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Anatomy 4.

November 15, 2011


Dr. Melissa Calilao

Accessory Glands of the GIT


OUTLINE
I. Salivary Glands
a) Functions
b) Types of Cells
c) Interlobular Ducts
d) Types of Salivary Glands
e) Major Salivary Glands
II. Liver
a) Functions
b) Surface of the Liver
c) Peritoneal Attachments
d) Divisions of the Liver
e) Blood Vessels
f) Portocaval Anastomoses
g) Lymphatic Drainage
h) Nerve Supply
i) Biliary Tract
j) Liver Histology
III. Gallbladder
a) Parts
b) Cystic Duct
c) Blood Supply and Lymphatic Drainage
d) Nerve Supply
e) Histology
IV. Pancreas
a) Relations
b) Parts
c) Pancreatic Duct
d) Arterial Supply
e) Venous Drainage
f) Lymphatic Drainage
g) Nerve Supply
h) Exocrine Functions
i) Endocrine Functions

Figure 1. Secretory Units

B. TYPES OF CELLS (SECRETORY UNITS)

Serous cells
o usually pyramidal in shape, with a broad base
o narrow apical surface with short, irregular microvilli
o rounded nuclei with basophilic cytoplasm
o usually form a spherical mass of cells called acinus or
alveolus with a small lumen at the center

Mucous cells
o cuboidal to columnar in shape
o nuclei are oval and pressed towards the base of the cells
due to presence of mucous in the cytoplasm
o often organized as tubules, consisting of cylindrical arrays
of secretory cells surrounding a lumen

Objectives:
Enumerate the major salivary glands and classify each based on the nature of its secretion.
State the important anatomic relationships, surfaces and peritoneal attachments of the liver.
Differentiate between classical and functional divisions of the liver.
Describe the circulation of blood within the liver.
Describe the intrahepatic biliary flow.
Enumerate the sites of portocaval anastomoses and explain the clinical significance of such.
Describe the innervation, blood supply, and lymphatic drainage of the liver.
Describe the location of the gallbladder and its anatomic relations.
Describe the innervation, blood supply and lymphatic drainage of the gallbladder.
Identify parts of the extrahepatic biliary system.

State the relations between the CBD and pancreatic duct as they open into the 2 nd portion of the duodenum.
Describe the pancreas and its location, as well as its parts and noting important anatomic relations.

State the exocrine and endocrine functions of the pancreas.


Describe the innervation, blood supply and lymphatic drainage of the pancreas.

I. SALIVARY GLANDS
A. FUNCTIONS

Wet and lubricate the oral cavity and its contents


Initiate the digestion of carbohydrates
Secrete substances such as:
o IgA Major immunoglobulin found in secretions that
protects mucosal surfaces against pathogens
o Lysozymes hydrolyze the walls of certain bacteria
o Lactoferrin binds iron, a nutrient necessary for bacterial
growth

Figure 2. Epithelial components of a submandibular gland lobule

C.

Group 17 | Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

INTERLOBULAR DUCTS (TUBULAR SYSTEM)

Intercalated ducts
o Where secretory end pieces empty into
o Lined by simple cuboidal epithelial cells, with
presence of striations
o Empty into or join to form striated ducts

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Striated ducts
o Characterized by radial striations that extend to form
the bases of the cells to the level of the central nuclei
Radial striations plasma membrane infoldings
with elongated mitochondria that are aligned
parallel to the infolded membranes
o Cells are columnar in shape
o Striated ducts of each lobule converge and drain into
interlobular or excretory ducts located in the CT
septae separating the lobules; initially lined with
pseudostratified or stratified cuboidal epithelium,
distally lined with stratified columnar epithelium
o Myoepithelial cells present in basal lamina of
glands or ducts which function to propel secretions
upon contraction

Histology
o Morphology: Compound tubulo-alveolar gland or
branched tubulo-acinar gland
o Nature of secretion: purely serous
o White structures are fat cells
o Basophilic cytoplasm
o Rounded nucleus at base
o High in Alpha amylase and proline-rich proteins, which are
antimicrobial and have calcium-binding property
o Parotid glands may become acutely inflamed as a result of
retrograde bacterial infection from the mouth via the
parotid duct
o May also become infected via the bloodstream, as in
mumps

D. TYPES OF SALIVARY GLANDS

E.

