Paul Couto – W2015

MED 1 – WET LAB BLOCK 3 NOTES

Note: Do not use this guide as your sole source of information for the wet lab exams. Have Netter’s
Atlas of Human Anatomy open while studying this guide. Also, note that not all of this information is
high yield – please compare this guide with your lecture notes and lab objectives.

ORAL CAVITY:
 DESCRIBE THE PRIMARY STRUCTURES COMPOSING THE EXTERNAL WALLS, ROOF, AND FLOOR
OF THE ORAL CAVITY.
 IDENTIFY THE PRIMARY MUSCLES OF THE TONGUE.
 DISCUSS THE SENSORY AND MOTOR INNERVATION OF THE TONGUE.
 IDENTIFY THE HARD PALATE AND SOFT PALATE.
 IDENTIFY THE SALIVARY GLANDS AND RELATIONSHIPS BETWEEN THE HYPOGLOSSAL NERVE
(CN XII), LINGUAL NERVE (BR. CN V-3), AND SUBMANDIBULAR DUCTS.
 IDENTIFY THE PARTS AND SALIENT FEATURES OF THE PHARYNX.

- Boundaries in relation to the oral cavity:

o Ventrally limited by the lips
o Superiorly limited by the palate (hard & soft)
o Laterally limited by the cheeks (mainly contributed by buccinator muscle – muscle of
facial expression that is derived from the 2nd pharyngeal arch; and innervated by the
facial nerve).
 The 1st pharyngeal arch is by the mandibular nerve (muscles of mastication)
o Limited posteriorly by the palato-glossal fold
- Palatine tonsil
o Limited ventrally by the palato-glossal fold
o Limited dorsally by the palato-pharyngeal fold
o (Between these folds lies the palatine tonsil)
o Since the oral cavity goes from the lips to the palato-glossal fold, the palatine tonsil is
not contained within the oral cavity, rather, it is located within the oropharynx.
- Oropharyngeal Isthmus (isthmus = narrow connection; oro-pharyngeal = oral cavity & pharynx)
- The constriction of the palatoglossal fold results in closure of the oropharyngeal isthmus.
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- Tongue – main structure in the oral cavity

o Has mucous membrane
o Intrinsic muscles [do not have bony origin, and take their origin from connective tissue]
 Transverse, superior, inferior, longitudinal fibers
o Extrinsic muscles [have a bony origin]
 Genioglossus – main bulk of the tongue
 Styloglossus
 Hypoglossus
 Palatoglossus – exception: only one innervated by pharyngeal plexus.

Nerve Supply
- All of the muscles of the tongue, except the palatoglossus is by hypoglossal nerve
(palatoglossus is only one by the pharyngeal plexus).
- Palatoglossus is supplied by the Pharyngeal plexus:
o Vagus nerve (X)
o Accessory nerve (CN XI)
o Glossopharyngeal (IX)
o Sympathetic plexus
- If Hypoglossal nerve is injured, tongue is deviated towards the paralyzed side (ipsilateral). For
example, if the right hypoglossal nerve is injured, when the patient protrudes their tongue it
deviates to the right.
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- Sulcus terminalis (V-shaped) – also called terminal sulcus.

