EXAM FOUR ANATOMY

Abdominal Quadrants

RH – Small intestine, right kidney, gallbladder, liver

LH – Pancreas, left kidney, colon, spleen

E – Adrenal glands, spleen, pancreas, duodenum, liver, stomach

RL – Right colon, liver, gallbladder

LL – Left kidney, descending colon

U – Duodenum, ileum, jejunum, umbilicus

RI – Cecum, appendix

LI – Sigmoid colon, descending colon

P – Female reproductive organs, sigmoid colon, urinary bladder

What are the layers of the fascia of the abdominal wall? (Superficial to Deep)

Skin → Camper Fascia → Scarpa Fascia → Superficial Investing Fascia → External Oblique → Intermediate Investing Fascia → Internal Oblique → Deep Investing Fascia → Transversus Abdominus → Transversalis Fascia → Extraparitoneal Fat → Parietal Peritoneum

Where is a potential space for fluid to accumulate in the abdomen?

Between the membranous layer and the deep fascia covering the rectus abdominus and external oblique muscle is a potential space where fluid can accumulate.

External Oblique

O: external surfaces of 5th-12th ribs

I: Linea alba, pubic tubercle, and anterior half of iliac crest

N: Thoracoabdominal N.

V:

Internal Oblique

O: thoracolumbar fascia, anterior iliac crest, inguinal ligament

I: Inferior borders of 10th-12th ribs, linea alba, pubis via conjoint tendon

N: Thoracoabdominal N.

V:

Transversus Abdominis

O: Internal surfaces of 7th-12th costal cartilages, thoracolumbar fascia, iliac crest, inguinal ligament

I: Linea alba, pubic crest, pubis via conjoint tendon

N: Thoracoabdominal N.

V: Lower posterior intercostal and subcostal arteries, superior and inferior epigastric arteries, superficial and deep circumflex arteries, posterior lumbar arteries

Rectus Abdominis

O: Pubic symphysis and pubic crest

I: Xiphoid process and 5th-7th costal cartilages

N: Thoracoabdominal N.

V:

Pyramidalis

O: Body of pubis

I: linea alba

N: Illiohypogastric N.

V:

What are the actions of the abdominal muscles?

1. Provides support for the region while allowing expansion

2. Helps protect the abdominal viscera from injury

3. Compresses abdominal viscera to maintain or increase intra-abdominal pressure. Especially helpful during respiration, coughing and burping

4. Produces the necessary force for action such as defecation, micturition, vomiting, and parturition

5. Actions to help move the trunk

   1. Flexion of trunk – External and Internal obliques, Rectus abdominis

   2. Rotation of trunk – External and Internal obliques

Umbilical Peritoneal Folds

1. Median umbilical fold – from apex of bladder to umbilicus, covers median umbilical ligament and has urachus

2. Medial umbilical folds – lateral to median umbilical folds, cover medial umbilical ligaments which has umbilical artery which becomes medial umbilical ligament

3. Lateral umbilical folds – lateral to the medial umbilical folds, cover inferior epigastric vessels

The thoracoabdominal nerves come from what spinal branches?

T7-T11

In the case that there is a blockage in either vena cava what anastomoses will provide collateral circulation?

The superficial and deep anastomoses provide collateral circulation in the event that there is a blockage in either vena cava.

Where do nodes drain in relation to the transumbilical plane?

Superficial lymphatics accompany the superficial veins

Those above the transumbilical plane drain to the axillary lymph nodes, or some may drain to parasternal nodes

Those below the transumbilical plane drain to the superficial inguinal lymph nodes

Where do the deep lymphatics of the anterolateral abdominal wall drain to?

Deep lymphatics accompany the deep veins of the abdominal wall and drain to the external iliac, common iliac and right and left lumbar lymph nodes.

What is inside the Inguinal Canal? (Male & Female)

Spermatic Cord or Round ligament of the uterus

What are the borders of the Inguinal Canal?

