymph Nodes Superior

mesenteric
1. Epicolic artery
2. Paracolic Middle
colic Inferior
3. Ileocolic artery mesenteric
artery
4. Intermediate colic
a. Right colic
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b. Middle colic Right
colic Left colic
c. Left colic artery artery
5. Inferior mesenteric
6. Lateral aortic
7. Superior mesenteric
8. Appendicular
Ileocolic
artery
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Superior
mesenteric
Small Intestine Lymph Nodes artery
1. Juxta-intestinal
2. Mesenteric
3. Superior central
4. Superior mesenteric
5. Pancreaticoduodenal
6. Celiac
Celiac trunk
Cisterna Chyli
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Cisterna Chyli Superior

mesenteric artery
Right crus of
diaphragm
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Clinical Application
● A patient presents to the ED with the following symptoms
○ Generalized abdominal pain & tenderness
○ Fever
● You order a CT abdomen/pelvis and see multiple enlarged
lymph nodes and make the diagnosis of mesenteric
lymphadenitis
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● If the enlarged nodes are in the area circled, which nodes

are most likely impacted?
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Clinical Application
● If the enlarged nodes are in the area circled, which nodes
are most likely impacted?
References
1. Slides 2&3: Created with BioRender.com
2. Slide 5: Mikael Häggström, M.D. - Author info - Reusing images- Conflicts of interest:
NoneMikael Häggström, M.D., CC0, via Wikimedia Commons
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RUGAE GASTRICFOLDS
FOUND IN THESTOMACH
ALLOWFOR EXPANSIONOF STOMACH
WHEN A BOLUS ENTERS
WHAT ARE THE FOUR PARTS

OF THE DUODENUM
I 1
2
3
AfraTafreeh.com 4
2
3
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CIRCULAR FOLDS
FOLDS IN THEMUCOUS MEMBRANE OF
THE SMALL INTESTINE
SLOW PASSAGE OF PARTIALLY DIGESTEDFOOD
I INCREASED SURFACE AREA FOR ABSORPTION
LOCATIONS
BEGIN 2.5 CM AFTER PYLORIC SPHINCTER
ALMOST ENTIRELY MISSING IN LOWER ILEUM
UNCINATE PROCESS
HEAD PROPER
AfraTafreeh.com NECK
BODY
TAIL
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WHAT ARETHE NAMES OF THE DUCTS

COMINGFROMTHE LIVER E GALLBLADDER
MAINPANCREATICDUCT
JOINSTHEPANCREAS TOTHECOMMON BILEDUCT
the EXOCRINEFUNCTION DIGESTION
PANCREATICJUICE DUODENUM
ACCESSORY PANCREATICDUCT
CAN BEFUNCTIONAL OR NON FUNCTIONAL
MAJORDUODENALPAPILLA
ROUNDED PROJECTION INTO DUODENUM WHERE
THECOMMONBILEDUCT PANCREATICDUCT DRAIN
gjd HEPATOPANCREATIC SPHINCTER

MUSCULARVALVEAROUNDTHEMAJORDUODENAL
PAPILLA
CONTROLSFLOWOFDIGESTIVEJUICES INTO
THEDUODENUM
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MINOR DUODENALPAPILLA
ROUNDED PROJECTION INTO DUODENUM WHERE
THEACCESSORY PANCREATIC DUCT DRAINS
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SEMILUNAR FOLDS
CONTRACTIONS OFCOLON WHICH FORM
CRESCENT SHAPED FOLDS
CECUM
OPENINGOFTHEILEUM
OPENINGOFTHE APPENDIX
DRAWAND NAME ALL OF THE ARTERIES

IN THE ABDOMINAL CAVITY
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WHAT VEINS DRAIN INTO THE

HEPATIC PORTAL VEIN
NAME THE FIVE PARTS OF THE PANCREAS
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REVIEW OUTLINE
1. Arteries 3. Organs
Mesenteric Arteries, ●
●
Superior mesenteric
Inferior mesenteric
●
●
Duodenum
Bile duct
Small Intestine, ● Middle colic ● Pancreas