Minor salivary glands


o Scattered within palatine cavity only
o Named according to location
o Secrete only 10% of the total volume of saliva, but
account for approximately 70% of the mucous
secreted
o Under local neural control
Major salivary glands
o Secrete in response to parasympathetic activity
induced by physical, chemical, and psychological
stimuli
o Large, include the Parotid,
Submandibular/Submaxillary, and Sublingual Glands

MAJOR SALIVARY GLANDS (3 PAIRS)

Figure 4. Parotid Gland


(L-lobules, each containing many secretory units; S-supporting tissue septa,
conveying blood vessels, nerves and large E- excretory ducts)

Arterial supply
- External carotid artery (ECA) and its superficial
terminal branches (Superficial temporal and maxillary
aa.)

Venous drainage
- Retromandibular v.

Lymphatic drainage
- Parotid and Deep cervical nodes

Nerve supply
o Parasympathetic: Secretomotor supply from the
glossopharyngeal nerve (via the tympanic branch, the
Lesser Petrosal nerve, the Otic ganglion, and the
Auriculotemporal nerve)
o Sympathetic: Plexus around ECA

Figure 3. Salivary Glands

I.

Parotid Glands
Gross
o Largest of the salivary glands
o Wedge-shaped
o Situated below the external auditory meatus
o Lies in a deep hollow behind the ramus of the mandible, and
in front of the sternocleidomastoid muscle
o Secretes 25% of total saliva
o Stensens/Parotid duct emerges from the anterior border of
the gland, runs toward the lateral surface of the masseter
muscle, pierces the buccinator muscle, opens opposite the
nd
upper 2 molar tooth, into the parotid papilla of the oral
cavity

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

II.

Submandibular/Submaxillary glands
Gross
o Partly below the mandible
o Seen in the submandibular triangle
Histology
o Whartons Duct
o branched tubuloacinar gland, both mucous and serous,
predominantly serous with basophilic cytoplasm
o secretes lyzozyme
o goes along with the tongue and empties into the
sublingual caruncle
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o produces 70% of total saliva


o Striated ducts are larger than in sublingual glands
(predominantly mucous glands)
o Determines the role of the striated duct in modifying
isotonic basic saliva to produce hypotonic saliva

Figure 6. Sublingual gland

Arterial Supply and Venous Drainage


- Facial and Lingual artery and veins

Lymphatic drainage
- Submandibular and Deep cervical nodes

Nerve supply
o Parasympathetic: Secretomotor supply is from the facial
nerve via the chorda tympani & the submandibular
ganglion (Superior Salivary nucleus of CN VII) (increases
secretions)
o Sympathetic: Plexus around facial and lingual a. (Decreases
secretion)

Figure 5. Submandibular glands

III.

Arterial Supply and Venous drainage


- Facial & Lingual (artery & vein)

Lymphatic drainage
- Retromandibular and Deep cervical nodes

Nerve supply
o Parasympathetic: secretomotor supply is from the
facial nerve via the chorda tympani & the
submandibular ganglion (Superior Salivary nucleus of
CN VII)
o Sympathetic: Plexus around facial and lingual a.
Sublingual glands
Gross
o Smallest
o Seen on the floor of mouth, beneath mucus membrane,
close to the midline
o 8-20 sublingual ducts which empty into sublingual folds
but a few may open into the sublingual caruncle
o Secretes 5% of the total saliva

*In the human submandibular and sublingual glands, serous and


mucous cells are arranged in a characteristic pattern. The mucous
cells form tubules, but their ends are capped by serous cells,
which constitute the serous demilunes
CLINICAL CORRELATION
Xerostomia or dry mouth is associated with difficulties in chewing,
swallowing, tasting, and speaking, dental caries, and atrophy of
the oral mucosa. It is a chronic autoimmune disorder characterized
by lymphocytic infiltration of the exocrine glands, particularly the
salivary and lacrimal gland

II. LIVER
-

Figure 7. Location of sublingual duct openings

Histology
o branched tubulo-acinar gland formed of serous and
mucous cells
o mucous cells more predominant
o serous cells are present almost exclusively on demilunes
of mucous tubules
o Histologically lung-like appearance
Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