Two walls, Floor and Roof:

Anterior wall – formed by external oblique aponeurosis

Posterior wall – formed by tranversalis fascia

Roof – lateral portion is tranversalis fascia, central portion by musculo-aponeurotic arches of internal oblique and transversus abdominis muscles, medial portion formed by medial crus and intercrural fibers

Floor – lateral portion formed by iliopubic tract, central portion by superior surface of inguinal ligament, medial portion by the lacunar ligament

Direct Hernias

Less common

Predisposing factor: Weakness of anterior abdominal wall in inguinal triangle

Coverings: Peritoneum plus tranversalis fascia

Rarely enters scrotum

Herniating bowel passes medial to inferior epigastric vessels through superficial ring

Indirect Hernias

More common

Predisposing factor: Patency of processus vaginalis

Coverings: peritoneum plus all three fascial coverings of cord/round ligament

Commonly passes into scrotum/labium majus

Herniating bowel passes lateral to the inferior epigastric vessels through the deep inguinal ring

Explain the process of relocation in regards to fetal testes and ovaries.

Fetal testes relocate from dorsal abdominal wall to the deep inguinal rings during the 9th to 12th fetal weeks. Final location of the testis in the scrotum usually occurs before or shortly after birth

Fetal ovaries relocate during the 12th week

What are some key features of the peritoneal cavity?

• Contains leukocytes and antibodies to help resist infection

• Completely closed in males

• In females, - communication pathway to exterior of body through uterine tubes, uterine cavity and vagina

• Potential source of infection from exterior

What is the difference of pain sensation in regards to the parietal and visceral regions?

Parietal

Sensitive to pressure, pain, heat, cold

Pain is well localized

Visceral

Insensitive to touch, heat, cold and laceration, stimulated by stretching and chemical irritation

Pain is poorly localized; referred to the dermatomes of the spinal ganglia that provide the sensory fibers

Describe the areas of referred pain; foregut, midgut, hindgut.

• Pain from foregut derivatives (pharynx, esophagus and stomach) is experienced inepigastric region

• Pain from midgut derivatives (sm. Intestine, cecum, appendix, and ascending colon) - umbilical region

• Pain from hindgut derivatives (descending and sigmoid colons) - pubic regions

What does the supracolic compartment contain?

Stomach, Liver, Spleen

What does the infracolic compartment contain?

Small intestine, ascending/descending colon

Explain the relationship between the abdominal organs and their location in regards to the peritoneum.

• Liver: The liver is almost completely enveloped by peritoneum, forming a structure known as the "hepatogastric ligament" that connects it to the lesser curvature of the stomach. The peritoneum over the liver is known as the "coronary ligament."

• Pancreas: The pancreas has a retroperitoneal location, meaning it is situated behind the peritoneum. However, the head of the pancreas is covered by peritoneum and is in close proximity to the duodenum.

• Spleen: The spleen is intraperitoneal, meaning it is covered by peritoneum, but it is not suspended by a mesentery.

• Kidneys: The kidneys are retroperitoneal, meaning they are situated behind the peritoneum.

• Stomach: The stomach is intraperitoneal, and it is suspended by a double layer of peritoneum known as the "greater omentum."

• Duodenum: The first part of the duodenum is retroperitoneal, while the remaining parts (second, third, and fourth) are intraperitoneal.

• Small Intestine (Jejunum and Ileum): The jejunum and ileum are suspended by a mesentery known as the "mesentery proper."

• Cecum and Appendix: The cecum and appendix are intraperitoneal and are suspended by the "mesoappendix."

• Colon (Ascending, Transverse, Descending, Sigmoid): The ascending and descending colon are retroperitoneal, while the transverse and sigmoid colon are intraperitoneal and have mesenteries known as the "transverse mesocolon" and "sigmoid mesocolon."

• Rectum: The upper part of the rectum is retroperitoneal, while the lower part is intraperitoneal.

What is the purpose of the “small bowel mesentery”?

The small bowel mesentery, or "mesentery proper," is a double layer of peritoneum that supports the jejunum and ileum. It contains blood vessels, lymphatic vessels, and nerves. The superior mesenteric artery and vein, along with lymphatic vessels and nerves, travel within the mesentery, supplying the small intestine. The mesentery allows for mobility of the small intestine within the abdominal cavity, facilitating digestion and absorption of nutrients.

How is the colon organized in the abdomen?

The ascending and descending colon have retroperitoneal attachments, which means they are fixed to the posterior abdominal wall. This attachment provides stability to these parts of the colon and prevents them from excessive movement.

What is the significance of the paracolic gutters?