● Right colic ● Main pancreatic duct
● Accessory pancreatic duct
Pancreas, Large
● Ileocolic
● Appendicular ● Hepatopancreatic sphincter
● Superior rectal ● Rugae (gastric folds)
Intestine ●
●
Sigmoidal
Left colic
●
●
Circular folds
Major and minor duodenal papilla
● Marginal ● Cecum
● Inferior pancreaticoduodenal ● Semilunar folds
Review Questions ●
●
Intestinal
Vasa recta
● Haustra
• Where are the circular folds the ● Arcades

least plentiful?
• How do the superior mesenteric 2. Veins
and inferior mesenteric arteries
join together? ● Splenic
● Hepatic portal
DRAWAND NAME ALL OF THE ARTERIES

IN THE ABDOMINAL CAVITY
ant. + post. inf.

pancreaticoduodenal
middle colic a.
aa.
SMA
right colic a.
ileocolic a. left colic a. AfraTafreeh.com

IMA
sigmoidal aa.
*this diagram covers some, but

not all, of the arteries discussed
superior
rectal a.
in this chapter.
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REVIEW OUTLINE
1. Causes
• Vitellointestinal duct (omphalo-enteric duct)
Meckel’s
2. Rule of 2s
• Incidence
• Location
Diverticulum • Length
3. Clinical Relevance
• Symptoms
• Treatment
Meckel’s Diverticulum Bootcamp.com
Congenital anomaly that represents a remnant of the proximal part of the vitellointestinal duct
(omphalo-enteric duct/yolk stalk)
midgut
Rule of 2s
• Occurs in 2% of patients
• Located 2 feet before the
ileocecal junction
• About 2 inches long AfraTafreeh.com
anterior abdominal yolk sac
Clinical Relevance wall (umbilicus)
• Often asymptomatic
• Contains ileal mucosa but
may include ectopic gastric Inflammation & pain mimicking
or pancreatic tissue causing appendicitis
ulceration
Treatment
• Surgical resection
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Knowledge Check Bootcamp.com
A 18-year-old male arrives to the emergency department presenting with pain in the lower right
quadrant. You suspect appendicitis or Meckel’s diverticulum and order a CT scan to confirm a
diagnosis. CT suggests Meckel’s diverticulum.
Which early derivative of the GI system is responsible for this condition?
Vitellointestinal duct (omphalo-enteric duct/yolk stalk)
Although often asymptomatic, explain how Meckel’s diverticulum may produce pain that mimics
appendicitis.
A 18-year-old male arrives to the emergency department presenting with pain in the lower right
quadrant. You suspect appendicitis or Meckel’s diverticulum and order a CT scan to confirm a
diagnosis. CT suggests Meckel’s diverticulum.
Which early derivative of the GI system is responsible for this condition?
Vitellointestinal duct (omphalo-enteric duct/yolk stalk)

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Although often asymptomatic, explain how Meckel’s diverticulum may produce pain that mimics
appendicitis.
Perforation may occur due to ectopic gastric or pancreatic tissue that may be within the
mucosa causing ulceration and inflammation.
References
AfraTafreeh.com Bootcamp.com
Slide 2
• <a href="https://commons.wikimedia.org/wiki/File:Meckel-Divertikel.jpg">Milliways</a>,
<a href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via
Wikimedia Commons
REVIEW OUTLINE
1. Causes
• Vitellointestinal duct (omphalo-enteric duct)
Meckel’s
2. Rule of 2s
• Incidence
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• Location
Diverticulum • Length
3. Clinical Relevance
• Symptoms
• Treatment
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REVIEW OUTLINE
1. Causes
• Young people vs older people
2. CT Scan
3. Referred Pain
Appendicitis • Peri-umbilical region
• McBurney’s point
4. Treatment
• Antibiotics
• Appendectomy
Appendicitis Bootcamp.com
Acute inflammation of the appendix
Causes
• Young people: hyperplasia of lymphatic follicles
• Older people: fecalith
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Appendicitis
Vague referred pain in Irritation of parietal peritoneum lining posterior

peri-umbilical region abdominal wall causes severe pain at McBurney’s point
Treatment
• Antibiotics
• Appendectomy
A 27-year-old woman reported to the emergency department with abdominal pain that began in the peri-
umbilical region and has now localized to the right lower quadrant. You suspect appendicitis and order a
blood test and CT scan to confirm your diagnosis.
Explain the cause of appendicitis and how it can lead to inflammation of the appendix.
Hyperplasia of lymphatic follicles that occlude the lumen. This prevents the secretions from leaving the
appendix causing inflammation
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Explain why pain begins in the periumbilical region then occurs in the right lower quadrant.
Vague pain from afferent fibers that enter the spinal cord at T10. As the appendix swells, it can
irritate the parietal peritoneum causing localized pain.
What is the name of the area where localized pain is occurring?

