Abdominal Viscera: Liver, Gall Bladder, Pancreas and Spleen

Question 1

The liver and pancreas are derivatives of what?

Answer 1

The foregut.

Question 2

The spleen derives from what?

Answer 2

The mesoderm

Question 3

What does the falciform ligament attach together?

Answer 3

The falciform ligament is a ligament that attaches the liver to the front body wall.

Question 4

During development, what degree and direction does the stomach locate to form the lesser sac?

Answer 4

90 degrees to the right and then 90 degrees clockwise.

Question 5

What does the lesser sac lie behind?

Answer 5

The stomach and lesser omentum.

Question 6

What is the main function of the lesser sac?

Answer 6

To allow for unrestricted movement of the stomach.

Question 7

What is the only entrance to the lesser sac?

Answer 7

Epiploic foramen.

Question 8

Is the pancreas intraperitoneal or retroperitoneal?

Answer 8

Secondary retroperitoneal.

Question 9

Is the 2nd part of the duodenum intraperitoneal or retroperitoneal?

Answer 9

Retroperitoneal.

Question 10

List some causes of fluid accumulation in the lesser sac.

Answer 10

1. Perforated gastric ulcer

2. Inflammation of the pancreas

Question 11

What 2 areas can the greater sac be divided into?

Answer 11

Supracolic compartment and infracolic compartment.

Question 12

Is the liver normally palpable without a pathology? What can the patient do to help the doctor palpate the liver? Why does this work?

Answer 12

No, not normally palpable without a pathology. The patient can breathe in, which makes the diaphragm contract and lower, which temporarily displaces the liver.

Question 13

Which ligament can be found at the inferior end of the Falciform ligament? What is this ligament a remnant of?

Answer 13

Ligamentum teres hepatis - which is a remnant of the umbilical vein.

Question 14

Which ligament can be found approximately between the left and right lobes of the liver posteriorly? What is this a remnant of?

Answer 14

The Ligamentum Venosum - remnant of Ductus Venosus.

Question 15

What are the lobes of the liver called?

Answer 15

Right, left, caudate, quadrate.

Question 16

How many segments can the liver be separated into?

Answer 16

8

Question 17

What is the bare area of the liver?

Answer 17

The area of the liver that is not covered in peritoneum - it is in direct contact with the diaphragm.

Question 18

How is the coronary ligament formed?

Answer 18

The coronary ligament is formed by the reflection of the peritoneum from the undersurface of the diaphragm onto the superior and posterior surfaces to the right lobe of the liver.

Question 19

What is the name of the peritoneal recess located between the diaphragm and liver?

Answer 19

Sub-phrenic space.

Question 20

Where is the portal vein most commonly formed?

Answer 20

Posterior to the neck of the pancreas.

Question 21

What do the central veins of the liver drain into?

Answer 21

Hepatic veins, then IVC.

Question 22

What is caput medusae and what causes it?

Answer 22

Caput medusae is the appearance of distended and engorged superficial veins, which are seen radiating from the umbilicus across the abdomen. It can be caused by severe cases of portal hypertension / liver disease / cirrhosis.

Question 23

The fundus of the gallbladder sits on what anatomical plane?

Answer 23

Transpyloric plane (L1)

Question 24

When is Murphy’s sign elicited and what is the procedure to check?

Answer 24

Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

Question 25

What are the 5 parts of the pancreas called?

Answer 25

1. Uncinate process
2. Head
3. Neck
4. Body
5. Tail

Question 26

Which sphincter controls the flow of bile and pancreatic juices through the major duodenal papilla?

Answer 26

Hepatopancreatic sphincter.

Question 27

In what region on surface anatomy does the pancreas sit?

Answer 27

Epigastric, and extends into the left hypochondrium.

Question 28

The neck of the pancreas sits on what horizontal plane?

Answer 28

Transpyloric (L1).

Question 29

The tail of the pancreas sits near what?

Answer 29

The splenic hilum.

Question 30

The pancreas develops from how many different buds?

Answer 30

2

Question 31

How could the development of the pancreas go wrong in relation to the ventral bud?

Answer 31

It could start to migrate both ways around the duodenum, creating an extra ring of pancreatic tissue encircling the duodenum, known as an annular pancreas.

Question 32

The minor duodenal papilla receives an accessory pancreatic duct from the ventral or dorsal bud of the pancreas?

Answer 32

Dorsal

Question 33

The spleen is related to which ribs?

Answer 33

10-12

Question 34

Is the splenic artery anterior or posterior to the pancreas?

Answer 34

Posterior

Question 35

If the spleen is injured, describe the nature of the bleeding and what repair is like.

Answer 35

The spleen bleeds profusely - repair is difficult.

Question 36

In which direction does the spleen enlarge?

Answer 36

Inferomedially.

Question 37

Which particular anatomical feature of the spleen may be palpated if the spleen is enlarged?

Answer 37

The notches of the border of the spleen.