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The spleen is the largest lymphoid organ in the body.
It acts as both a blood filter and a reservoir.
Situated in the left hypochondrium, between the fundus of the stomach and the diaphragm.
Lies along the axis of the 10th rib; long axis corresponds to the 10th rib.
Shape: Ovoid, wedge-shaped.
Surfaces:
Diaphragmatic surface — smooth, convex.
Visceral surface — concave; shows gastric, renal, colic, and pancreatic impressions.
Borders:
Superior border — notched (diagnostically important).
Inferior border — rounded.
Poles:
Anterior pole — broad, directed forward.
Posterior pole — pointed, directed backward.
Hilum: Located on visceral surface; transmits splenic artery, vein, and lymphatics.
Anteriorly: Stomach (fundus).
Posteriorly: Diaphragm, left pleura, 9th–11th ribs.
Inferiorly: Left colic flexure and phrenicocolic ligament.
Medially: Left kidney and tail of pancreas (in lienorenal ligament).
Splenic artery, the largest branch of the celiac trunk, tortuous course along superior border of pancreas.
Divides into 5–6 segmental branches before entering hilum.
Each branch supplies a distinct splenic segment (no anastomosis → segmental resection possible).
Splenic vein arises from hilum → runs behind pancreas → joins superior mesenteric vein to form portal vein.
Drains into pancreaticosplenic lymph nodes, then into celiac lymph nodes.
Rupture of spleen: Common in trauma; profuse internal bleeding → splenectomy may be required.
Splenomegaly: Enlargement in malaria, kala-azar, leukemia, and portal hypertension.
Accessory spleen: Seen in ~10% of individuals; usually near hilum or tail of pancreas.
Splenic enlargement direction: Downward and obliquely toward the right iliac fossa (limited by phrenicocolic ligament).
Splenic puncture site: 9th or 10th left intercostal space in midaxillary line (to avoid lung injury).
Capsule: Fibroelastic with smooth muscle fibers.
Trabeculae: Extend inward carrying blood vessels.
Splenic pulp:
White pulp: Lymphatic tissue (Malpighian corpuscles).
Red pulp: Sinusoids filled with RBCs; macrophages filter aged RBCs.
Reticular cells and macrophages form splenic cords.
1 × 3 × 5 × 7 × 9 × 11 rule:
1 inch thick
3 inches wide
5 inches long
Weight 7 ounces
Lies between 9th and 11th ribs
Intraperitoneal organ.
Develops from dorsal mesogastrium (mesodermal origin).
Moves with respiration.
Splenic artery and vein + tail of pancreas lie in lienorenal ligament.
Short gastric and left gastroepiploic vessels lie in gastrosplenic ligament.
A soft, lobulated retroperitoneal gland located transversely across the posterior abdominal wall.
It is both exocrine (digestive enzymes) and endocrine (hormones like insulin and glucagon) in function.
Extends from the duodenal C-loop (right) to the spleen (left).
Lies within the C-shaped curve of the duodenum.
Uncinate process: Small projection from the lower part of the head that hooks behind the superior mesenteric vessels.
Relations:
Anterior: Transverse colon and jejunum.
Posterior: Inferior vena cava, right renal vessels, bile duct.
The bile duct passes through the posterior surface of the head before opening into the second part of the duodenum.
Triangular in cross-section.
Lies obliquely across the midline at the level of L1 vertebra.
Anterior surface: Related to stomach (via lesser sac).
Posterior surface: Related to aorta, left kidney, renal vessels, and splenic vein.
Inferior surface: Related to duodenojejunal flexure and coils of jejunum.
Superior border: Lodges the splenic artery (tortuous).
Narrow, tapering left end.
Lies in the splenorenal ligament, close to hilum of spleen and left kidney.
The only intraperitoneal part of the pancreas.
Contains many islets of Langerhans (endocrine-rich zone).
Main pancreatic duct (Duct of Wirsung):
Runs from tail → head.
Joins common bile duct to form hepatopancreatic ampulla (of Vater).
Opens at major duodenal papilla in the second part of duodenum.
Accessory pancreatic duct (Duct of Santorini):
Opens separately into duodenum at the minor duodenal papilla (above the major).
Drains upper part of head and uncinate process.
Head: Superior and inferior pancreaticoduodenal arteries (from gastroduodenal and superior mesenteric arteries).
Body and Tail: Branches from splenic artery (pancreatic, great pancreatic, and caudal pancreatic arteries).
Corresponds to the arteries.
