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Y2S2-Anatomy-GI > Anatomy of the pancreas and spleen > Flashcards

Anatomy of the pancreas and spleen Flashcards

1
Q

What is the pancreas?

A
  • It is a retroperitoneal, lobulated organ that extends from the curve of the duodenum to the hilus of the spleen, with both endocrine and exocrine functions
  • It lies deep to the abdominal cavity (not palpable)
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2
Q

Where is the pancreas located?

A

1) Epigastrium

2) Left hypochondrium

  • Between L1 and L2
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3
Q

What are the parts of the pancreas?

A

1) Head

2) Neck (anterior to the portal vein)

3) Body

4) Tail

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4
Q

Describe the head of the pancreas

A
  • Flattened and lies within the curve of the duodenum
  • It has two surfaces (anterior and posterior)
  • It has 4 borders (superior, inferior, right, and left)
  • It has 1 process (unicate process, which extends posteriorly and wraps around the superior mesenteric vessels)
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5
Q

Describe the structure of the neck of the pancreas

A
  • It has 2 surfaces (anterior and posterior)
  • It has 2 borders (upper and lower)
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6
Q

Describe the structure of the body of the pancreas

A
  • It extends from the front of the aorta to the front of the left kidney
  • It has 3 borders (anterior, superior, and inferior)
  • It has 3 surfaces (anterior, posterior and inferior)
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7
Q

A patient is undergoing pancreatic surgery. The surgeon identifies a structure posterior to the neck of the pancreas. Which of the following is most likely?

A

Portal vein

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8
Q

A patient with pancreatic cancer develops jaundice. A tumor is found compressing the bile duct as it passes through the pancreas. Which part of the pancreas is most likely affected?

A

The head of the pancreas

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9
Q

Which of the following statements about the pancreas is incorrect?

A) The tail of the pancreas reaches the hilum of the spleen
B) The head of the pancreas surrounds the superior mesenteric artery
C) The neck of the pancreas lies anterior to the portal vein
D) The body of the pancreas extends anterior to the left kidney

A

B (it is the unicate process)

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10
Q

What are the relations of the body of the pancreas?

A

1) It is related to the lesser sac (superiorly)

2) Related to the greater sac (inferiorly)

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11
Q

What is the lienorenal ligament?

A
  • AKA: Splenorenal ligament
  • It connects the spleen to the left kidney
  • It contains important structures like the tail of the pancreas, splenic vessels, and short gastric artery
  • It has a role in supporting the spleen and providing a passage for the vessels
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12
Q

What is the postero-superior surface of the head related to?

A

The bile duct

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13
Q

What is the posterior surface of the neck of the pancreas related to?

A

The portal vein

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14
Q

Cancer occurring in which parts of the pancreas may obstruct the portal vein or the IVC?

A

Head and Neck of the pancreas

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15
Q

What is the course of the main pancreatic duct?

A
  • The main pancreatic duct (of Wirsung) begins at the tail, transversing the length of the gland receiving smaller tributaries
  • In the head of the pancreas, it joins with the bile duct to form the dilated hepatopancreatic ampulla “of vater”, which opens into the second segment of the duodenum
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16
Q

Describe the course of the accessory pancreatic duct

A
  • Pancreatic duct of santorini
  • When present, it drains the head and the unicate process
  • It opens separately into the 2nd part of the duodenum
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17
Q

Which of the following statements about the pancreatic ducts is true?
A) The accessory pancreatic duct always opens into the duodenum separately.
B) The main pancreatic duct empties into the major duodenal papilla.
C) The pancreatic duct is located anterior to the stomach

A

B

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18
Q

What are the sphincters of the pancreatic ducts?

A

1) Sphincter of Oddi (hepatopancreatic)

2) Bile duct (Boyden)

  • They are smooth muscle sphincters that control the flow of bile and pancreatic juice into the duodenum
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19
Q

What will happen if a gallstone gets stuck in the mpulla?

A

This will lead to the spasm of the hepatopancreatic sphincter, which will cause a reflux of the bile into the pancreatic duct and thus pancreatitis

  • In case the accessory pancreatic duct connects to the main duct, it might compensate for the obstruction
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20
Q

What will happen if a cancer occurs in the pancreas?