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A 27-year-old woman reported to the emergency department with abdominal pain that began in the peri-
umbilical region and has now localized to the right lower quadrant. You suspect appendicitis and order a
blood test and CT scan to confirm your diagnosis.
Explain the cause of appendicitis and how it can lead to inflammation of the appendix.
Hyperplasia of lymphatic follicles that occlude the lumen. This prevents the secretions from leaving the
appendix causing inflammation
Explain why pain begins in the periumbilical region then occurs in the right lower quadrant.
Vague pain from afferent fibers that enter the spinal cord at T10. As the appendix swells, it can
irritate the parietal peritoneum causing localized pain.
What is the name of the area where localized pain is occurring?
McBurney’s point
References Bootcamp.com
Slide 2
• Inflamed Appendix: <a
href="https://commons.wikimedia.org/wiki/File:Depiction_of_a_person_suffering_from_Appendicitis.png">https://www.myupchar.com
/en</a>, <a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
• CT Scan: <a href="https://commons.wikimedia.org/wiki/File:AppendicitisMark.png">James Heilman, MD</a>, <a
href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
Slide 3
• Dermatome Map: <a href="https://commons.wikimedia.org/wiki/File:Dermatoms_alt.svg">Ralf Stephan
(mailto:ralf@ark.in-berlin.de)</a>, Public domain, via Wikimedia Commons
• McBurney’s Point: <a
href="https://commons.wikimedia.org/wiki/File:Surface_projections_of_the_organs_of_the_trunk-es.svg">Mikael Häggströmde la
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traducción Ortisa</a>, <a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via Wikimedia Commons
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REVIEW OUTLINE
1. Causes
• Young people vs older people
2. CT Scan
3. Referred Pain
Appendicitis • Peri-umbilical region
• McBurney’s point
4. Treatment
• Antibiotics
• Appendectomy
REVIEW OUTLINE
1. Causes
• Children vs adults
2. Risk Factors
Volvulus
3. Symptoms
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4. Diagnosis
• CT Scan
• X-Ray
5. Treatment Methods
Volvulus
Twisting of the small intestine (children) or cecum/sigmoid colon (adults) around itself causing a
bowel obstruction
Volvulus of the Sigmoid Colon
Risk Factors
• Intestinal malrotation (birth defect)
• Enlarged colon
• Hirschsprung’s disease
• Abdominal adhesions
• Chronic constipation
Symptoms
• Abdominal distension & pain
• Vomiting
• Constipation
• Bloody stool
• Fever
Volvulus Bootcamp.com
Treatment
• Sigmoidoscopy
AfraTafreeh.com • Colonoscopic detorsion
• Bowel resection (if
necrosis occurs)
CT Scan X-Ray
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A 48-year-old female presents to the emergency department with abdominal distension and
pain, constipation, and bloody stool. Based on the symptoms, you suspect a volvulus but order
a CT to confirm your diagnosis. The results are demonstrated in the image below.
Locate the volvulus on the CT scan.
Which two procedures would you perform to

accurately diagnose and correct the volvulus?
A 48-year-old female presents to the emergency department with abdominal distension and
pain, constipation, and bloody stool. Based on the symptoms, you suspect a volvulus but order
a CT to confirm your diagnosis. The results are demonstrated in the image below.
Locate the volvulus on the CT scan.
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Which two procedures would you perform to
accurately diagnose and correct the volvulus?
Sigmoidoscopy & colonoscopic detorsion

References
Slide 2
• Cartoon Volvulus: <a href="https://commons.wikimedia.org/wiki/File:Volvulus.PNG">James Heilman, MD</a>, <a
• Non-Necrotic Volvulus: <a href="https://commons.wikimedia.org/wiki/File:Volvulus_04.jpg">‫<آرﻣﯾن‬/a>, CC0, via Wikimedia
Commons
• Necrotic Volvulus: <a href="https://commons.wikimedia.org/wiki/File:Volvulus_(Dickdarm).JPG">Herecomesdoc</a>, <a
Slide 3
• CT Scan: <a
href="https://commons.wikimedia.org/wiki/File:Zoekalvolvulus_26jm_-_CT_cor_05_-_001.jpg">Hellerhoff</a>, <a
• X-Ray: <a href="https://commons.wikimedia.org/wiki/File:Sigmoidvolvulus.jpg">Mont4nha</a>, CC0, via Wikimedia
Commons
Slide 4
• <a href="https://commons.wikimedia.org/wiki/File:Zoekalvolvulus_26jm_-_CT_cor_anim_r_-_001.gif">Hellerhoff</a>, <a
REVIEW OUTLINE
1. Causes
• Children vs adults
2. Risk Factors
Volvulus
3. Symptoms
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4. Diagnosis
• CT Scan
• X-Ray
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REVIEW OUTLINE
1. Causes
Hirschsprung’s 2. Risk Factors
Disease 3. Symptoms
Hirschsprung’s Disease Bootcamp.com
Congenital abnormality that results in an obstruction caused by an aganglionic section within the
distal colon (descending & sigmoid) and rectum
Parasympathetic Innervation
Pelvic splanchnic nerves (S2-S4)
Inferior hypogastric plexus