• Right and Left paracolic gutters

  • Can be sites of passage for infections fluids from different compartments

    • Ex: Fluid from an affected appendix can travel up the right paracolic gutter to the hepatorenal recess

Peritonitis

•Infection or inflammation

•Bacterial contamination or gut trauma

•If widespread can be lethal

Peritoneal Adhesions

• Damage to peritoneum (infection, stab wounds, abdominal operations)

• Release of fibrin - replaced by fibrous scar tissue

• Limit movement of viscera

• Chronic pain or emergency complications

• Adhesiotomy

Peritoneal Dialysis

Peritoneal dialysis (PD) is a medical procedure used to treat individuals with kidney failure, a condition in which the kidneys can no longer adequately filter waste and excess fluid from the blood. PD involves the use of the peritoneum, a membrane that lines the abdominal cavity, as a natural filter for waste removal.

In peritoneal dialysis, a sterile dialysate solution (a mixture of water, electrolytes, and glucose) is introduced into the peritoneal cavity through a catheter surgically placed in the abdominal wall. The peritoneum acts as a semi-permeable membrane, allowing waste products and excess fluid from the bloodstream to diffuse into the dialysate solution.

Describe the component making up each 1/3 of the esophagus.

Upper 1/3 skeletal muscle

Lower 1/3 smooth muscle

Middle 1/3 both

Where does the esophagus pass through the diaphragm?

Passes through thoracic diaphragm - T10

Emerges through the right crus of diaphragm before terminating at the cardiac opening of the stomach

What is significant about the lower esophageal sphincter?

Transition from stratified squamous epithelium of the abdominal esophagus to simple columnar epithelium of the stomach

Continuous irritation → metaplasia (Barrett’s esophagus) → esophageal adenocarcinoma

What supplies the thoracic and abdominal esophagus?

Arterial supply to the esophagus is from thoracic and abdominal sources

• Thoracic esophagus

  • small branches of thoracic aorta

• Abdominal esophagus

  • Branches from left gastric artery (celiac trunk)

  • Branches from left inferior phrenic artery (abdominal aorta)

Venous drainage of the esophagus

Blood above the diaphragm → drains to azygous vein → drains to superior vena cava

Blood below the diaphragm → drains to left gastric vein → drains to portal venous system

(The left gastric vein and its anastomoses are the usual suspect in an alcoholic that presents with painless hematemesis)

Innervation of the esophagus

The esophagus is innervated by the esophageal plexus coming from the right and left vagus nerves as well as the afferent fibers that pass through the sympathetic trunk and splanchnic nerves.

What are the four regions of the stomach?

Divided into 4 regions:

Cardia – surrounds the opening of the esophagus into the stomach

Fundus – above the level of the cardial orifice

Body – largest region

Pylorus – most distal end of stomach; transition to small intestine

More stomach features

Greater curvature – faces inferiorly and is an attachment for greater omentum

Lesser curvature – faces superiorly and is an attachment for lesser omentum

Pyloric canal – ends in a smooth-muscle pyloric sphincter that controls movement of stomach contents into the duodenum

Muscle layers of the stomach

1. Longitudinal = outermost muscle layer

2. Circular

3. Oblique = innermost muscle layer

Stomach’s anatomical relationship to: liver, spleen, pancreas, transverse colon

1. Liver: superior & to the right of stomach

   1. Hepatogastric ligament – attaches lesser omentum to liver'

2. Spleen: Lies against the posterior abdominal wall to the left of the stomach

3. Pancreas: Lies posterior

4. Transverse Colon: Attached to greater omentum & greater curvature by transverse mesocolon

Parasympathetic & Sympathetic Innervation of the Stomach

• Parasympathetic

  • From anterior & posterior vagal trunks and their branches

• Sympathetic

  • From T6-T9 segments of spinal cord

  • Passes to celiac plexus via greater splanchnic nerves

Function of the spleen

• Acts as a filter for old RBCs

• Filters blood for immune system

• Storage for specialized white blood cells and platelets

What is the location of the spleen?

Lies in the left upper quadrant against the diaphragm – in the area of ribs 10-12; usually not palpable

Phrenico-colic Ligament

connects left colic flexure to diaphragm; contacts lower pole of the spleen

Gastrosplenic Ligament

Connects spleen to stomach

(Contains short gastric vessels & left gastro-omental vessels)

Splenorenal Ligaments

Connects spleen to left kidney

(contains splenic artery and vein)

Branches of the splenic artery

Pancreatic branches – enter its superior border

Left gastro-omental artery – anastomoses w/ right gastro-omental

Short gastric arteries – supplies fundus of stomach

Splenic branches – enter hilum of spleen

Spleen venous drainage

Splenic vein joins the superior mesenteric vein to form the portal vein

Spleen Lymph drainage

Lymphatic fluid from spleen drains to pre-aortic nodes near the origin of the celiac trunk (celiac nodes)

Spleen Innervation

Parasympathetic: Vagus N.