A

It will cause extrahepatic obstruction of the biliary duct, retaining the bile and enlarging the gallbladder which might lead to obstructive jaundice

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21
Q

A 45-year-old woman with a history of gallstones presents with severe epigastric pain radiating to the back. Blood tests show elevated amylase and lipase levels. Imaging reveals a gallstone lodged at the hepatopancreatic ampulla (Ampulla of Vater). What is the most likely diagnosis?

A

Acute pancreatitis

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22
Q

A 55-year-old man is diagnosed with pancreatic head cancer that compresses the main pancreatic duct and common bile duct. What is the most likely clinical finding?

A

Steatorrhea and jaundice

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23
Q

What is the blood supply of the head of the pancreas?

A

1) Superior pancreaticoduodenal artery (from the celiac trunk)

  • Abdominal aorta - celiac artery - common hepatic artery - gastroduodenal artery (descends forming the right epiploic) and - superior pancreaticoduodenal artery

2) Inferior pancreaticoduodenal artery (from the superior mesenteric artery)

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24
Q

What is the blood supply of the tail of the pancreas?

A

Pancreatic branches from the splenic artery

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25
What is the blood supply of the body of the pancreas?
1) Superior pancreaticoduodenal artery (from the celiac trunk) 2) Inferior pancreaticoduodenal artery (from the superior mesenteric artery) 3) Pancreatic branches from the splenic artery
26
What is the venous drainage of the pancreas?
It corresponds to the artery and drains into the: 1) Superior mesenteric vein (body and head) 2) Splenic vein (tail)
27
During surgery, a vascular structure running along the superior border of the pancreas is accidentally injured, leading to massive bleeding. Which artery is most likely affected?
Splenic artery
28
A 52-year-old woman with a history of chronic pancreatitis presents with upper GI bleeding and splenomegaly. Imaging shows dilated veins around the pancreas and stomach. The most likely cause of her condition is obstruction of which vein?
Splenic vein
29
What is the lymphatic drainage of the pancreas?
1) Ventral and dorsal pancreatico-duodenal lymph nodes: drains the head and neck 2) Pancreatico-splenic lymph nodes: drain the body and tail - They will ultimately drain into the celiac and superior mesenteric lymph nodes
30
A 65-year-old man with a history of chronic pancreatitis presents with significant weight loss and jaundice. A CT scan reveals a mass in the head of the pancreas. If the cancer has spread through the lymphatic system, which lymph nodes are most likely first affected?
superior mesenteric and lymph nodes
31
A patient with suspected pancreatic cancer undergoes a biopsy. The pathology report confirms adenocarcinoma of the head of the pancreas with extensive lymph node involvement. What is the most likely prognosis?
Poor prognosis due to early lymphatic spread
32
What is the sympathetic nerve supply of the pancreas?
1) Greater celiac 2) Lesser splanchnic (superior mesenteric) - Pain fibers accompany the sympathetic supply and thus, pancreatic pain might radiate into the distribution of the thoracic dermatomes
33
What is the parasympathetic innervation of the pancreas?
Both vagus nerves - They activate the secretory function of the pancreas along with the hormones (secretin and pancreozyme)
34
A 47-year-old man presents with severe epigastric pain radiating to the back. The pain worsens when he lies flat and improves when he leans forward. He has a history of chronic alcohol use. What is the most likely cause of his pain?
Chronic pancreatitis
35
A patient undergoes surgery for a pancreatic tumor. During the procedure, the surgeon identifies a large nerve plexus surrounding the celiac trunk. This plexus is responsible for:
Inhibiting the exocrine secretion (celiac ganglion receives sympathetic fibers->greater splanchnic nerve-> inhibits pancreatic secretion and causes vasoconstriction)
36
What is pancreatectomy?
The removal of the pancreas is not complete due to anatomical relationships, blood supply to the head, bile ducts, and the duodenum, which makes it impossible
37
What is meant by annular pancreas?
It is a congenital anomaly where the head of the pancreas encircles the second part of the duodenum, causing a duodenal obstruction - Symptoms can range from vomiting, feeding difficulties, and billous vomiting in newborns
38
Where is the spleen situated?
- It lies in the left upper quadrant (left hypochondrium) - It lies obliquely behind the 9-11th ribs - Blunt trauma to those ribs or this site can tear the thin capsule of the spleen leading to a profuse bleeding - The repair of a ruptured spleen is difficult and thus splenectomy is usually preformed to stop the bleeding