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Abdominal aortic plexus
Inferior mesenteric plexus
Myenteric (Auerbach’s) plexus &

submucosal (Meissner’s) plexus
Hirschsprung’s Disease
Congenital abnormality that results in an obstruction caused by an aganglionic section within the
distal colon (descending & sigmoid) and rectum
Risk Factors
• Male
• Other inherited conditions (Down
syndrome*, congenital heart disease)
Symptoms
• Failure to pass meconium stool within
1-2 days after birth
• Reluctance to eat (poor weight gain,
slow growth)
• Bile-stained vomiting
• Abdominal distension & pain
Treatment
• Surgical resection of the affected
portion of the colon
A 34-hour-old male neonate born at 39 weeks’ gestation presents with abdominal distension
and a failure to pass meconium after 24 hours. You suspect Hirschsprung’s disease.
Which organs of the GI tract are normally affected in this condition?
Descending colon, sigmoid colon, or rectum

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Which plexuses of the parasympathetic nervous system are affected? Select all that apply.
a. Inferior hypogastric plexus

b. Myenteric (Auerbach’s) plexus
c. Inferior mesenteric plexus
d. Abdominal aortic plexus
e. Submucosal (Meissner’s) plexus
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A 34-hour-old male neonate born at 39 weeks’ gestation presents with abdominal distension
and a failure to pass meconium after 24 hours. You suspect Hirschsprung’s disease.
Which organs of the GI tract are normally affected in this condition?
Descending colon, sigmoid colon, or rectum
Which plexuses of the parasympathetic nervous system are affected? Select all that apply.
a. Inferior hypogastric plexus

b. Myenteric (Auerbach’s) plexus
c. Inferior mesenteric plexus
d. Abdominal aortic plexus
e. Submucosal (Meissner’s) plexus
References Bootcamp.com
Slide 2
• <a
href="https://commons.wikimedia.org/wiki/File:The_American_journal_of_roentgenology,_radium_therapy_and_nuclear_m
edicine_(1906)_(14757309595).jpg">Internet Archive Book Images</a>, No restrictions, via Wikimedia Commons
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REVIEW OUTLINE
1. Causes
Hirschsprung’s 2. Risk Factors
Disease 3. Symptoms
REVIEW OUTLINE
1. Causes
2. Risk Factors
Mesenteric 3. Symptoms
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Ischemia 4. Diagnosis
Mesenteric Ischemia
Inadequate blood supply to the intestines caused by an embolism, thrombosis, or

atherosclerosis
Risk Factors
• > 60 years old
• Smoking
• High cholesterol
SMA
Symptoms
• Abrupt & severe abdominal pain (acute)
Jejunal arteries • Abdominal pain 15-30 mins after eating (chronic)
• Weight loss (chronic)
• Nausea & vomiting
Arcades • Fever
• Diarrhea
Vasa recta
Ileal arteries
Mesenteric Ischemia Bootcamp.com
Inadequate blood supply to the intestines caused by an embolism, thrombosis, or

atherosclerosis
Diagnosis
• Angiography
• Doppler ultrasound
Treatment Methods
SMAAfraTafreeh.com
• Angioplasty
• Open surgery to remove plaque or clot
Jejunal arteries • Bypass surgery
• Resection (if tissue death occurs)
• Medications
Arcades
Vasa recta
Ileal arteries
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What are the main causes of mesenteric ischemia?
Embolism, thrombosis, or atherosclerosis
Which arteries are affected in mesenteric ischemia?
a. Jejunal arteries
b. Arcades
c. Ileal arteries
d. Vasa recta
e. Superior mesenteric artery
What are the main causes of mesenteric ischemia?
Embolism, thrombosis, or atherosclerosis
Which arteries are affected in mesenteric ischemia?
a. Jejunal arteries AfraTafreeh.com

