Lecture 20: Anatomy

Question 1

Name these parts of the pancreas, duodenum and spleen

Question 2

In a healthy adult, in which region of the abdominal cavity does the spleen normally lie

Answer 2

The left hypochondrium

Question 3

At the level of which ribs does the spleen lie

Answer 3

Level of left 9th and 11th ribs

Question 4

List the 4 structures that lies between the spleen and the lower left ribs

Answer 4

The peritoneum

The diaphargm

The left lung

The pleural cavity

Question 5

Give four functions of the adult human spleen

Answer 5

Storage of iron

Phagocytosis of old/damaged erthryocytes

Immune response to circulating antigens

Production of B and T cells

Phagocytosis of old/damaged white blood cells

Question 6

The spleen is most commonly damaged in abdominal trauma. What can happen if the spleen has ruptured

Answer 6

It can cause significant haemorrhage and perhaps shock

Question 7

Describe the blood supply to the pancreas

Answer 7

Main blood supply is via splenic artery, which supplies the neck, body and tail of the pancreas.

The head of the pancreas is supplied by the superior and inferior pancreatoduodenal arteries

Question 8

Describe the venous drainage of the pancreas

Answer 8

Mainly via the splenic vein

Question 9

Trypsinogen and chymotrpsinogen are proenzymed produced by the pancreas.

Why are they stored as proenzymes?

What activates them?

Answer 9

The proteolytic enzymes are stored this way to avoid self-digestion.

Trypsinogen is cleaved by brush border enzymes in the duodenum into its active form, trypsin.

Chymotrypsinogen is convereted to chymotrypsin by trypsin

Question 10

a patient with suspected cholecystitis comes with pain located in the right side of the upper abdomen but also radiated to the right shoulder area.

Why does the pain radiate to the right shoulder

Answer 10

This is referred pain

The phrenic nerve gives sensory fibres to the adjacent diaphragm and possibly to the gallbladder. Many of the fibres come from C4 spinal nerve, which is also sensory to the shoulder

Question 11

Explain the hormonal control of gallbladder contraction

Answer 11

Cholecystokinin (CCK) release is stimulated by the presence of fatty and acidic chyme in the small intestine.

CCK stimulates the contraction of the gallbladder

Question 12

By which two veins does the bound bilirubin pass from the spleen to the liver

Answer 12

Splenic and portal veins

Question 13

Which cell organelle is responsible for conjugation of bilirubin?

Answer 13

Endoplasmic reticulum

Question 14

Into which lumen is conjugated bilirubin directly secreted by hepatocytes?

Answer 14

Bile canaliculus

Question 15

What is the source of the enzymes the reduce bilirubin to urobilinogen in the bowel?

Answer 15

Bacteria

Question 16

Which vein carries resorbed urobiliogen from the terminal ileum to the portal vein?

Answer 16

Superior mesenteric vein

Question 17

In alcoholic hepatitis what is the ratio that is important?

Answer 17

AST:ALT ratio is often greater than 2

Question 18

Name the 4 parts of the duodenum?

Answer 18

Superior: 5cm in length

Descending: 7.5cm

Horizontal: 10cm

Ascending: 2.5cm

Question 19

Where does the head of the pancreas sit inside?

Answer 19

The curvature of the duodenum

Question 20

The superior porition of the duodenum is connected to the liver by what?

Answer 20

Hepatoduodenal ligament

Question 21

Which part of the duodenum is associated with the hepatoduodenal ligament?

Answer 21

Superior portion of the duodenum

Question 22

Duodenal ulcers are most likely to occur in the ____ portion of the duodenum.

Answer 22

Duodenal ulcers are most likely to occur in the superior portion of the duodenum.

Question 23

The superior mesenteric artery lies ___ the neck of the pancreas

Answer 23

behind

Question 24

The superior mesenteric artery lies ___ to the uncinate process.

Answer 24

Anterior

Question 25

Which veins unite to form the hepatic portal vein

Answer 25

the splenic and superior mesenteric veins

Question 26

Which part of the pancreas is framed by the duodenum

Answer 26

Head of the pancreas

Question 27

Name these parts of the duodenum

Answer 27

Question 28

Name these parts of the pancreas

Answer 28

Question 29

Name these parts of the biliary tree

Answer 29

Question 30

Name these parts regarding the vascular of the pancreas

Answer 30

Question 31

The spleen is connected to the pancreas by which parts?

Answer 31

The spleen is connected to the tail of the pancreas

Question 32

What locations are drained by the superior mesenteric vein

Answer 32

venous drainage of the midgut – which spans from the major duodenal papilla (of the duodenum) to the proximal 2/3 of the transverse colon.

Question 33

Which veins drain the spleen? Describe where it drains into

Answer 33

Splenic veins drain the spleen Unlike the splenic artery, the splenic vein is straight and it maintains contact with the body of the pancreas as it crosses the posterior abdominal wall. As it reaches the neck of the pancreas, the splenic vein joins the superior mesenteric vein to form the portal vein.

Question 34

What locations does the inferior mesenteric vein drain

Answer 34

Drains the hindgut – the distal 1/3 of the transverse colon, splenic flexure, descending colon, sigmoid colon and rectum.

Question 35

The inferior mesenteric vein drains into which vessel?

Answer 35

Splenic vein- which joins with the superior mesenteric vein to form the portal vein.

Question 36

Name these parts of the venous drainage system in the abdomen

Answer 36

This is the Portal Venous System ## Footnote The portal system carries venous blood (rich in nutrients that have been extracted from food) to the liver for processing. This is the system for the venous drainage of the spleen, pancreas, gallbladder and the abdominal part of the gastrointestinal tract. The portal vein is formed by the union of the splenic vein and the superior mesenteric vein, posterior to the neck of the pancreas, at the level of L2. As it ascends towards the liver, the portal vein passes posteriorly to the superior part of the duodenum and the bile duct. Immediately before entering the liver, the portal vein divides into right and left branches which then enter the parenchyma of the liver separately.

Question 37

Describe the accessory duct

Answer 37

The duct drains the head of the pancreas Drains directly into the duodenum More superior to the hepatoduodenal papilla

Question 38

In the presence of portal hypertension the spleen may be enlarged. Why is this?

Answer 38

The splenic vein is a tributary of the portal vein. The portal venous system does not contain valves so in portal hypertension the spleen becomes congested and enlarged