39
Describe the structure of the spleen
1) It has two ends (posterior and anterior) 2) It has two borders (superior and inferior) 3) It has two surfaces (diaphragmatic and visceral hilus)
40
What is the anterior basal angel?
- It is the junction between the superior border and the anterior end - It is the most anterior projecting part of the spleen - It is located at the 9th intercostal space (a little bit behind the left mid-axillary line) - When the spleens enlarges 2-3 times its size this angle gets palpable under the left costal margin (that's why it is called the clinical angle of the spleen)
41
To which organs is the visceral surface of the spleen in contact with (what are the impressions found on the spleen)?
1) Left kidney and suprarenal gland 2) Pancreas 3) Stomach 4) Colon
42
Describe the notch of the spleen
- The superior border of the spleen is often notched - When the spleen is enlarged, the notched superior border lies inferiorly, which is a helpful landmark when palpating an enlarged spleen
43
What is the anterior relation of the visceral surface of the spleen?
1) Stomach
44
What is the posterior relation of the visceral surface of the spleen?
The left kidney and suprarenal gland
45
What is the inferior visceral relation of the spleen?
The splenic flexure of the colon
46
What is the organ related directly to the hilus of the spleen and lies in the lieno-renal (splenorenal) ligament?
The pancreas
47
What is the diaphragmatic surface of the spleen related to?
- Separated from the left pleural sac (costo-diaphragmatic recess), lung and ribs 9-11 by the diaphragm - The costo-diaphragmatic recess extends to the level of the10th rib in the mid-axillary line
48
What can happen if the lower ribs gets fractured?
It might produce sharp bone fragments which can lacerate the spleen
49
What are the variations of the inferior mesenteric vein?
1) It could open into the splenic vein (in most individuals) 2) It could open into the superior mesenteric vein (a variation)
50
What are the peritoneal relations of the spleen?
- The spleen is covered by the peritoneum and it is suspended at its hilus by the: 1) Lieno-renal ligament (contains the vessels and the tail of the pancreas "spleen to the kidney") 2) Gastro-splenic ligament ("spleen to the stomach") - Both of these ligaments forms the lateral limit of the omental bursa (prevents us from reaching to the left side through the lesser sac) - A rupture of the spleen results in severe intraperitoneal hemorrhage and thus the spleen must be removed
51
What is meant by wandering spleen?
It is a rare condition where the spleen is abnormally mobile
52
What are the causes of wandering spleen?
The loss, weakening, or malformation of the ligaments which helps to keep the spleen located in the upper left quadrant
53
What are the symptoms of a wandering spleen?
1) Enlarged size of the spleen 2) Change in the location of the spleen - It can present as an abdominal mass that changes its position 3) Abdominal pain or swelling (blocking of the arteries and torsion of the spleen)
54
What enables us to move the spleen around in the abdomen?
The spleen pedicle being abnormally long
55
What is the treatment of a wandering spleen?
1) Splenoplexy (the usual treatment "fixation of the spleen") 2) If there was no blood flow after the unwinding of the spleen (then splenectomy must be performed)
56
A 35-year-old woman presents with recurrent left upper quadrant pain. On examination, a palpable mass is noted in the lower abdomen that changes position with movement. Ultrasound reveals an ectopic spleen in the pelvis with a twisted vascular pedicle. What is the most likely diagnosis?
Wandering spleen with torsion
57
A 28-year-old woman undergoes imaging for chronic abdominal discomfort. A CT scan reveals the spleen located in the lower abdomen instead of the left upper quadrant. Doppler ultrasound shows normal vascular flow. What is the most appropriate treatment?
Splenoplexy
58
What is the most common complication of wandering spleen?
splenic torsion and infarction
59
What is the arterial supply of the spleen?
The splenic artery - It is the largest branch of the celiac trunk - It follows a torturous course along the superior border of the pancreas - It enters the lienorenal ligament where it divides into branches that enters the hilum - It gives the short gastric and left gastroepiploic branches
60
What is the venous supply of the spleen?
The splenic vein (emerges from several tributaries at the hilum of the spleen "inferior mesenteris -in some cases-, left gastroepiploic and the short gastric veins) - It lies posterior to the tail and body of the pancreas at a lower level compared to the splenic artery - It unites with the superior mesenteric artery to form the portal vein behind the neck of the pancreas

Y2S2-Anatomy-GI (9 decks)

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