Pancreas, Spleen & Portal System

Question 1

Pancreas gross anatomy
-aspects of pancreas and where they are
Label diagram

Answer 1

• Head = in concavity of duodenum.
  (Uncinate process wraps behind SM vessels)
• Neck = narrow area from head to body
  (Lies ant. To SMA vessel origins)
• Body = passes across laterally, superiorly and posteriorly
• Tail = passes into lienorenal lig. and into contact with hilus of spleen

Question 2

What does the anterior pancreas supply

What does the posterior pancreas supply

Answer 2

• Anterior = transverse colon, stomach
• Posterior = bile duct,
  portal vein, splenic vein, IVC, aorta, superior mesenteric artery, L psoas, L supra‐renal gland, L kidney, spleen

Question 3

Pancreatic Ducts
what are the two main types and their roles

Answer 3

1. Main duct = from tail to Ampulla of Vater ‐ (joined by Bile Duct)
   ‐ enters descending duodenum
   via the Sphincter of Oddi (major duodenal papilla)
2. Accessory Duct – may be present
   ‐ drains into upper part of head,
   then into duodenum (minor duodenal papilla)

Question 4

Label drawing of pancreas

Answer 4

Lecture Slide

Question 5

ERCP – Sphincter of Oddi
- useful for?

Answer 5

ERCP = Endoscopic Retrograde
Cholangiopancreatography

• Useful for visualising
  biliary tree
• Stones
• Blockages
• Leaks

Question 6

Blood supply of pancreas

Answer 6

1. Common hepatic (right of midline - aka aortic artery)
   -gastroduodenual
   Superior Pancreaticoduodenal
   ‐ (Ant. branch)
   ‐ (Post. branch)
2. Splenic (left of midline - aka aortic artery)
   ‐ Dorsal Pancreatic
   ‐ Great Pancreatic

**BOTH OF THESE ARE CELIAC TRUNK ORIGIN

3. Superior Mesenteric
   ‐ Inferior Pancreaticoduodenal
   ‐ (Ant. Inf. branch)
   ‐ (Post. Inf. branch)

Question 7

Label blood supply to pancreas (posterior and anterior view)

Answer 7

Lecture Slide

Question 8

Venous/Lymphatic Drainage & ANS

Answer 8

1. Portal System:
   Will flow back to portal vein regardless of artery origin
   ‐ back through Splenic or SMV
   - into liver
   -into IVC
2. Lymphatics:
   Dual arterial supply = dual lymphatic drainage
   ‐ Coeliac nodes (T12)
   ‐ SM nodes (L1)
3. ANS
   Celiac plexus
   -greater and lesser splanchnic
   -vagus X

Question 9

Purpose of spleen
Location
Ligaments and what they carry

Answer 9

Largest single mass of lymphoid tissue in the body – filters & recycles blood and
supports immune system

Lies anterior to ribs 9‐11 in the left hypochondrium (posterior to stomach)

Gastrosplenic ligament carrying short gastric and gastro‐omental vessels

Splenorenal ligament to left kidney carrying splenic vessels and tail of pancreas

Question 10

MAIN Spleen blood and vein supply

Answer 10

Arterial
-splenic artery (from celiac axis)

Venous
Splenic vein (into portal vein)

Question 11

anterior and posterior spleen located

Answer 11

Anterior:
Tail of pancreas
L Colic flexure
Stomach

Posterior
L kidney
Ribs 9-11

Question 12

Morphology of spleen

Answer 12

2 Surfaces
* Diaphragmatic
* Visceral

2 poles
upper
lower

3 areas
Related to neighbouring organs
* Gastric
* Colic
* Renal

Question 13

Splenic ligaments on cross section

Answer 13

Lecture Slide

Question 14

Causes of splenomegaly

Answer 14

1. bacterial infection (sphyillus)
2. Viral infection (MN)
3. Parasitic infection (malaria(
4. Cancer (lymphomas)
5. Metabolic disorders
6. Hemolytic anaemias

Question 15

Internal anatomy of liver

Answer 15

Lecture Slide

Question 16

Portal shunting

Answer 16

Portal hypertension – forces blood to
find another path through systemic
system

3 main shunts
1. Bottom 1/3 of esophagus
2. Around umbilicus (umbilical vein into superficial veins)
3. Anus (superior rectal veins into interior and middle rectal veins)

Question 17

Label organs on CT scan

Answer 17

Lecture Slide

Question 18

What is both of the spleem ligaments?

Answer 18

Splenorenal:
* Spleen – L. Kidney
* Splenic vessels
* Tail of Pancreas

Gastrosplenic:
* Stomach – Spleen
* Short gastric vessels
* Gastro‐omental vessels

Question 19

The Tail is located in which peritoneal ligament?

Answer 19

Splenorenal

Question 20

The Bile duct and Pancreatic duct join in the ____ of the pancreas. to form the ____ . They enter the ____ part of the Duodenum via the ____

Answer 20

The Bile duct and Pancreatic duct join in the head of the pancreas to form the ampulla vater. They enter the 2nd part of the Duodenum via the major duodenial papilla

Question 21

The Portal vein is formed by the union of the _____ and ____ Veins posterior to the ____of the Pancreas.

Answer 21

The Portal vein is formed by the union of the splenic and
superior mesenteric veins posterior to the neck of the Pancreas.

Question 22

• Which part of the Pancreas is the Splenic Vein in contact with as it courses medially?

Answer 22

Body