Anatomy - Abdominal Organs: Solid Viscera

Question 1

What is the position of the spleen?

Answer 1

The spleen lies between the 9th and 11th ribs (left hypochondriac region, between the diaphragm and stomach/colon).

Question 2

Which ribs potect the spleen?

Answer 2

9, 10 and 11

Question 3

3 ligaments that support the spleen

Answer 3

• Splenorenal ligament
• Gastrosplenic ligament
• Phrenicocolic ligament

Question 4

The following ligaments connect the spleen to…
* Splenorenal ligament
* Gastrosplenic ligament
* Phrenicocolic ligament

Answer 4

Splenorenal ligament: Connects the spleen to the body wall

Gastrosplenic ligament: Connects the spleen to the stomach

Phrenicocolic ligament:
Does not connect to the spleen, but helps support it (ligament that attaches the colon to the diaphragm)

Question 5

3 spleen impressions

Answer 5

gastric
colic
renal

Question 6

Blood supply of the spleen

Answer 6

Splenic artery (main branch of celiac trunk)
Splenic vein (joins SMV to form hepatic portal vein)

Question 7

Spleen rupture can occur as a result of blunt force trauma. How can we repair the spleen?

Answer 7

We can suture the greater omentum (a highly vascularized structure) to the ruptured spleen to revascularize the organ.

Question 8

What do we call a procedure by which the spleen is removed?
Do we perform spleen transplants?

Answer 8

Spleen removal is called a splenectomy.
The spleen is NOT essential for life, so it can be safely removed (liver and bone marrow will take over its functions).

Question 9

Splenomegaly

Answer 9

Enlarged spleen - etiologies are usually associated with increased workload conditions (e.g. hemolytic anemia).

Question 10

How can we treat splenomegaly?

Answer 10

Splenectomy

Question 11

4 regions of the pancreas

Answer 11

Head
Neck
Body
Tail

Question 12

What is the uncinate process?

Answer 12

A part of the head of the pancreas (develops separately from the rest of the pancreas in the fetus)

Question 13

Majority of the pancreas is…
a) intraperitoneal
b) retroperitoneal

Answer 13

b) retroperitoneal

Question 14

Which part(s) of the pancreas is are intraperitoneal?

Answer 14

Tail of the pancreas
(because it extends into the splenorenal ligament)

Question 15

The superior mesenteric artery and vein cross the duodenum and pancreas. Describe how they are all positioned relative to each other.

Answer 15

The superior mesenteric artery and vein run anterior to the duodenum, but posterior to the neck of the pancreas.

They are “sandwiched” between the pancreas and duodenum.

Question 16

What is the position of the uncinate process relative to the superior mesenteric artery and vein? What are the implications of this layout?

Answer 16

The uncinate process (and duodenum) are posterior to he superior mesenteric vessels but anterior to the abdominal aorta, which can result in Nutcracker syndrome.

Question 17

The main pancreatic duct drains to…
The accessory pancreatic duct drains to…

Answer 17

Main pancreatic duct: major duodenal papilla
Accessory pancreatic duct: minor duodenal papilla

The papilla are located in the 2nd (descending) part of the duodenum

Question 18

Bile duct function

Answer 18

Carries bile from the liver to the duodenum; joins the main pancreatic duct to open into the major duodenal papilla

Question 19

Bile is produced in…
Bile is stored in…

Answer 19

Bile is produced in the liver
Bile is stored in the gallbladder

Question 20

The common bile duct has 2 branches…

Answer 20

1. Common hepatic duct (connecting to the liver)
2. Cystic duct (connecting to the gallbladder)

Question 21

What do we call the small “reservoir” where your common bile duct and pancreatic duct meet before entering the duodenum?

Answer 21

Hepatopancreatic ampulla

Question 22

What is the name of the sphincter located in the major duodenal papilla?

Answer 22

Hepatopancreatic sphincter

Question 23

What arteries supply the head of the pancreas?