Largest mass of glandular tissue in the body


Largest internal organ: 1.5 kg
Found in the abdominal cavity beneath the diaphragm
lies mainly in the RUQ
occupies most of the Right hypochondrium and upper
epigastric
extends into the left hypochondrium
Biliary ducts: Right and left join to form the common hepatic
duct
Common/bile duct: hepatic duct + cystic duct
Blood supply:
Portal vein 70-80%
Hepatic artery 20%

A. FUNCTIONS

Aids in the emulsification of fat


Produces bile
Filtration of blood
Heparin synthesis

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B. SURFACE OF THE LIVER


o Diaphragmatic surface
Convex, smooth
Subphrenic recesses : superior extensions of the peritoneal
cavity
o Separated into right and left by the falciform ligament
Subhepatic space: supracolic compartment inferior to the
liver
Hepatorenal recess (Hepatorenal pouch/Morison pouch):
posterosuperioir extension of the subhepatic space
o Fluid draining from the omental bursa flows here
anterior layer is continuous on the left with the right
layer of the falciform ligament
posterior layer is continuous with right layer of the
lesser omentum
* all recesses of the peritoneal cavity are potential spaces with
enough peritoneal fluid for lubrication
o Anterior aspect
o Posterior aspect
o Visceral (posteroinferior)
Flat; concave
Covered with peritoneum except at the bed of the
gallbladder and the portahepatis
Portahepatis: transverse fissure in the middle visceral
surface of the liver
o Gives passage to the portal vein, hepatic artery, hepatic
nerve plexus, hepatic ducts, and lymphatic vessels
o Related to:
Right kidney
Right suprarenal gland
Hepatic flexure
Duodenum
Gallbladder
Fundus of the stomach
Abdominal esophagus
o Impressions
Renal
Esophageal
Duodenal
Colic
Fecal
Gastric
Suprarenal
Visceral surface shows an H-shaped pattern (2 vertical limbs
and 1 horizontal limb)
o Left limb of the H
Divides surface into right and left lobes
Fissure for ligamentumtereshepatis (remains of the left
umbilical vein)
Fissure for ligamentumvenosum ( remains of the
ductusvenosus)
o Right limb of the H
Gallbladder fossa - Between the right lobe and quadrate
lobe
Sulcus for inferior vena cava between the right lobe
and caudate lobe
o Horizontal limb of the H
the portahepatis or hilum of the liver
between caudate and quadrate lobe

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

C.

PERITONEAL ATTACHMENTS OF THE LIVER

Falciform Ligament
o attaches the liver to the anterior wall of the abdominal
cavity up to the level of the diaphragm
o its free edge forms the ligamentum teres
o passes on to the anterior and then the superior surfaces
of the liver then splits into 2 layers
right layer: forms the upper layer of the coronary
ligament; free margin forms the right triangular
ligament
left layer: forms the upper layer of the left
triangular ligament
Coronary ligament: has an upper and lower layer which
encloses an area of the liver devoid of peritoneum known as
the bare area; attaches the right lobe of the liver to the
diaphragm
Right triangular ligament: V-shaped fold of peritoneum
formed by the right extremity of the coronary ligament;
connects the posterior surface of the right lobe of the liver to
the diaphragm
Left triangular ligament: attaches the left lobe of the liver to
the diaphragm; communicate with appendix fibrosa at the left
tip of liver
Areas devoid of Peritoneum
o Bare area
o Area proximal to the inferior vena cava
o Gallbladder in contact with liver bed
o Portahepatis

D. TYPES OF DIVISIONS OF THE LIVER& LOBES OF LIVER


Table 1. Liver lobe divisions

Lobes

Classical
Right Lobe:
subdivided into
quadrate and caudate
Left lobe

Functional
Left Lobe: including
quadrate and
caudate lobes
Right lobe

Lobes of liver
o Right lobe
larger than the left lobe
blood supply of functional right lobe: right hepatic artery
venous and lymphatic drainage: right hepatic vein and
hepatic duct
o Left lobe
extends to left hypochondrium
th
reaches the upper border of the 6 rib
blood supply: left hepatic artery
venous and lymphatic drainage: left hepatic vein and
hepatic duct
o Quadrate lobe
lower portion of the classical right lobe
o Caudate lobe
upper portion of the classical right lobe
*refer to appendix for summarized table

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Retroperitoneal anastomosis
o veins of ascending colon, descending colon, duodenum,
pancreas and liver (portal) with renal, lumbar and phrenic
veins (systemic)
o retroperitoneal varicose portocaval anastomosis

G. LYMPHATIC DRAINAGE

Figure 8. Liver divisions

E.

