Spleen and pancreas

Question 1

Which tissue type is the spleen derived from?

Answer 1

Mesoderm

Question 2

What sort of injury can damage spleen?

Answer 2

Rib fractue, difficult to repair so common to have it removed

Question 3

What can happen to the spleen in portal hypertension?

Answer 3

Splenomegaly, due to backing up of pressure along splenic vein. Spleen is soft and so tissue can expand easily

Question 4

Which part of the spleen is most easy to palpate and when?

Answer 4

Splenic notch when spleen is enlarged

Question 5

What is significant about the splenic artery?

Answer 5

Tortuous so can stretch and move with other organs around it

Has no anastamoses, so no back up supply if damaged

Question 6

What are the 5 anatomical parts of the pancreas?

Answer 6

Tail
Body
Neck
Head
Uncinate process

Question 7

What are the 3 main arteries that supply the pancreas and where do they originate?

Answer 7

Splenic artery - Coeliac trunk
Super pancreaticoduodenal - coeliac trunk
Inferior pancreaticoduodenal - SMA

Question 8

Where does the pancreas sit?

Answer 8

Secondarily retroperitoneal 
In C of duodenum
Behind stomach and lesser sac
Neck sits on transpyloric plane L1
Tail sits near splenic hilum
In epigastrium and extends to right hypochondrium

Question 9

Why is a pancreatectomy a particularly difficult procedure?

Answer 9

Multiple blood supplies

Retroperitoneal

Question 10

What guards the entrance to the major duodenal papilla?

Answer 10

Hepatopancreatic sphincter

Question 11

Where does the neck of the pancreas sit?

Answer 11

Transpyloric plane L1

Question 12

Where does pancreatitis pain refer to?

Answer 12

Back
Epigastric
Fluid accumulation in lesser sac

Question 13

Which bud of the developing pancreas rotates to its adult position?

Answer 13

Ventral bud rotates 90 degrees clockwise

Question 14

What is an annular pancreas?

Answer 14

Ring of pancreatic tissue surrounding duodenum which can cause blockage

Question 15

What is the visceral afferent responsible for pancreatitis pain?

Answer 15

Greater splanchnic nerve T5-9

Question 16

Where would fluid collect in pancreatitis?

Answer 16

Lesser sac, posterior to stomach

Question 17

Why might pancreatic cancer cause jaundice?

Answer 17

Blocked bile duct

Question 18

What are the relations of the spleen?

Answer 18

Stomach
Colon
Pancreas
Kidney
Diaphragm
Ribs 9-12
Costodiaphragmatic recess

Question 19

What is the lymph drainage of the spleen?

Answer 19

Coeliac nodes

Question 20

Where should an examination of the spleen start?

Answer 20

Right iliac fossa

If enlarged, won’t feel splenic notch unless start down here

Question 21

What would be a test for acute pancreatitis?

Answer 21

Amylase (lipase)

Question 22

What are secretions of the exocrine pancreas?

Answer 22

Alkali - isotonic solution rich in HCO3
Digestive enzymes - Trypsin (endopeptidase), Chymotrypsin (endopeptidase), Carboxypeptidase (ectopeptidase), Pancreatic amylase (breaks down starches), Lipases (break down fats)
Other enzymes (phospholipase, cholesterol esterase, ribonuclease)

Question 23

Which cells of the exocrine pancreas secrete enzymes?

Answer 23

Acinar cells

Question 24

Which exocrine pancreas cells secrete alkali?

Answer 24

Duct cells

Question 25

What converts Trypsinogen to trypsin?

Answer 25

Membrane bound enterokinase on epithelial cells

Question 26

Describe the mechanism of pancreatic HCO3 secretion

Answer 26

Carbonic anhydrase converts H2O and CO2 into HCO3 and H+
HCO3 is antiported with Cl into duct lumen
H is antiported with Na out into blood

Question 27

What controls enzymatic secretion from the exocrine pancreas?

Answer 27

CCK and ACh

Question 28

What controls bicarbonate secretion in the exocrine pancreas?

Answer 28

Stimulated by secretin and potentiated by CCK and ACh (vagal tone)

Question 29

Where does the spleen sit in the abdominal cavity?

Answer 29

Left posterolateral abdominal wall, related to ribs 9-12