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DS > Lecture 18 > Flashcards

Lecture 18 Flashcards

1
Q

What type of organ is the pancreas?

A

Glandular - endocrine and exocrine.

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2
Q

Where is the head of the pancreas located?

A

In the concavity of the duodenum.

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3
Q

Where does the ucinate process wrap around?

A

Behind the superior mesenteric vessels.

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4
Q

Where is the neck of the pancreas?

A

Anterior to the superior mesenteric vessel origins.

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5
Q

Where is the body of the pancreas?

A

It passes across laterally and superiorly.

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6
Q

Where is the tail of the pancreas?

A

It passes into the lienorenal ligament and into contact with the hills of the spleen.

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7
Q

What lies anterior to the pancreas?

A

Transverse colon.

Stomach.

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8
Q

What lies posterior to the pancreas?

A 
Bile duct.
Portal vein.
Splenic vein.
IVC.
Aorta.
Superior Mesenteri artery.
L psoas.
L supra-renal gland.
L kidney.
Spleen.
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9
Q

What does the main duct drain into?

A

The main duct is from the tail to the ampulla of vater. It is joined by the bile duct, where it enters the descending duodenum via the sphincter of oddi (major duodenal papilla - is really the mass, where as the sphincter is the control).

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10
Q

What happens if an accessory duct is present?

A

It may drain into upper part of head then into duodenum (not at ampulla - minor duodenal papilla).

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11
Q

Describe the arterial supply to the pancreas?

A

Highly vascular.
Quite complicated.
Halfway between foregut and midgut - dual supply.

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12
Q

Describe the arterial pathway for the common hepatic artery in terms of the pancreas?

A

Common Hepatic -> gasproduodenal -> superior pancreatoduodenal -> anterior superior and posterior superior pacnreatoduodenal arteries.

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13
Q

Describe the arterial pathway for the splenic artery in terms of the pancreas?

A

Splenic -> Dorsal pancreatic and greater pancreatic.

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14
Q

Describe the arterial pathway for the superior Mesenteric artery in terms of the pancreas?

A

Sup.Mesenteric -> Inferior Pancreatoduodenal -> anterior inferior and posterior inferior pancreatoduodenal.

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15
Q

Describe the portal system of the pancreas?

A

Will flow back to the portal vein regardless of artery origin. Goes through either the splenic or sup.mesenteric vein, then into the liver, then into IVC.

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16
Q

Describe the lymphatics of the pancreas?

A

Dual arterial supply = dual lymphatic drainage. These are at:

Coeliac nodes (T12).
SM nodes (L1).
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17
Q

Describe the ANS of the pancreas?

A

Coeliac and Superior Mesenteric plexi: Greater (and lesser) splanchnic, Vagus [X].

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18
Q

What is pain referred to in regards to the pancreas?

A

Epigastric region.

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19
Q

What is the acronym for Acute Pancreatitis?

A

I GET SMASHED.

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20
Q

What does the I stand for?

A

Idiopathic:

Hypersensitive sphincter or microlithiasis.

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21
Q

What does the G stand for?

A

Gallstones:

45%.

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22
Q

What does the E stand for?

A

Ethanol:

35% i.e. alcohol.

23
Q

What does the T stand for?

A

Tumours:

Pancreas, Ampulla, Choledochocele.

24
Q

What does the S stand for?

A

Scorpion stings.

25
Q

What does the M stand for?

A

Microbiological:

Bacteria (e.g. mycoplasma), viral (e.g. mumps), parasites (e.g. ascariasis).

26
Q

What does the A stand for?

A

Autoimmune:

e.g. SLE, polyarteritis nodosa, Crohn’s.

27
Q

What does the (2nd) S stand for?

A

Surgery (or trauma):

Post-cardiac surgery, blunt trauma, penetrating peptic ulcer.

28
Q

What does the H stand for?

A

Hyperlipidemia:

(TG>11.3mmol/L; >1000mg/dL). Hypercalcemia. Hypothermia.

29
Q

What does the (2nd) E stand for?

A

Emboli (or ischaemia).

30
Q

What does the D stand for?

A

Drugs (or toxins):

e.g. azathioprine, furosemide, oestrogen, H2Blockers, Antibiotics, Salicylates, Methanol, Organophosphates, Steroids.

31
Q

What is the largest single mass of lymphoid tissue?

A

Spleen.

32
Q

What does the spleen do?

A

Filters and recycles blood and supports immune system.

33
Q

Where does it lie?

A

Inferior to ribs 9-11 in the left hypochondrium (posterior to the stomach).

34
Q

What does the gastrosplenic ligament carry?

A

Short gastric and gastro-epiploic vessels.

35
Q

What does the lienorenal ligament carry?

A

It carries splenic vessels and tail of pancreas to the left kidney.

36
Q

What lies anterior to the spleen?

A

Tail of pancreas.
L.colic flexure.
Stomach.

37
Q

What lies posterior to the spleen?

A

L.kideny.

Ribs 9-11.

38
Q

Describe the morphology of the spleen?

A

2 surfaces: diaphragmatic (pressed up against the body wall) and visceral (in contact with anterior structures).
2 poles: upper and lower; important for measuring in ultrasound.
3 areas: related to neighbouring organs.

39
Q

Describe the gastrosplenic ligament?

A

There are two vascular bundles that go in: short gastric and left gastro-ometnal. It comes from the stomach to the spleen.

40
Q

Describe the splenorenal/lienorenal ligament?

A

Contains splenic vessels and tail of pancreas. It comes from the spleen to the L.kidney.

41
Q

What is the arterial supply of the spleen?

A

Splenic artery (from coeliac axis).

42
Q

What is the venous drainage of the spleen?

A

Splenic vein into the portal vein.

43
Q

What is the lymphatics of the spleen?

A

Coeliac nodes at T12.

44
Q

What is the ANS of the spleen?

A

Coeliac plexus at T12:
Vagus [X]
Greater splanchnic (T5-9).

45
Q

Where is pain referred in regards to the spleen?

A

Epigastric region.

46
Q

What is the spleen dimensions?

A

1x3x5 inches: 1 inch thick, 3 inches wide, 5 inches long.

47
Q

What is the spleen’s weight?

A

7 ounces - 200g.

48
Q

Where is the spleen found?

A

Ribs 9-11.

49
Q

What is splenomegaly?

A

Abnormally enlarged spleen.

50
Q

What causes splenomegaly?

A
  1. Bacterial infection e.g. syphilis.
  2. Viral infection e.g. mononucleosis.
  3. Parasitic infection e.g. malaria.
  4. Cancer e.g. lymphomas.
  5. Metabolic disorders.
  6. Haemolytic anaemias.
  7. High pressure/clots in venous system.
51
Q

What is length o the normal spleen?

A

11-13cm.

52
Q

Where is the trans-pyloric plane (L1)?

A

Midway between suprasternal notch and pubic symphsysi.

53
Q

What structures occur in the trans-pyloric plane?

A
  1. Pyloric region of the stomach.
  2. 1st part Duodenum.
  3. Fundus of gallbladder.
  4. Hila of kidneys
  5. Hilum of the spleen.
  6. Neck of pancreas.
  7. Transverse mesocolon origin + colic.
  8. SMA origin.
  9. Portal vein origin.
  10. Tip of 9th costal cartilage.
  11. End os spinal cord.

DS (32 decks)

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