Sympathetic: T6-T8

Pain in the left shoulder

Kehr’s sign

Splenic Rupture: Kehr's sign is most commonly associated with a ruptured spleen, often due to trauma or injury. When the spleen ruptures, it can release blood into the abdominal cavity, causing irritation to the diaphragm and resulting in referred pain in the left shoulder.

Function of liver

Largest gland in the body

Except for fat, nutrients absorbed through GI tract are conveyed to liver by portal venous system

Stores glycogen, produces bile

Subphrenic recesses

superior extensions of peritoneal cavity; separated into right and left by falciform ligament

Sub hepatic space

portion of supracolic compartment inferior to liver

Hepatorenal Recess

extension of subhepatic space; communicates with right subphrenic recess

Ligaments of the liver

Coronary ligament – reflection of peritoneum from diaphragm to anterior and posterior portions of the liver

Falciform ligament – separates the left and right lobes

Left triangular ligament – where anterior and posterior portions of the coronary ligament meet on the left side

Right triangular ligament – where anterior and posterior portions of the coronary ligament meet on the right side

Bare area – portion of liver not covered with visceral peritoneum

What makes up the portal triad? What encloses it?

Portal triad = hepatic artery proper, common bile duct, and portal vein

Lesser omentum encloses portal triad

Hepatoduodenal ligament

Hepatogastric ligament

What makes the caudate lobe of the liver unique?

Caudate lobe may be considered a third liver as it receives vessels from both sides

Describe the venous drainage of the liver.

Right hepatic vein – drains V-VIII

Intermediate hepatic vein drains IV, V, VIII

Left hepatic vein drains II-IV

These veins connect to IVC and help hold the liver in place

Caudate lobe veins drain caudate lobe directly to IVC

Liver Lymph Drainage

Anterior superficial drain to hepatic then celiac nodes then cisterna chyli

Posterior superficial drain to phrenic and posterior mediastinal then the right lymphatic and thoracic ducts

Innervation of the liver

Parasympathetic: Anterior and Posterior Vagal Trunks

Sympathetic: Celiac Plexus

Four anastomoses of the portal venous system

1. Esophageal Vein → Gastric veins

2. Superior Rectal Vein → Inferior Rectal Vein

3. Paraumbilical Veins → Epigastric Veins

4. Colon veins

When portal circulation through liver is diminished or obstructed (e.g., liver disease), blood from alimentary tract can still reach right side of heart through IVC by way of these collateral routes.

Describe the steps to bile and blood flow through the hepatocytes.

1. Blood flows into sinusoids from vein and artery

2. Hepatocytes detoxify the blood and produce bile

3. Blood flows to central veins and then to hepatic veins

4. Bile flows through bile canaliculi to the interlobular biliary duct then to larger collecting bile ducts which merge to form right and left hepatic ducts

5. Hepatic ducts combine to form the common hepatic duct

6. Common hepatic duct joins with cystic duct to form the bile duct

Arterial supply of the hepatic ducts

Cystic artery supplies the proximal part

Right hepatic artery supplies the middle part

Posterior superior pancreaticoduodenal artery and gastroduodenal artery supplies the rectoduodenal part

Venous drainage of hepatic ducts

Proximal part drains to liver directly

Distal part empties into hepatic portal vein

Lymph drainage of bile duct

Can drain to cystic lymph nodes, lymph nodes of the omental foramen and hepatic lymph nodes which then drains to celiac lumph nodes

Parts of the gallbladder

Fundus – wide end that often projects from inferior border of liver

Body – main portion that connects to the visceral side of the liver

Neck – Narrow tapering end toward the porta hepatis, connects to the cystic duct

Cystic duct – connects neck of gallbladder to common hepatic duct

Cystohepatic triangle (of Calot) – triangle formed by common hepatic duct, cystic duct and visceral surface of liver

