 Good day everybody. Dr. Sajja Sanyal, Professor Department Chair. So this is going to be a demonstration of the deodenum, pancreas, spleen and the vessels. This is a supine cadaver. I'm narrating from the right side. The camera person is also on the right side. We have completely eviscerated the deodenum, the pancreas and the spleen with their accompanying blood vessels from the location but we have kept it inside too. This is the first part of the deodenum. This is the descending part, second part. This is the horizontal third part. This is the ascending fourth part and this is the deodenus regional flexure. This is the pancreas and we can see that the head and the insinate process of the pancreas is completely necrosed in this particular cadaver. In life perhaps he had suffered from necrotizing pancreatitis and that's the reason why even the adjacent part of the deodenum is discolored and black. This is the neck of the pancreas. This is the body of the pancreas and the body of the pancreas is abutting against the hilum of the spleen which I shall describe later on. We have cannulated the common bile duct here and we have opened out the deodenum and that is what we are going to demonstrate. Now I am opening out the cut portion of the deodenum here and you can see, first of all, the myocosa of the deodenum. I have inverted it out and you can see that the first part of the deodenum, the myocosa is smooth. From the second part onwards the myocosa becomes rugos and these are the horizontal folds of the deodenal myocosa and this is how it continues throughout the rest of the deodenum and we can see that here. This is cannula which has gone through the common bile duct here and we can see it is passing behind the deodenum. When we push the cannula through the common bile duct, we can see it has come into the ampoule of water here and it is coming out through the opening into the second part of the deodenum. This opening and the papilla of water marks the junction between the foregut and the midgut part of the deodenum. This is the foregut part, this is the midgut part. If you were to take a close look at the myocosa here, we see a characteristic pattern of the myocosa in this particular region. Above this opening the myocosa is forming a curved portion and that is called the hood and below the opening the myocosa is longitudinal. So this hood and the longitudinal fold of myocosa is an important landmark which is used during endoscopy to locate the ampoule of water and it is through this opening that the cannula is inserted to do the procedure which is known as endoscopic retrograde cholangio pancreatogram to study the pancreatic system as well as the biliary system for strictures, stones, etc. and it is through the same opening that endoscopist can do endoscopic sphinctrotomy in case there is a stricture of the papilla of water. This is an endoscopic retrograde cholangio pancreatogram to show the biliary and the pancreatic ducts. Now let's take a look at the pancreas itself. As we mentioned the pancreas is highly necrotic so therefore we cannot make out much of it but what we can see are the phlinic artery and the splinic vein behind. So let's take a look at the vessels of the pancreas. This is the opening the cut portion of the splinic artery. The splinic artery runs in a very tortuous fashion along the superior border of the pancreas and we can see it is running here. The reason for its tortuosity is because it forms a bed of the stomach and this tortuosity allows for movement of the stomach. Splinic artery then enters into the spleen along with the tail of the pancreas through the hilum and they are located in the spleenorenal ligament which has been removed. It supplies not only the spleen but also gives these branches and we can see one branch here, we can see another branch here, we can see another branch here. These other branches they are called the vasaprivia which supplies the fundus in the greater curvature of the stomach near its upper part and they run in the gastro splinic ligament and it also gives this branch here. This is the left gastroepiploid artery which also runs in the gastro splinic ligament and then it runs in the greater momentum and supplies the stomach greater curvature from the left side. So this is about the splinic artery. Now I will turn the pancreas and when I turn it we can see this structure here. This is the splinic vein. The splinic vein runs behind the pancreas and it unites at the neck of the pancreas with this structure here. This is the superior miscentric vein and at the point of union which is occurring behind the neck of the pancreas it forms the portal vein. We can see the cut portion of the portal vein here. The portal vein runs behind the neck of the pancreas and it comes up and then it runs in the extra hepatic portal triad along with the common bile duct. This portal vein as we can clearly see here if I lift up the neck of the pancreas we can see it is formed by the union of the superior miscentric vein and the splinic vein. This enters the liver through the portal hepatus in the extra hepatic portal triad and it ramifies inside the liver. That is the next structure that we can see here. Now let's take a look at the spleen. As I mentioned we have completely evisirated the spleen out. So let's take a gross look at the spleen. The spleen has got this surface which is the diaphragmatic or the costal surface and this is the visceral surface. It has got three borders, superior border and inferior border and anterior border. The superior border is denoted by these notches. This is how we recognize a spleen when we are clinically palpating an enlarged spleen by its notched superior border. Just under the superior border this surface that we see here this is referred to as the gastric area because this is referred to as the fundus of the stomach. Coming to the inferior border this is the inferior border. Just above that this region is referred to as the renal area because it is related to the left kidney which is here. And this is the anterior border and just behind the anterior border this area is referred to as the colic area because it is related to the spleen flexure of the colon. Now I shall draw your attention to this whole region is the hyalum of the spleen. But the hyalum of the spleen if you look closely is subdivided into two components. You can see cut portion of peritoneum here. This is the cut margin of the gastro splenic ligament which is attached to the hyalum. Below that we can see another structure here. This is the cut margin of the splenorenal ligament. Both of them enter through the hyalum of the spleen. They have different structures within each of them. The gastro splenic ligament contains the vasabrivia. We can see a branch from this splenic artery which supply the greater curvature and near the fundus of the stomach. There are not one but there are many vasabrivia. Vasabrivia means small or short gastric vessels which are both arteries and veins. Also running through the gastro splenic ligament we have this which is also a branch of the splenic artery. This is the left gastrofibloic. Running through the splenorenal ligament we have these two structures. One of them is the tail of the pancreas and the other is the main splenic artery. There is an important clinical correlation here. Whenever there is an injury to the spleen or any surgery of the spleen the tail of the pancreas is quite likely to get injured because of its anatomical proximity to the hyalum of the spleen. Let's come to the costal of the diaphragmatic surface of the spleen. We see these three impressions here. We can see one impression here. We can see another impression here and we can see a third impression here. These are the costal markings or the rib markings and these are the 9th, 10th and 11th ribs. Here again we have a very important clinical correlation. Fracture of the left lower 9th, 10th, 11th ribs we must assume spleen injury unless proved otherwise. This is a very important surgical dictum. The spleen is covered by visceral tritonium and under that there is a capsule of the spleen. It is said that we have the spleen sinusoid. When we cut open the spleen we shall be able to see that. So my assistants have done a wonderful job of cutting open the spleen. What we see here is the capsule of the spleen. This is a normal portion of the spleen that we have cut open here. And if you were to take a close look we see that this margin this is the spleenic capsule and inside that is the red pulp which is filled with sinusoid. And we cannot see very clearly but these will also contain the spleenic trabeculae. Inside the trabeculae will be the venous of the spleen and inside the red pulp which contains the spleenic sinusoid will be the arterios. And this is what acts as a spleenic reservoir of temporary collection of blood. We have made another cut in this area of the spleen where the consistency of the spleen is distinctly different from the rest of the spleen and we can see it is very soft and mushy. And when we cut this open we see the red pulp but here the red pulp is very soft as compared to the normal area. So this is a perhaps a place where this cadaver during life may have sustained a blunt trauma to his lower chest left side which would have produced this softness of the spleen in this area. So these are the few salient points about the spleen. The pancreas, the diodenum, ampoule of wetter, the spleenic artery, spleenic vein and the portal vein. Thank you very much for watching Dr. Sanjay Sanyal signing out. David Ho is the camera person. If you have any questions or comments please put them in the comment section below. Have a nice day.