F.

BLOOD VESSELS OF THE LIVER


Hepatic Portal vein
o Bring 75-80% of blood to the liver
o portal blood, containing about 40% more oxygen than blood
returning to the heart from the systemic circuit to sustain the
liver parenchyma.
o it is formed by superior mesenteric and splenic veins posterior
to the pancreas.
o it ascends anterior to the IVC as part of the portal triad in the
hepatoduodenal ligament.
Hepatic artery
o it accounts for 20-25% of blood receives by the liver to nonparenchymal structures particularly the intrahepatic bile
ducts.
o it is a branch of the celiac trunk maybe divided into:
Common hepatic artery- from celiac trunk to the
origin of the gastroduodenal artery.
Hepatic artery proper-from the gastrdoudenal artery
to the bifurcation of the hepatic artery

PORTOCAVAL ANASTOMOSES

- Portal hypertension may be caused by block in intrahepatic portal


vein tree, cirrhosis, impaired outflow of blood from the liver,
excessive flow of splanchnic or hepatic arterial blood to the liver

Esophageal
o Esophageal branches of left gastric (portal) with
rd
esophageal veins draining middle 3 of esophagus
(systemic)
o Esophageal varicosities: esophageal hemorrhage : most
dangerous complication of the portal HPN

Rectal
o Superior rectal veins (portal) with middle and inferior
rectal veins (systemic)
o Superior rectal veins (portal) with middle and inferior
rectal veins (systemic)
o Hemorrhoidal piles: swollen/inflamed vascular structures
in the anal canal

Para-umbilical
o Paraumbilical veins(portal) with superficial veins of
anterior abdominal wall (systemic)
o Caput Medusae: distended and engorged paraumbilical
veins radiating from the umbilicus
Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

The lymphatic vessel of the liver occurs as:


o Superficial lymphatics (in fibrous capsule of the liver)
which forms its outer surface drains to hepatic lymph
nodes
o Deep lymphatics (in connective tissue) which accompany
the ramification of the portal triad and hepatic veins.
Space of Mall
o lymph from sinusoids is brought to an area between the
stromal of periportal area and hepatocytes
o Between the outermost hepatocytes and stroma of the
portal triad
o it travels with the portal triad but in different direction
Celiac nodes
o majority of the lymph vessels from the liver enter the lymph
nodes in the portahepatis and eventually pass to the celiac
nodes
Posterior mediastinal lymph nodes
o vessels from the bare area of the liver pass through the
diaphragm to the posterior mediastinal lymph nodes
Lymph Flow : Portal area (space of mall) hepatic lymph nodes
celiac lymph nodes cisterna chyli of the thoracic duct

H. NERVE SUPPLY

The nerves of the liver are derived from the hepatic plexus
which accompanies the branch of the hepatic artery and
hepatic portal vein.
o hepatic plexus
Sympathetic fibers from celiac plexus
Parasympathetic fibers from the anterior vagal trunk

I.

BILIARY TRACT

Bile
o produced by hepatocytes
o golden yellow or greenish yellow
o alkaline water containing sodium bicarbonate, bile salts,
bile pigments, cholesterol, lecithin and mucin
o aids in the breaking down of fats
o stored and concentrated (thru absorption of water and
salts) in the gallbladder when digestion is not take place
o first collected by the bile cannaliculi or bile capillaries
between hepatocytes
nd
Common bile duct drains into 2 part of the duodenum at the
ampulla of vater.