Arterial/Venous supply of the gallbladder

cystic artery

Neck of gallbladder and cystic duct – cystic veins

Fundus and body – drain into liver

Lymph drainage of the gallbladder

cystic/hepatic → celiac

Innervation of the gallbladder

Celiac plexus – sympathetic and visceral afferent

Vagus – parasympathetic

Right phrenic – somatic afferent

Alcoholic & Nonalcoholic Liver Disease

Portal Hypertension

Portal hypertension arises when there is diminished flow through the portal venous system, which may occur because of obstruction at the prehepatic, intrahepatic, or posthepatic level. While it can occur in acute liver failure, portal hypertension is more commonly seen with chronic liver failure. In acute liver failure, the obstruction is usually intrahepatic, and its major clinical consequences are ascites and hepatic encephalopathy. In chronic liver disease, portal hypertension develops over months to years, and its effects are more complex and widespread

Cholestasis

Cholestasis is a condition caused by extrahepatic or intrahepatic obstruction of bile channels or by defects in hepatocyte bile secretion. Can be reversed if obstruction is removed.

Cholestatic hepatocytes (1) are enlarged and are associated with dilated canalicular spaces (2). Apoptotic cells (3) may be seen, and Kupffer cells (4) frequently contain regurgitated bile pigments. (B) Cholestasis, showing the characteristic accumulation of bile pigments in the cytoplasm.

Cholelithiasis

Composed mainly of cholesterol crystals

Pigment stones are brown or black made up of insoluble calcium bilirubinate salts. They form when bile contains a high concentration of unconjugated bilirubin

Can form in gallbladder, cystic duct, or bile duct

Become symptomatic when they are large enough to cause mechanical injury to gallbladder or obstruction of biliary tract

Ultrasound and CT scans are used for locating stones

What are the four parts of the duodenum?

1. Superior

   1. Short, mobile, ampulla

2. Descending

   1. longer (7–10 cm), runs vertically along right sides of L2 and L3, curving around head of the pancreas; lies to right and parallel to IVC

   2. bile duct and main pancreatic ducts enter its posteromedial wall via hepatopancreatic ampulla.

3. Inferior

   1. 6–8 cm long, crosses anterior to the IVC and aorta and posterior to the superior mesenteric artery and vein at level of L3

4. Ascending

   1. short (~ 5 cm) and begins left of L3 and rises superiorly as far as superior border of the L2, 2–3 cm to left of midline. Passes on left side of aorta to reach inferior border of body of pancreas. Here, it curves anteriorly to join the jejunum at the duodenojejunal junction, which takes the form of an acute angle, the duodenojejunal flexure. The flexure is supported by the attachment of suspensory muscle of the duodenum (ligament of Treitz).

   2. The suspensory muscle – slip of skeletal muscle from the diaphragm and a fibromuscular band of smooth muscle from the third and fourth parts of duodenum. The muscle passes posterior to pancreas and splenic vein and anterior to left renal vein.

      1. Widens the angle of the duodenojujunal flexure and facilitates movement of the intestinal contents

      2. Upper GI bleed

Blood supply of the duodenum

supraduodenal & superior pancreaticoduodenal a. supplies parts ½

inferior pancreaticoduodenal (anterior & posterior) aa., supplies parts 3 and 4

Lymphatics of the Duodenum

Anterior lymphatic vessels → pancreaticoduodeal lymph nodes (along the superior and inferior pancreatiocuodeanl arteries) → Pyloric lymph nodes (along the gastroduodeal artery)

Posterior lymphatic vessels → superior mesenteric lymph

Innervation of the Duodenum

Parasympathetic – Vagus (X)

Sympathetic – Greater and Lesser Splanchnic nerves by way of celiac and superior mesenteric plexuses and peri-arterial plexuses

Jejunum vs. Ileum

Jejunum is mainly in abdominal cavity (LUQ), where terminal Ileum begins in pelvis and ascends to medial aspect of cecum. The jejunum represents the proximal two-fifths and begins at the duodenojejunal flexure. It is mostly in the left upper quadrant of the abdomen and is larger in diameter and has a thicker wall than the ileum (this is going to be very slight) although it is shorter than the illeum. The Jejunum has prominent and numerous plicae circulares. Less prominent arterial arcades and longer vasa recta (straight arteries) The illeum has peyer’s patches

Arterial & Venous supply of the jejunum and illeum

SMA & SMV

Jejunum & Illeum Innervation

Sympathetic - T8-10

Parasympathetic - Posterior Vagal Trunks

Visceral afferent fibers - Insensitive to most pain stimuli such as cutting or burning but is very sensitive to distension (abdominal pins or intestinal cramps)

Peristalsis

• Rhythmic contraction of the GI tract pushes food bolus along

• Enteric nervous system: regulates and controls peristalsis and GI secretions, independently of the para- and sympathetic systems

  Succinctly, the myenteric and submucosal plexuses are interconnected and regulate GI tract activity, from peristalsis to secretomotor functionality. They’re also interconnected with the sympathetic and parasympathetic systems.