- Foramina cecum – opening of the thyroglossal duct (embryological origin of the thyroid glands).
- *Anterior 2/3: nerve of general sensation is lingual nerve (from V3; 1st pharyngeal arch), special
sensation (taste) by the facial nerve branch (Chorda tympani; from CNVII)
- *Posterior 1/3: lingual tonsils, innervated by the glossopharyngeal nerve (for both general and
special sensation)
- Motor = hypoglossal for all except palatoglossus (which is by pharyngeal plexus).
- Circumvallate papillae/Vallate papillae (present in the anterior 2/3, but not innervated by the
lingual nerve or the chorda tympani – it is innervated by the glossopharyngeal nerve for both
the general and the special sensations)
- Fungiform papillae on the anterior 2/3
- Gag reflex, vomiting center – glossopharyngeal will send sensory stimulus to vomiting center
(afferent). Efferent fibers will be carried through Vagus which will cause that reflex.
- Nasopharynx – nasopharyngeal tonsils, Eustachian tube/auditory tube, torus tubarious/tubal
elevation/tubal tonsils, pharyngeal recess, superior/dorsal part of the soft palate [nerve supply
of nasopharynx is maxillary nerve]
- Oropharynx – main part is by palatine tonsil, also ventral/inferior part of the soft palate [nerve
supply of oropharynx is glossopharyngeal nerve]
- Laryngopharynx – piriform fossa (nerve for this is internal laryngeal nerve). [nerve supply of
laryngopharynx is the internal laryngeal nerve]
Epithelial changes
- From esophagus to stomach: Stratified squamous epithelium  Simple Columnar
- From above epiglottis to below epiglottis: Stratified squamous epithelium  Respiratory
epithelium
- Areas where there are epithelial changes are
prone to cancer.

Salivary glands
1) Parotid
- Mostly serous (basophilic)
- *Dangerous gland – has Facial Nerve VII, if you
get parotiditis you can have paralysis on one side
of your face – Bell’s Palsy.
2) Submandibular
- Two types of acinii (mucus & serous acinii) –
about 50/50
- Serous is basophilic – have lots of RER, secretes
lots of proteins
- Mucus is acidophilic – mucous, SER
- Mumps – viral infection
3) Sublingual
- By the Frenulum, partition under the tongue
- Most made up by mucus acinus – watery fluid,
acidophilic
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ANTERIOR ABDOMINAL WALL:

 IDENTIFY THE PALPABLE BONY LANDMARKS OF THE ABDOMINAL WALL.
 IDENTIFY THE LAYERS OF THE ANTERIOR ABDOMINAL WALL.
 IDENTIFY THE LATERAL AND VENTRAL MUSCLES OF THE ABDOMINAL WALL.
 RECOGNIZE THE RELATIONSHIPS BETWEEN THE LATERAL ABDOMINAL MUSCLES AND THE
RECTUS ABDOMINIS MUSCLE.
 DESCRIBE HOW THE LATERAL MUSCLES FORM THE ANATOMY OF THE INGUINAL CANAL.
 IDENTIFY THE LAYERS OF THE SPERMATIC CORD AND SCROTAL SAC.
 CORRELATE THE LAYERS OF THE ABDOMINAL BODY WALL WITH THOSE OF THE SPERMATIC
CORD AND SCROTAL SAC.
 IDENTIFY & DISCUSS THE CONTENTS OF THE INGUINAL CANAL, SPERMATIC CORD, AND
SCROTAL SAC.
- Bony landmarks: Xyphoid process, Costal margin, Pubic symphysis, Pubic crest, Pubic tubercle.
- Umbilicus between L3/L4 vertebrae (dermatome = T10)
- Muscles
o Laterally: External oblique, Internal oblique, Transverse abdominis
o Medially: Rectus abdominis, Anterior rectus sheath, Posterior rectus sheath (not
present below arcuate line), Linea alba (midline).
Major layers from superficial to deep:
o Skin
o Campers fascia (fatty)
o Scarpas fascia (membranous)
o External oblique (fibers run
superolateral to
inferomedial)
o Internal oblique (fibers run
superomedial to
inferolateral)
o Transversalis abdominis
(fibers run horizontally)
o Transversalis fascia
- Arcuate line: Horizontal line ~4cm
below the level of the umbilicus that
separates different types of fascia envelopes of the rectus sheath
- Layers in the area above the arcuate line (superficial to deep):
o Skin
o Campers fascia (fatty)
o Scarpas fascia (membranous)
o External oblique aponeurosis runs anterior to rectus abdominis
o Internal oblique aponeurosis splits and goes ant & post to rectus abdominis
o Transversus abdominus aponeurosis runs posterior to rectus abdominis
o Transversalis fascia
o Extraperitoneal fascia
o Peritoneum
- Layers in the area below the arcuate line
o Same as above except all the aponeuroses go anterior to the rectus abdominis muscle
 Paul Couto – W2015