J. LIVER HISTOLOGY
i.

STRUCTURAL ORGANIZATION
STROMA
o Glissons Capsule: thin connective tissue
o Thicker at hilum
o Vessels and ducts covered with connective tissue all the
way to termination/origin

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PARENCHYMA
o
Organized plated of hepatocytes:
80% liver cell population
1-2 spherical nuclei with nucleoli
Acidophilic cytoplasm with basophilic bodies
Numerous microvilli

Organelles:
- Rough ER - sites for synthesis of plasma proteins
(albumin, fibrinogen, prothrombin and lipoprotein)
- Smooth ER important in CHO metabolism, bile
formation, catabolism of drugs and other toxic
substances; also site of VLDL synthesis
- Golgi complexes important in concentrating and
packaging secretory products
- Mitochondria energy production
- Lysosomes for turnover and degradation of
organelles
- Peroxisomes oxidative metabolism of lipids, purines
& alcohol; participate in cholesterol and bile acid
synthesis
Bile canaliculus
- tubular space between two abutted hepatocytes,
which forms a complex of anastomosing network
- Empties from the canals of Hering to preductules of
cholangioles into bile ductules which then end in the
into bile ducts in the portal spaces
- Bile ducts gradually enlarge and fuse to form the right
and left hepatic ducts, which subsequently leave the
liver as the common hepatic duct
- Bile flow opposite of blood flow: center to periphery

SINUSOIDAL CAPILLARIES
o Sinusoids
o Vascular channels between plates of hepatocytes that are
lined by fenestrated endothelium
o Contain Kupffer cells: macrophages that belong to the
mononuclear phagocyte system that metabolize aged
RBCs, digest hemoglobin, secrete proteins related to
immunological processes and destroy bacteria (later sent
to space of Disse)

PERISINUSOIDAL SPACE (SPACE OF DISSE)


o Where exchange of nutrients and waste products occur
o Subendothelial space that separates the endothelial cells
from the hepatocytes

ii.

BLOOD SUPPLY
Portal Vein
o supply 80% of blood flow
o nutrient-rich but oxygen-poor
o from abdominal viscera
o branches into portal venules to the portal spaces
o Portal Venules
o branch distributing venules that run around the
periphery of each lobule and lead into the sinusoids as
inlet venules
o sinusoids: run radially, converging in the center to form
central or centrolobular venule
o central venules converge into sublobular veins to form
large hepatic veins, which drains -> inferior vena cava

Figure 9. Intrahepatic vascular strucuture

Hepatic Artery 20-30%


o Supply 20% of blood flow
o Oxygen-rich
o Branch of celiac plexus
o Ramifies parallel with portal veins branches, some of which
lead into the sinusoids
o In the hepatic sinusoids, there is mixing of arterial and portal
venous blood
Blood always flows from periphery to the center of each hepatic
lobule
o Intrahepatic vascular system: blood from portal vein and
hepatic artery is drained into the sinusoids central venule
sublobular vein hepatic vein IVC
iii.

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

HEPATIC LOBULE
Functional units of the liver
Composed of hepatocytes arranged into polyhedral structures
Each lobule has three to six portal areas at its periphery and a
venule in the center (central vein)
The portal zones at the corners consist of connective tissue in
which the PORTAL TRIAD are embedded; portal triad consists
of venule (from portal vein), arteriole (from the hepatic
artery), and a branch of the bile duct (duct of cuboidal
epithelium)

Figure 10.Lobule structures

Hepatic Lobule Structure and Function


Classic Hepatic Lobule
o Hexagon
o Center: Central Venule
o Angles: portal canals
o Blood flow from 6 portal triad areas to a central venule
o Emphasizes endocrine function of liver
Portal Lobule
o Triangular
o Center: Portal Triad
o Angles: Central Venule at each tip
o Bile flow: from hepatocytes to bile duct of portal triad
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Emphasizes major exocrine function of liver: bile


secretion
Liver Acinus
o Diamond or rhomboid in shape
smallest functional unit of hepatic parenchyma
o Area irrigated by terminal branch of the distributing vein
o Short axis: terminal branches of portal triad
o Long axis: line drawn between two central veins
o Has 3 zones:
o Zone I
- periphery of classic lobule
st
- get most oxygen and nutrients (1 to receive)
- can most readily carry out oxidative metabolism
st
- 1 to show morphologic changes after bile duct
occlusion
st
- Last to die if circulation impaired, but 1 to
regenerate
o Zone II
- Middle
- Have intermediate range of metabolic functions
o Zone III
- closest to central venule
- most central part of classic lobule
- get least oxygen and nutrients
- preferential sites of glycolysis, lipid synthesis and
drug biotransformation
st
- 1 to undergo fatty accumulation and ischemic
necrosis
- Last to respond to toxic substances and bile stasis