Answer 23

Superior & inferior pancreaticodudodenal arteries (also supply duodenum).

Question 24

What arteries supply the rest of the pancreas (not the head)?

Answer 24

Branches of the splenic artery.

The main branch is called dorsal pancreatic artery, which then branches into transverse pancreatic arteries.

Question 25

Which liver lobe (right/left) is smaller? How are they separated?

Answer 25

Left lobe is smaller than the right lobe. They are separated by the falciform ligament.

Question 26

The gallbladder is tucked under... a) the left lobe of the liver b) the right lobe of the liver

Answer 26

b) the right lobe of the liver

Question 27

Name the 4 lobes of the liver (inferior view)

Answer 27

* Right lobe * Left lobe * Quadrate lobe (between the gallbladder and round ligament) * Caudate lobe (between the IVC and ligamentum venosum)

Question 28

What is the porta hepatis?

Answer 28

Region where the portal triad enters the liver: * hepatic bile duct * proper hepatic artery * portal vein

Question 29

Describe the anatomical vs functional lobes of the liver, and what separates them in each case

Answer 29

Anatomical: separated by falciform ligament Functional: defined by ductal and vascular anatomy separated by gallbladder/IVC)

Question 30

Describe the ducts of the liver and gallbladder

Answer 30

The cystic duct (from the gallbladder) and the common hepatic duct (from the liver) connect to form the bile duct.

Question 31

Where is bile produced?

Answer 31

In the liver (stored in gallbladder)

Question 32

Where does bile go when the hepatopancreatic sphincter is closed?

Answer 32

It backs up into the gallbladder

Question 33

How does the common hepatic artery (from the celiac trunk) branch?

Answer 33

It branches into the proper hepatic artery, which branches into the right and left hepatic arteries (to liver) and the cystic artery (to the gallbladder).

Question 34

The portal triad is contained within a ligament called...

Answer 34

hepatoduodenal ligament (component of the lesser omentum)

Question 35

What is the difference between the portal system and caval system?

Answer 35

Portal system: drains the blood from the GI tract (brings it to the liver) - it then connects to the caval system Caval system: drains blood from the body wall, limbs, and structures that do not pass through the liver, returning it directly to the heart via the superior and inferior vena cava

Question 36

What are portacaval anastomoses?

Answer 36

Connections between the portal and caval (systemic) venous systems.

Question 37

Postacaval anastomoses: 4 important sites

Answer 37

1. esophageal 2. paraumbilical 3. rectal 4. retroperitoneal

Question 38

What is the most common cause of portal hypertension?

Answer 38

Cirrhosis

Question 39

Under what condition will blood from the portal system move into the caval system rather than going to the liver?

Answer 39

Portal hypertension

Question 40

In portal hypertension, shunting of blood from the portal to the caval system results in...

Answer 40

distension of the caval veins, which gives rise to esophageal varices (esophageal anastomoses) and caput medusae (paraumbilical anastomoses).

Question 41

If a dug is administered orally, what percentage will go to the liver? What is the drug is absorbed rectally instead?

Answer 41

100% of the blood from the stomach goes to the liver, and the first-pass effect will reduce the amount of active drug that reaches the systemic circulation. However, if it is adminstered rectally, 50% of the drug will bypass the liver.

Question 42

Which rectal veins carry blood to the liver? Which rectal veins carry blood directly to the caval system (systemic)

Answer 42

Superior rectal vein -> portal system (liver) Middle and inferior rectal veins -> caval system (systemic)

Question 43

Sympathetic nervous system effect on the GI vs parasympathetic

Answer 43

SNS: decreases GI activity (fight or flight) PSNS: increases GI activity (rest and digest)

Question 44

Define GI activity as influenced by the SNS and PSNS

Answer 44

Gi activity: * muscular contractions (force & frequency) * glandular secretions * blood flow to GI organs PSNS will increase these factors, SNS will decrease these factors.