- The 3 layers of muscle end in 4 aponeuroses (the intercostal muscles end in membranes):
o External oblique aponeurosis
o Internal oblique aponeurosis – splits into 2 (wraps around the rectus abdominus)
o Transversus abdominus aponeurosis
o These three aponeuroses form the rectus sheath and covers the rectus abdominus
muscle.
- Between the umbilicus and the pubic symphysis is the arcurate line.
o Above the arcurate line, the rectus sheath is uniform – 2 aponeuroses are in front of
the rectus abdominus (the external oblique aponeurosis and the first of the 2 internal
oblique aponeuroses), and behind the rectus abdominus (the second of the 2 internal
oblique aponeuroses, and the transversus abdominus aponeurosis).
o Below the arcurate line, the rectus sheath is not uniform. Below the arcurate line, the 4
layers of the aponeuroses all come in front of the rectus abdominus muscle.

- Linea alba – less vasculature, takes a long time to heal if cut -> can
lead to an insertional hernia (abdominal contents try to come out)
- Pressure in the abdominal cavity is positive
- IVC obstruction => superficial veins (superficial epigastric and lateral
thoracic veins) dilated and varicosed.
- Portal Vein Obstruction => Caput Medusa (blood shunted to
superficial epigastric and paraumbilical veins), engorged veins at
umbilicus. Seen on the right.

A = Above Arcuate Line

B = Below Arcuate Line
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INGUNAL CANAL
- Testes and ovary both develop in the abdomen.
- Sperm cannot survive in body temperature, so testes descend into the scrotum (where it is less
than body temperature). Descent of the testes starts during the 4th month, migrates to the
scrotum at the time of birth.
- When the testes descend into the scrotum, they have to pierce all the abdominal wall layers;
from deep to superficial. When it is piercing through, it brings all the layers with it
- Superficial & deep rings - The deep ring is more lateral; The superficial ring is more medial
- Inguinal hernias (“ILL MD”)
o Direct: medial to inferior epigastric, superficial inguinal ring, due to weakness in
abdominal wall.
o Indirect: lateral to inferior epigastric, deep inguinal ring, due to patency.
Scrotal Sac Layers: (“Some Dumb Englishman Called It The Testes”)
o Skin
o Superficial (Darto’s) fascia (continuous with Scarpa’s fascia)
o External spermatic fascia (continuous with external oblique)
o Cremasteric fascia (continuous with internal oblique)
o Internal spermatic fascia (continuous with transversus abdominis) - Note: no layer that
is continuous with transversalis muscle
o Parietal layer of tunica vaginalis - Adherent to the layers superficial to it
o Visceral layer of tunica vaginalis - Adherent to the tunica albuginea
o Tunica albuginea - Adherent to the testis
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Spermatic Cord - Passes through deep & then superficial rings

- Contents:
o Vas deferens (Passage for sperm)
o Testicular artery - Testicular torsion: occlusion of the testicular artery, loss of blood
supply to the testes.
o Pampiniform venous plexous - Entwines around testicular artery; This is to cool the
blood going to the testis. Varicocele: pampiniform plexus becomes engorged, looks like
a “bag of worms”
o Neuronal fibers, including Genital branch of genitofemoral nerve & Postganglionic
sympathetic fibers
o Lymphatic vessels - Lymph nodes: Scrotum: superificial inguinal lymph nodes;
Testicles: lumbar/aortic lymph nodes
o Cremasteric muscle
Spermatic cord
- Coverings: Example of a question = The following tagged muscle gives rise to which covering of
the spermatic cord?
o External spermatic fascia – External Oblique muscle
o Cremasteric fascia – Internal Oblique muscle
o Internal Spermatic fascia - Transversalis fascia
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ABDOMINAL VISCERA & CELIAC TRUNK