Peritoneum completely covers the fundus of the gallbladder


and binds its neck and body to the liver

A. PARTS
FUNDUS: wide, blunt end that projects from the inferior lobe of
th
the liver at the right 9 costal cartilage
BODY: main portion that contacts the liver, transverse colon, and
superior part of the duodenum
NECK: narrow, tapering end, opposite the fundus; directs to the
portahepatis and joins the cystic duct
INFUNDIBULUM/HARTMANNS POUCH: funnel shaped cavity
located close to the neck

Figure 12. Gallbladder

B. CYSTIC DUCT
Figure 11. Liver acinus

Liver Regeneration
Has extraordinary capacity for regeneration
Controlled by chalones
o Self-regulating
o Compensatory hyperplasia a process in which the
remaining healthy hepatocytes begin to divide continuing
until the original mass of tissue is restored
Liver cirrhosis
o Continuous or repeated damage to hepatocytes over a
long period of time by various agents such as ethanol,
drugs or other chemicals, hepatitis virus (B,C, or D),
parasites and autoimmune liver disease
o Formation of disorganized hepatocytes
o Causes liver failure, and is usually fatal

III. GALLBLADDER
-

Lies in the fossa for the gallbladder at the visceral surface of the
liver, located at the junction of the left and right lobe
Pear-shaped sac
Can hold 30-50mL of bile
Stores and concentrates bile

Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

Connects the neck of the gallbladder to the common hepatic duct


Passes between the layers of the lesser omentum, parallel to the
common hepatic duct, joining it to form the (common)bile duct;
(cystic duct + common hepatic duct = common bile duct)
As the common bile duct, joins the pancreatic duct to form the
nd
Ampulla of Vater, which opens into the 2 part of the duodenum
by the Major Duodenal Papilla; (common bile duct + pancreatic
duct = Ampulla of Vater)
Contains mucosal duplications forming the spiral fold/spiral valve
(of Heister) that regulates gallbladder filling and emptying; and
offers additional resistance to sudden bile dumping

C.

BLOOD SUPPLY AND LYMPHATIC DRAINAGE

CYSTIC ARTERY
o Supplies the gallbladder and the cystic duct
o Arises from the Right Hepatic Artery in the
Cystohepatic Triangle of Calot (the triangle between
the common hepatic duct, cystic duct and visceral
surface of the liver/free edge)
CYSTIC VEINS
o Drains the neck of the gallbladder and cystic duct

Page 7 of 11

Multiple, small veins that enter the liver after joining


the veins that drain the hepatic ducts and proximal
bile duct
o Veins from the fundus and the body of the gallbladder
pass directly into the hepatic sinusoids
LYMPHATIC VESSELS
o Drainage is through the Cystic lymph node, which
drains into the Hepatic lymph node, which then drains
into the Celiac lymph node

D. NERVE SUPPLY

The gallbladder and the cystic duct is supplied by the Celiac


Plexus formed by sympathetic and parasympathetic vagal fibers
Parasympathetic stimulation causes contractions of the
gallbladder and relaxation of the sphincters at the
hepatopancreatic ampulla.
CCK, produced by the enteroendocrine cells of the duodenum,
causes gallbladder contraction in response to consumption of
fatty food (stimulus)
Biliary tract pains are either circumscribed tenderness in the
gallbladder region or colicky pain.
Pain radiation: back, just below the tip of the right scapula,
right shoulder, substernal area, anterior left chest

E.

GALLBLADDER HISTOLOGY

MUCOSA:
o Simple columnar epithelium with microvilli
o Tubuloacinar glands (mucous glands are present only in the
neck)
o Absence muscularis mucosa
o Lining epithelia with prominent mitochondria, microvilli and
intercellular spaces; indicative of absorptive cells (bile
concentration achieved through water absorption)
Absence of muscularis mucosa
Muscular Layer
o Discontinuous
o Inner layer: longitudinally oriented; outer layer:
diagonally oriented
Presence of Serosal layer
Rokitansky-Aschoff Sinuses: pseudodiverticula
True Ducts of Luschka: aberrant vestigial bile ducts

F.