b. Arcades
c. Ileal arteries
d. Vasa recta
e. Superior mesenteric artery
References
Slide 2
• <a href="https://commons.wikimedia.org/wiki/File:Colonic_blood_supply.svg">Filip em</a>, <a
href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
Slide 3
• <a href="https://commons.wikimedia.org/wiki/File:Angioplasty_-_Balloon_Inflated_with_Stent.png">BruceBlaus</a>, <a
REVIEW OUTLINE
1. Causes
2. Risk Factors
Mesenteric 3. Symptoms
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Ischemia 4. Diagnosis
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REVIEW OUTLINE
1. Pancreatic Cancer
• Head of the pancreas
• Whipple procedure (pancreatoduodenectomy)
• Neck & body of the pancreas
Diseases of • Distal pancreatectomy
2. Accidental Removal of the Tail of the Pancreas

the Pancreas • Splenectomy
3. Annular Pancreas
• Cause
• Symptoms
Pancreatic Cancer Bootcamp.com
Cancer of the Head of the Pancreas
• Compresses and obstructs the

common bile duct or the x
hepatopancreatic ampulla
Hepatopancreatic ampulla
• Leads to enlargement of the

gallbladder and obstructive
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jaundice due to retention of bile
pigments
• Can lead to pancreatitis due to bile

entering the pancreatic duct
Pancreatic Cancer
Whipple Procedure (Pancreatoduodenectomy)
Removal of the head of the pancreas, duodenum, gallbladder, and common bile duct
Reattachment of the bile

duct, pancreas, and
stomach to the jejunum
Cancer of the Neck & Body of the Pancreas
May lead to obstruction of the:

x
Hepatic portal vein
Inferior vena cava
Aorta NECK
Superior mesenteric artery

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Pancreatic Cancer

x
Hepatic portal vein
Inferior vena cava
Aorta
Early metastasis to the liver due to the close

proximity of the hepatic portal vein

x
Hepatic portal vein
Inferior vena cava
Aorta
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Early metastasis to the liver due to the close
proximity of the hepatic portal vein
Treatment
• Distal pancreatectomy – removal of neck & body

of the pancreas
Accidental Removal of the Tail of the Pancreas
May occur during a splenectomy (surgical removal of the spleen) leading to sugar diabetes
Annular Pancreas Bootcamp.com
Most common birth defect seen in the

pancreas
Ventral and dorsal pancreatic buds form a ring

around the duodenum leading to obstruction
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Symptoms
• Feeding intolerance in newborns
• Intestinal blockage & fullness after eating
• Abdominal pain
• Nausea and vomiting
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Explain how cancer of the head of the pancreas can lead to obstructive jaundice and pancreatitis.
The surgical removal of the _____ may lead to the accidental removal of the tail of the pancreas.
a. First part of the duodenum

b. Quadrate lobe of the liver
c. Portion of the stomach
d. Spleen
e. Gallbladder
Which outgrowths during embryological development are responsible for

producing an annular pancreas?
Explain how cancer of the head of the pancreas can lead to obstructive jaundice and pancreatitis.
• Obstructive jaundice: due to obstruction of the common bile duct or hepatopancreatic ampulla
• Pancreatitis: due to bile entering the pancreatic duct
The surgical removal of the _____ may lead to the accidental removal of the tail of the pancreas.
a. First part of the duodenum

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b. Quadrate lobe of the liver
c. Portion of the stomach
d. Spleen
e. Gallbladder
Which outgrowths during embryological development are responsible for