 IN-SITU, IDENTIFY THE PRIMARY ORGANS OF THE DIGESTIVE SYSTEM:
ESOPHAGUS, STOMACH, LIVER, GALLBLADDER, SPLEEN, SMALL
INTESTINES, CECUM, ASCENDING COLON, TRANSVERSE COLON,
DESCENDING COLON, SIGMOID COLON.
 IDENTIFY THE ANATOMY OF THE STOMACH, DUODENUM, JEJUNUM, ILIUM
APPENDIX, CECUM, ASCENDING COLON, TRANSVERSE COLON,
DESCENDING COLON AND SIGMOID COLON.
 COMPARE AND CONTRAST THE JEJUNUM AND ILEUM.
 IDENTIFY THE BRANCHES OF THE CELIAC TRUNK, SUPERIOR MESENTERIC
ARTERY & INFERIOR MESENTERIC ARTERY.

To make the 9 regions of the abdomen, draw the

following imaginary lines: Midclavicular, transcostal,
transtubercular (iliac)

- *Foregut: esophagus, stomach, 1st part of

duodenum, 0.5 of 2nd part of duodenum
(receives exocrine secretions from bile and
pancreatic duct).
o All nourished by the Celiac artery
(level of T12) – supplies foregut
derivatives
o Venous drainage: portal vein
o Parasympathetic innervation: vagus
nerve
- *Midgut: 0.5 of 2nd part of duodenum jejunum, ileum, appendix, cecum, ascending colon, 2/3 of
transverse colon
o All nourished by the Superior mesenteric artery (level of L1) (behind the duodenum;
retroperitoneal) – (branches right side and above)
o Venous drainage: superior mesenteric vein -> portal vein
o Parasympathetic innervation: vagus nerve
- *Hindgut: 1/3 of transverse colon, descending colon, sigmoid colon, rectum, 0.5 of anal orifice.
o Nourished by Inferior mesenteric artery (level of L3)(branches to left side)
o Venous drainage: inferior mesenteric vein -> portal vein
o Parasympathetic innervation: pelvic splanchnic nerves (S2-S4)

- Bifurcation of the abdominal aorta into common iliac arteries is at L4 vertebra

- 3 main branches of the abdominal aorta: celiac trunk, superior mesentery artery, inferior
mesenteric artery.
- Mesentery is a 2 layer peritoneum with a neurovascular connection between the body wall and
an organ.
- Gonadal vessels: ovarian or testicular vessels
- Stomach is in left hypochondriac region (know placement of the organs)
- Greater omentum (from greater curvature of the stomach) – made of visceral peritoneum,
contains the gastrocolic, gastrosplenic, and gastrophrenic ligaments.
- Lesser omentum (from liver to lesser curvature of the stomach) – both made of visceral
peritoneum, contains the hepatogastric and hepatoduodenal ligaments.
 Paul Couto – W2015

o Hepatoduodenal Ligament
contains the portal triad
(hepatic artery, hepatic vein,
bile duct).

- Mesentery is also part of the visceral

peritoneum.
- Distal part of the stomach is stained
darker by bile – pyloric end. Upper
end is the cardiac end.
- Appendix is narrowest part of the GI
tract
- Lesser sac space behind stomach and
in between layers of greater
omentum. Connected by epiploic
foramina (Foramen of Winslow) –
communicates greater sac with lesser sac. (lesser sac is also called
the omental bursa).
- Greater sac space anterior to the stomach
- Epiploic Foramen serves as a point of communication
between the greater sac and the lesser sac.

- Anterior surface of the stomach – the structures that are related:

o Left lobe of the liver (not right lobe)
o Anterior abdominal wall
o Left dome of diaphragm
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- 1st part of duodenum is retroperitoneal (identified by its

C-shaped portion)
- L & R gastric arteries
- Epiploic arteries

Jejunum and ileum differentiation:

- Artery pattern (vasa recta) is different
o Jejunum: long and few; also more fatty
deposition
o Ileum: short and many; also less fatty deposition
- Ileum has the cecum and the appendix at its distal
portion.
Small intestine vs. large intestine:
1) Large intestine has fatty pockets (appendices epiploicae); Surface of small intestine is clean
2) Large intestines luminal diameter is larger – also is not uniform has saculations/haustrations;
the small intestine diameter is uniform throughout
3) Thick muscle bands on large intestine longitudinally – tinea colae.