EXTRAHEPATIC BILIARY SYSTEM


The right and left hepatic bile duct converge to form the
common hepatic duct
The common hepatic duct and cystic duct come together to
form the common bile duct
The common bile duct joins the main pancreatic duct to form
nd
the Ampulla of Vater, that enters the 2 part of the duodenum
through the major duodenal papilla

G. PARTS OF THE COMMON BILE DUCT

Supraduodenal
Retroduodenal
Infraduodenal
Intraduodenal

IV. PANCREAS
-

Mixed exocrine-endocrine gland that produces digestive


enzymes and hormones

Exocrine pancreatic juice from acinar cells

Endocrine glucagon and insulin from pancreatic islets of


Langerhans
An elongated structure that lies in the epigastrium and the left
upper quadrant
Soft and lobulated
It crosses the pyloric plane (L1-L2 vertebral bodies) and situated
on the posterior abdominal wall behind the peritoneum
(retroperitoneal)

A. RELATIONS
Anteriorly (from (R) to (L)):
- Transverse colon
- Attachment of the transverse mesocolon
- Lesser sac
- Stomach
- Spleen
Posteriorly (from (R) to (L)):
- Bile duct
- Portal vein
- Splenic vein
- Inferior Vena Cava
- Aorta
- Origin of Superior Mesenteric Artery
- Left Psoas muscle
- Left suprarenal gland

B. PARTS

Figure 13. Types of ducts in gallbladder

Figure 14. Pancreas


Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado

Page 8 of 11

C.

HEAD
o Disc shaped and lies within the concavity of the duodenum
o A part of the head extend to the left behind the superior
mesenteric vessels and is called the uncinate process (or
lingula of the pancreas)
o It rests posteriorly on the IVC, right renal artery and vein,
and left renal vein.
o The bile duct lies in a groove on the postero-superior
surface of the head or is embedded in its substance
NECK
o Constricted portion of the pancreas and connects the head
of the body
o Lies in front of the beginning of the portal vein and the
origin of the superior mesenteric artery from the aorta
BODY
o Runs upward to the left across the midline
o Lies to the left of the superior mesenteric vessels, passing
over the aorta and L2 vertebra.
o Sometimes triangular in cross section
o Lies in the epigastric area
o Comes in contact with hilum of spleen
TAIL
o Anterior to the left kidney and passes forward in the
splenicorenal ligament
o Comes in contact with the hilum of the spleen

Accessory pancreatic duct (of Santorini)


o If present, drains the upper part of the head and then
opens into the duodenum about 2 cm above the main duct
on the minor duodenal papilla
o Frequently communicates with main pancreatic duct

D. ARTERIAL SUPPLY

PANCREATIC DUCTS

Figure 16. Arterial supply of the pancreas

Figure 15. Pancreatic Ducts

Main pancreatic duct (of Wirsung)


o Begins in the tail and runs the length of the gland,
receiving numerous tributaries
o Opens into the 2nd part of the duodenum about its middle
with the bile duct into a saclike dilatation called Ampulla
of Vater(aka Hepatopancreatic papilla) and into the Major
duodenal papilla

Sphincter of Oddi
o Circular muscles fibers which surround the Ampulla of
Vater and the terminal segments of the main pancreatic
duct and common bile duct
o Functions to contract the Ampulla of Vater to prevent the
throw of bile during the basal state
o Prevents reflux
o Presence of food relaxes the sphincter, allowing bile to
flow into the duodenum
o Without food, the sphincter is contracted

Derived mainly from the splenic artery


o Head & neck: (anterior and posterior) superior & (anterior
and posterior) inferior pancreaticoduodenal arteries

Superior pancreaticoduodenal a. is a branch of


gastroduodenal a.

Inferior pancreaticoduodenal a. is branch of superior


mesenteric artery
o Body & tail: Splenic body from celiac artery

E. VENOUS DRAINAGE

Figure 17. Venous drainage of pancreas


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Pancreatic veins Tributaries of the splenic and superior


mesenteric parts of the portal vein but most empty into the
splenic veins

F.