Sigmoid Colon

• characterized by S-shaped loop of variable length, links descending colon and rectum.

• Extends from iliac fossa to third sacral segment, where it joins the rectum.

• The termination of the teniae coli indicates the rectosigmoid junction.

• Usually has a relatively long mesentery (sigmoid mesocolon) and has considerable freedom of movement, especially its middle part.

• The left ureter and the division of the left common iliac artery lie retroperitoneally posterior to the apex of the root of the sigmoid mesocolon.

Blood supply to the large intestine

Ascending colon

SMA -> ileocolic -> colic

SMA -> ileocolic -> anterior cecal

SMA -> ileocolic -> posterior cecal

SMA -> right colic

Transverse colon

SMA -> right colic

SMA -> middle colic

IMA -> left colic

Descending colon

IMA -> left colic

Sigmoid colon

IMA -> sigmoidal aa.

Innervation of the Colon

The innervation to the colon is dependent on embryological origin:

•Midgut-derived structures - ascending colon and proximal 2/3 of the transverse colon receive sympathetic, parasympathetic and sensory supply via nerves from the superior mesenteric plexus.

•Hindgut-derived - distal 1/3 of the transverse colon, descending colon and sigmoid colon receive their sympathetic, parasympathetic and sensory supply via nerves from the inferior mesenteric plexus:

Parasympathetic innervation - pelvic splanchnic nerves

Sympathetic innervation - lumbar splanchnic nerves.

Appendicitis

• Inflammation of the appendix

• LOWER RIGHT QUADRANT PAIN, fever, n & v, appetite loss

• Chief causes are fecal impaction and infection

• Acute appendicitis is an emergent condition

• 300,000 or so hospitalizations annually in the US

• Removal common

• Used to be considered vestigial/non-functional

• Now understood to play important role in immunity

Ischemic Bowel Disease

Disruption of blood flow to a specific segment of the intestines can produce ischemic bowel disease

Decreased bowel sounds, interruption of peristalsis, pain, etc. as a result of avascular necrosis of the bowel

Vascularization of the GI tract tends to be well-collateralized – facilitates surgical repair

LEFT COLIC FLEXURE IS MOST COMMON FOR VASCULAR BLOCKAGE

Celiac Disease

Immune-mediated pathology triggered by the ingestion of gluten.

Pediatric celiac disease

• Symptoms develop between 6 and 24 months

• Irritability, abdominal distension, anorexia, diarrhea, weight loss, muscle wasting, failure to thrive

• Affects male and female children equally

Adults

• Manifests between 30-60

• Can have extended periods of time with no symptoms

• Symptoms include anemia (due to iron deficiency and less commonly, B12 and folate deficiency), diarrhea, bloating and fatigue.

Bariatric Surgery

The duodenal switch is a weight-loss operation that modifies your stomach and your small intestine. It combines a gastrectomy (removal of part of your stomach) with an intestinal bypass, which makes the path your food takes through your intestines shorter.

If the head of the pancreas was injured what would we be most concerned about damaging?

Bile Duct

If the neck of the pancreas was injured what would we be most concerned about damaging?

Hepatic Portal Vein

If the body of the pancreas was injured what would we be most concerned about damaging?

Aorta

If the tail of the pancreas was injured what would we be most concerned about damaging?

Left Kidney

What branches of the splenic artery supply the pancreas?

Greater Pancreatic A. & Dorsal Pancreatic A.

What branches of the gastroduodenal artery supply the pancreas?

Anterior and posterior superior pancreaticoduodenal arteries

What branches of the SMA supply the pancreas?

Anterior and posterior inferior pancreaticoduodenal arteries

Describe the path of drainage in regards to pancreatic veins.

Pancreatic/Pancreatico-Duodenal Veins → Splenic & SMV → Hepatic Portal Vein

Pancreaticosplenic nodes (Neck, Body, Tail) drain to

Pyloric Nodes

Pyloric and/or Pancreaticoduodenal Nodes (Head) drain to

Pyloric → Hepatic