- Rugae of stomach – rough folds in the inner walls of the stomach

- Any extension of the peritoneal fold in relation to a particular viscera:
o If we find the peritoneum in relation to the sigmoid colon: called meso-sigmoid
- Mesocolon - surrounds parts of the colon
- Meso-appendix - peritoneum of the vermiform appendix
- Transverse mesocolon - peritoneum of the transverse colon
- Sigmoid mesocolon - peritoneum of the sigmoid colon

- Peritoneal cavity in males is a closed cavity; in females it is an open cavity:

o One end of the fallopian tubes enters in the abdominal cavity
o During ovulation, ova will be released into peritoneum (fimbrae will drag it in to uterus).
o Ectopic pregnancies (most common is tubal, but sometimes can go into peritoneal
cavity).
- If appendix ruptures:
o If lying supine, fluid might accumulate in hepatoduodenal pouch.
o If standing upright, it will accumulate in rectovesicle pouch (males) or rectouterine
pouch (females).
Organs that are retroperitoneal
(SAD PUCKER):
- Suprarenal (adrenal) glands
- Aorta/IVC
- Duodenum (2nd and 3rd
segments)
- Pancreas (head, not tail)
- Ureters
- Colon (ascending and
descending)
- Kidneys
- Esophagus
- Rectum
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BRANCHES OF THE CELIAC ARTERY

*High Yield (Look at Netter’s)
- Left & Right gastric artery
- Splenic artery
- Common hepatic artery
- Gastroduodenal artery

- *Know which part of the gut (foregut, midgut, hindgut) is supplied by which branch of the celiac
trunk (previously mentioned).
 Paul Couto – W2015

PERITONEUM
 IDENTIFY THE BASIC COMPONENTS OF THE PERITONEUM:
 PARIETAL PERITONEUM
 VISCERAL PERITONEUM
 GREARTER SAC AND LESSER SAC
 EPIPLOIC FORAMEN
 GREARTER AND LESSER OMENTUM
 MESSENTRY AND MESOCOLON
 PERITONEAL POUCHES AND PERITONEAL FOLDS

PERITONEUM
- Membrane that lines the abdominal cavity
- Peritoneum overlying the organ is visceral, folds back on itself to form parietal
- Mesentery is the double layer of peritoneum
- Mesenteries are peritoneal folds that hang or are attached to GI tract organs.
o They normally carry arterial supply, venous drainage, innervation to/from the organ
they attach to.
- The main things you want to concentrate on here are to know generally where the two sacs are
in 3-D space inside the body and how they relate to the viscera. This becomes important when
trying to locate ascites or where blood or other fluids are collecting in the case of trauma or
growths (neoplasias, cancers, tumors).

Peritoneum is divided into two layers: parietal and visceral

- Just like every other parietal and visceral layers in the body
- Parietal is adherent to body wall and visceral is adherent to the viscera (organs)
- The peritoneal cavity is between the visceral and parietal layers
- This provides an area for blood or other fluids to accumulate in pathological conditions
- Ascites: the name for accumulation of fluid in the peritoneal cavity
- The peritoneal cavity can be subdivided into two sub-spaces: Greater sac & lesser sac
- These sacs are formed by the mesentery formations: greater omentum & lesser omentum
o The greater omentum hangs down from the stomach, over the transverse colon and
comes back up and attaches to the bottom of the transverse colon.
o The lesser omentum hangs down from the liver and attaches to the stomach and
duodenum
- It is comprised of the hepatoduodenal
ligament and hepatogastric ligament
- *The hepatoduodenal ligament contains
the portal triad:
o The portal triad consists of:
 Hepatic artery proper
 Hepatic portal vein
 Common bile duct
- There is a passage behind the
hepatoduodenal ligament, that is the only
entry into the omental bursa – called the
epiploic foramen (aka omental foramen)
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POSTERIOR ABDOMINAL WALL:

 IDENTIFY THE MAJOR STRUCTURES OF THE POSTERIOR ABDOMINAL WALL (KIDNEYS, URETERS
ETC).
 IDENTIFY THE PRIMARY BRANCHES OF THE ABDOMINAL AORTA.
 IDENTIFY THE PRINCIPAL TRIBUTARIES FOR THE INFERIOR VENA CAVA.
 IDENTIFY THE MUSCLES OF THE POSTERIOR ABDOMINAL WALL.
 IDENTIFY SOMATIC AND AUTONOMIC NERVES OF THE POSTERIOR ABDOMINAL WALL.
- Muscles of the posterior abdominal wall:
o Psoas Major
o Quadratus lumborum
o Transversus abdominus
- Abdominal aorta, IVC are retroperitoneal. IVC is right to Aorta.
- Aorta pierces diaphragm at T12
- IVC pierces diaphragm at T8
- Aorta shorter than IVC – ends at L4 (where it branches into the Common Iliac arteries); IVC ends
at L5.
- Know the branches of the abdominal aorta:
o Superior mesenteric
o Inferior mesenteric
o Gonadal
o Renal arteries
o Etc.
- Aortic aneurism – loses elasticity and ruptures.
- Arteries divide into branches, Veins divide into tributaries
- Left renal vein is longer than right renal vein because IVC is on the right.
- *Left gonadal vein drains into the left renal vein (so it doesn’t cross over to drain into the IVC
like the right gonadal vein).
 Paul Couto – W2015

- Nutcracker syndrome: compression of the left renal vein between the Superior Mesenteric
Artery (SMA) and descending abdominal aorta
o Results in increased pressure and thus dilation of the left gonadal vein (testicular vein in
men). This is said to feel like a “bag of worms” in the left scrotum
 Paul Couto – W2015

HEPATOBILIARY SYSTEM
 IDENTIFY THE ANATOMY OF THE LIVER AND GALLBLADDER.
 IDENTIFY THE ANATOMY OF THE SPLEEN.
 IDENTIFY THE ANATOMY OF THE PANCREAS.
 IDENTIFY THE PRIMARY TRIBUTARIES OF THE HEPATIC PORTAL SYSTEM.
 IDENTIFY THE RECTUM AND ANAL CANAL IN THE SAGITTAL SECTION OF THE PELVIS.

- Most of the liver is shiny, but there is a dull area (anterior and superior) – this is the bare area
(not covered by visceral peritoneum). This is where the liver connects to the diaphragm.
- Falciform ligament – bilayer peritoneal fold splits the liver into 2 lobes.
- Ligamentum teres – derived from umbilical vein (which goes to fetal IVC)
- Ductus venosus – converted into ligamentum venosum.
- Caudate lobe (small lobe, superior on liver) - On the right of the Caudate lobe is the IVC
- Porta Hepatis
o 1) Portal vein
o 2) Proper Hepatic artery
o 3) Bile duct
- Know the impressions of the liver:
o Esophagus
o Stomach
o Duodenum
o Right colic flexure
o Right Kidney – big concavity
- Right suprarenal gland (near the bare area)
Posteroinferior surface:
o Caudate lobe: superior portion. Midline (left-right-wise)
o Quadrate lobe: inferior portion. Midline (left-right-wise)
o Porta hepatis: middle (superior-inferior-wise). Middle (left-right-wise)
o Ligamentum venosum: runs up the middle just to the right of the caudate & quadrate
lobes & porta hepatis
- In the fetus, the ductus venosus shunts blood from the placenta to bypass the liver
- This is because there is no nutrients coming from the GIT of the fetus
- Note: there are two embryologic organs with blood bypasses in the fetus:
o Liver and lungs
o The fetus is relying on the mother’s liver and lungs
Anterosuperior surface:
o *Falciform ligament: in the middle; connects liver to anterior body wall
o Hangs the liver from the inside of the anterior body wall
o Ligamentum teres hepatis (aka round ligament of the liver)
o Hangs at the inferior portion of the falciform ligament
o Embryologic remnant of the umbilical vein