LYMPHATIC DRAINAGE

Pancreaticosplenic nodes
o Major lymph drainage
o Lie along the splenic artery
o Most vessels drain into these and some to the Pyloric lymph
nodes toward the celiac nodes or superiormesenteric nodes
o Lymph nodes are situated along the arteries that supply the
gland
o Very extensive thats why carcinoma spreads easily
(intermingle with other lymph nodes)
CLINICAL CORRELATION
Cancer of the head of pancreas often obstructs the bile duct
and/or hepatopancreatic ampulla resulting in the retention of bile
pigments, enlargement of the gallbladder, and obstructive
jaundice. It may also cause obstruction of hepatic portal and
inferior vena cava because it overlies these veins. Surgical
resection of the pancreas is futile because of its extensive
drainage in relation to its inaccessible lymph nodes and
metastasis to the liver occurs early, via hepatic portal vein. Life
expectancy for individuals afflicted with it usually is 2-3 months.

G. NERVE SUPPLY

Motor:

Sympathetic: Greater splanchnic (T5-T9)

Majority

Lesser splanchnic (T10-T11)

Decreases stimulation

Parasympathetic: Vagus n.

Stimulation

Increases enzyme content


Secretion is mediated by secretin and cholecystokinin
Sensory:
o Afferent fibers of sympathetic and vagal (parasympathetic)
pathways through the celiac ganglia to greater splanchnic
nerves
o Pain is felt over the epigastrum and back area

H. EXOCRINE FUNCTION

Composed of:
1. Pancreatic acini composed of several serous cells
2.Intercalated ducts merge to form larger interlobar ducts
lined with columnar epithelium
Secretes pancreatic juice rich in bicarbonate ions (HCO3-) and
digestive enzymes (Proteases, Lipases, Nucleases and amylases)
Most proteases are stored as zymogen (inactive form) granules
of acinar cells
Centroacinar cells- constitute the intraacinar portion of the
intercalated duct and are only found in the pancreatic acini

I.

ENDOCRINE FUNCTION

Composed of:
Islets of Langerhans compact spherical masses of
endocrine tissue embedded within the acinar exocrine tissue.
o numerous in the tail region of pancreas
o arranged in cords separated by a network of
fenestrated capillaries
Table 3. Types of Cells found in the Islets
Hormone
Hormone
Cell Type
Quantity
Produced
Function
~20%
Glucagon
Increases
Alpha Cells
blood glucose
content
~70%
Insulin
Decrease
Beta Cells
blood glucose
content
~5-10%
Somatostatin
Inhibits
release of
Delta Cells
other islet cell
hormones
Pancreatic
Rare
Pancreatic
Stimulates
Polypeptide
Polypeptide
activity of
Cells
gastric chief
cells
(F Cells)

Table 2. Summary of pancreas nerve supply/visceral referred pain


Referred site &
Spinal
Origin
Nerve Supply
clinical
Cord
example
Inferior part of
Vagus and
Pancreatic
the epigastric
thoracic
T8-T9
head
region (e.g.
splancnic nerves
pancreatitis)

Gallbladder
& Liver

Nerves derived
from celiac
plexus
(sympathetic),
vagus nerve
(parasympatheti
c), and right
phrenic nerve
(sensory)

T6-T9

Epigastric
region and
right
hypochondriac
region; may
cause pain on
posterior
thoracic wall or
right shoulder
owing to
diaphragmatic
irritation

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APPENDIX:

Anatomical term
Functional/surgical
term

Right lobe
Right (part of )the liver [Right portal lobe]

Left lobe
Left (part of )the liver [left portal
lobe]

Caudate lobe
Posterior part of
the liver

Right lateral division

Right medial
division

Left medial
devisor

Left lateral
division

Posterior lateral
segment
SEGMENT VII
[posterior superior
area]
Right anterior lateral
segment
SEGMENT VI
[posterior inferior
area]

Posterior lateral
segment VIII
[anterior superior
area]

[Medial superior
area]
Left medial
segment

Anterior medial
segment V
[anterior inferior
area]

SEGMENT IV
[medial inferior
area= =quadrate
lobe]

Lateral
segment
SEGMENT II
[lateral
superior area]
Left lateral
anterior
segment
SEGMENT III
[lateral inferior
area]

Right
Left
caudate caudate
lobe
lobe
Posterior segment
I

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