Duodenum and pancreas
Organ supplied · Foregut Midgut T5–T9
The foregut–midgut boundary at the major duodenal papilla runs through both organs. Head and duodenum are fed by the pancreaticoduodenal arcades (gastroduodenal from the coeliac, inferior from the SMA); body and tail by pancreatic branches of the splenic artery. The dual supply protects the duodenum from ischaemia but binds it surgically to the pancreatic head.
Traced from the start
Detail
- Head, uncinate, duodenum
- Superior (GDA, coeliac) + inferior (SMA) pancreaticoduodenal arcades
- Body and tail
- Dorsal, great and caudal pancreatic arteries from the splenic
- Junction
- Foregut D1–D2 to papilla; midgut from papilla to D4
- Referred pain
- Epigastric, T5–T9, radiating to the back because the gland lies retroperitoneally on the splanchnic nerves
When it goes wrong
Acute pancreatitis (gallstones, alcohol)
Constant epigastric pain boring through to the back, eased by leaning forward; enzyme erosion of the splenic or gastroduodenal artery produces pseudoaneurysm and retroperitoneal haemorrhage (Grey Turner and Cullen signs)
Carcinoma of the head of pancreas
Painless obstructive jaundice with a palpable gallbladder; Whipple's resection must take head, duodenum and distal bile duct together because they share the arcades, and tumour at the SMA/SMV margin makes it unresectable
Practise this structure
1 question in the bank tagged Pancreas.