- Portal vein -> Hepatic veins (seen from superior view of liver) –> empty into the IVC
- Right and left hepatic ducts
- Sphincter of Oddi – at 2nd part of duodenum
- Continuous production of bile in liver.
- Concentration of bile is done in gall bladder.
 Paul Couto – W2015

- Sphincter of Oddi opens after eating

- In people with liver Cirrhosis or gall stones – obstructive jaundice due to blockage of the
cystic/bile ducts.
- Small triangle between cystic and hepatic ducts – triangle of Calot (ligate the vessel to remove
gall bladder).

Foregut/midgut line:
- Half-way down the second part of the duodenum at exactly the point of the ampulla of Vater
(aka the hepatopancreatic ampulla), which is where the sphincter of Oddi resides. This is where
bile and pancreatic juices enter the GIT.
- Midgut/hindgut line:
2/3 of the way across the transverse colon, on the left side
 Paul Couto – W2015

The Gallbladder
- The gallbladder is an overflow and
concentration device for bile. Bile is made in
the liver. When the sphincter of Oddi is closed,
the bile coming from the liver backs up and
overflows into the gallbladder. The gallbladder
slowly dehydrates the bile fluid, thus
concentrating it. A person can live without a
gallbladder with limited discomfort.
- Bile helps in absorption of fats (particularly
important for absorption of fat-soluble
vitamins (A, D, E, & K)
- Bile travels down the hepatic duct, which is
called the common bile duct after it gives off
the cystic duct, which goes to the gallbladder.
The common bile duct enters the tail of the
pancreas, where it merges with the pancreatic duct just before reaching the sphincter of Oddi.

- The sphincter of Oddi opens in response to cholecystokinin (CCK) (secreted by I cells), which
allows pancreatic juice and bile to enter the second part of the duodenum. CCK also causes
gallbladder contraction, squeezing the bile into the duodenum.

Gallstones aka cholelethiasis

- Etiology (causes):
o Too much cholesterol in the bile; usually coincides with hypercholesterolemia
o Too little bile secretion; Usually coincides with IV feeding (no CCK secretion because
no food in GI)
- Nomenclature (vocabulary):
o Lethiasis: stones
o Cholecystolethiasis: gallstones in the gallbladder
o Choledocholethiasis: gall stones in the bile ductal system

Pancreas:
 Paul Couto – W2015

- The pancreas is an combination endocrine and exocrine gland.

- Endocrine pancreas:
o There are small histologically visible structures containing packs of endocrine cells called
islets of Langerhans. These islets contain alpha cells, beta cells, and delta cells.
o Alpha cells: secrete glucagon in response to low levels of blood glucose
o Beta cells: secrete insulin in response to high levels of blood glucose. These are the
cells that are attacked by the autoimmune response in type I Diabetes Mellitus
o Delta cells: secrete somatostatin to signal an empty GI
- Exocrine pancreas:
o Secretes digestive enzymes into the pancreatic duct, which then joins bile duct and
exits into duodenum through sphincter of Oddi
o CCK signals exocrine pancreas secretion.
o Signals cessation of HCl secretion by parietal cells and cessation of pancreas juice
secretion by exocrine pancreas
Spleen:
- The spleen is an immune organ. It is basically a giant lymph node. In fact, histologically it looks
a LOT like a very large lymph node. It is also involved in retiring old erythrocytes (RBCs). Recall
the erythrocytes circulate for about 120 days in a healthy individual.
- Location: deep to ribs 9 – 11 on the left side, just posterior to mid-axillary line
- Arterial supply: splenic artery (a branch of the celiac artery, a branch of the descending
abdominal aorta)
- Drainage: splenic vein, which drains into the superior mesenteric vein, which drains into the
portal vein
- Note: this is one of the few non-GI organs that drains into the portal vein
- *Surfaces: Gastric impression, Renal impression, Colic impression, Diaphragmatic surface