producing an annular pancreas?
Ventral and dorsal pancreatic buds

References
Slide 2
• <a href="https://commons.wikimedia.org/wiki/File:Blausen_0699_PancreasAnatomy2.png">BruceBlaus. When using this image in external sources it can be cited
as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN
2002-4436.</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
Slide 3
• <a href="https://commons.wikimedia.org/wiki/File:Whipple_Surgery_(Close_Up).png">BruceBlaus</a>, <a
Slide 4
• <a href="https://commons.wikimedia.org/wiki/File:Blausen_0699_PancreasAnatomy2.png">BruceBlaus. When using this image in external sources it can be cited
as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN
2002-4436.</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
Slide 5
• <a href="https://commons.wikimedia.org/wiki/File:Secondary_tumor_deposits_in_the_liver_from_a_primary_cancer_of_the_pancreas.jpg">Haymanj</a>, Public
domain, via Wikimedia Commons
Slide 6
• <a href="https://commons.wikimedia.org/wiki/File:Ortenau_Klinikum_Schaubild_Teilentfernung_Bauchspeicheldruese.jpg">Ortenau Klinikum</a>, <a
href="https://creativecommons.org/licenses/by-sa/3.0/de/deed.en">CC BY-SA 3.0 DE</a>, via Wikimedia Commons
Slide 7
• <a href="https://commons.wikimedia.org/wiki/File:1820_The_Pancreas.jpg">OpenStax College</a>,
<a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
Slide 8
• <a href="https://commons.wikimedia.org/wiki/File:Suckale08FBS_fig1_pancreas_development.jpeg">Jakob Suckale,
Michele Solimena</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
REVIEW OUTLINE
1. Pancreatic Cancer
• Head of the pancreas
• Whipple procedure (pancreatoduodenectomy)
• Neck & body of the pancreas
Diseases of • Distal pancreatectomy
AfraTafreeh.com
2. Accidental Removal of the Tail of the Pancreas
the Pancreas • Splenectomy
3. Annular Pancreas
• Cause
• Symptoms

Mesenteric_Intestines atf

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AfraTafreeh.

Intestine 11. Clinical - Diseases of the Pancreas

Small Intestine, ● Middle colic ● Pancreas

SUPERIOR MESENTERIC ARTERY

RIGHT COLIC ARTERY

MIDDLE COLIC ARTERY

INFERIOR MESENTERIC ARTERY

LEFT COLIC ARTERY

SUPERIOR RECTAL ARTERY

SUPERIOR MESENTERIC VEIN

1. Lymph Nodes of the Large Intestines

2. Lymph Nodes of the Small Intestines

Large Intestine Lymph Nodes Superior

Cisterna Chyli Superior

● If the enlarged nodes are in the area circled, which nodes

WHAT ARE THE FOUR PARTS

WHAT ARETHE NAMES OF THE DUCTS

gjd HEPATOPANCREATIC SPHINCTER

DRAWAND NAME ALL OF THE ARTERIES

WHAT VEINS DRAIN INTO THE

NAME THE FIVE PARTS OF THE PANCREAS

Small Intestine, ● Middle colic ● Pancreas

• Where are the circular folds the ● Arcades

DRAWAND NAME ALL OF THE ARTERIES

ant. + post. inf.

ileocolic a. left colic a. AfraTafreeh.com

*this diagram covers some, but

Which early derivative of the GI system is responsible for this condition?

Vitellointestinal duct (omphalo-enteric duct/yolk stalk)

Which early derivative of the GI system is responsible for this condition?

Vitellointestinal duct (omphalo-enteric duct/yolk stalk)

Acute inflammation of the appendix

Vague referred pain in Irritation of parietal peritoneum lining posterior

What is the name of the area where localized pain is occurring?

What is the name of the area where localized pain is occurring?

Locate the volvulus on the CT scan.

Which two procedures would you perform to

Locate the volvulus on the CT scan.

Sigmoidoscopy & colonoscopic detorsion

Hirschsprung’s 2. Risk Factors

Pelvic splanchnic nerves (S2-S4)

Inferior hypogastric plexus

Inferior mesenteric plexus

Myenteric (Auerbach’s) plexus &

Which organs of the GI tract are normally affected in this condition?

Descending colon, sigmoid colon, or rectum

a. Inferior hypogastric plexus

Which organs of the GI tract are normally affected in this condition?

Descending colon, sigmoid colon, or rectum

a. Inferior hypogastric plexus

Hirschsprung’s 2. Risk Factors

Inadequate blood supply to the intestines caused by an embolism, thrombosis, or

Inadequate blood supply to the intestines caused by an embolism, thrombosis, or

What are the main causes of mesenteric ischemia?

Embolism, thrombosis, or atherosclerosis

Which arteries are affected in mesenteric ischemia?

What are the main causes of mesenteric ischemia?

Embolism, thrombosis, or atherosclerosis

Which arteries are affected in mesenteric ischemia?

a. Jejunal arteries AfraTafreeh.com

Diseases of • Distal pancreatectomy

2. Accidental Removal of the Tail of the Pancreas

Cancer of the Head of the Pancreas

• Compresses and obstructs the