Veins drain into the splenic vein, superior mesenteric vein, and then into the portal vein.
Into pancreaticosplenic, pyloric, and superior mesenteric lymph nodes, then to celiac nodes.
Sympathetic: From celiac and superior mesenteric plexuses (vasomotor, inhibitory to secretion).
Parasympathetic: From vagus (stimulates secretion).
Pain fibers: Follow sympathetic nerves to T6–T10 segments.
Exocrine part:
Secretes digestive enzymes—amylase, lipase, trypsinogen—into the duodenum.
Bicarbonate secretion neutralizes gastric acid.
Endocrine part (Islets of Langerhans):
α-cells: Glucagon
β-cells: Insulin
δ-cells: Somatostatin
PP-cells: Pancreatic polypeptide
Carcinoma of head of pancreas:
Compresses the bile duct → painless jaundice, clay-colored stools, Courvoisier’s sign.
Pancreatitis:
Inflammation from duct obstruction (gallstones, alcohol).
Severe epigastric pain radiating to the back.
Pancreatic cysts and pseudocysts:
May compress stomach or duodenum.
Accessory duct obstruction:
Leads to pain and minor pancreatic inflammation.
Referred pain:
To back and left shoulder due to retroperitoneal position (T6–T10 dermatomes).
Exocrine part:
Compound tubuloalveolar gland; serous acini lined by pyramidal cells with zymogen granules.
Centroacinar cells mark the start of intercalated ducts.
Endocrine part:
Scattered islets of Langerhans (1–2% of mass).
Rich capillary network for hormone secretion into blood.
Develops from two endodermal buds of the foregut:
Dorsal pancreatic bud → body, tail, and most of head.
Ventral pancreatic bud → uncinate process and part of head.
Fusion occurs during rotation of duodenum; ducts unite to form main pancreatic duct.
Transcription factors:
PDX1 (pancreatic and duodenal homeobox gene): Essential for pancreatic bud formation.
PTF1A: Promotes exocrine differentiation.
NGN3: Stimulates endocrine islet cell differentiation.
Sonic hedgehog (SHH) is inhibited in foregut endoderm to allow pancreatic bud formation.
Retroperitoneal organ except tail.
Supplied by celiac and superior mesenteric branches.
Dual function gland: exocrine + endocrine.
Clinical significance in pancreatic carcinoma, pancreatitis, and cysts.
The largest gland in the body (weighs about 1.5 kg).
Lies mainly in the right hypochondrium, extending partly into the epigastrium and left hypochondrium.
Performs vital metabolic, secretory, and detoxification functions.
Secretes bile—an exocrine secretion essential for fat digestion.
Shape: Wedge-shaped, soft, reddish-brown organ.
Surfaces:
Diaphragmatic surface — smooth and convex, facing upward.
Visceral surface — irregular, facing downward and backward.
Lobes: Right and left lobes divided by falciform ligament on anterior surface and ligamentum teres on inferior surface.
Weight: ~1.5 kg (adult male), ~1.3 kg (female).
Superior surface – Fits under the diaphragm.
Anterior surface – Related to diaphragm and anterior abdominal wall.
Posterior surface – Related to inferior vena cava and vertebral column.
Inferior (visceral) surface – Shows impressions of stomach, duodenum, right kidney, and colon.
Right surface – Related to right dome of diaphragm and ribs 7–11.
Inferior border separates diaphragmatic and visceral surfaces.
It is sharp anteriorly and notched by:
Falciform ligament
Gallbladder fossa
Ligamentum teres
Right lobe:
Impressions: Gallbladder, right kidney, hepatic flexure of colon, duodenum.
Left lobe:
Impressions: Stomach, oesophagus, lesser omentum.
Caudate lobe: Lies between inferior vena cava and ligamentum venosum.
Quadrate lobe: Lies between gallbladder fossa and ligamentum teres.
Dual supply:
Hepatic artery (30%) – oxygenated blood from celiac trunk via common hepatic artery.
Portal vein (70%) – nutrient-rich blood from intestines, pancreas, and spleen.
Both vessels enter liver at porta hepatis.
Blood from liver drains via hepatic veins (right, middle, left) → directly into inferior vena cava.
No valves are present in hepatic veins or portal vein.
Superficial lymphatics: From capsule → phrenic and hepatic nodes.
Deep lymphatics: Along portal triads → hepatic → celiac lymph nodes.
Portal hypertension → retrograde lymph flow → ascites.
Sympathetic: From celiac plexus (vasomotor).
Parasympathetic: From anterior and posterior vagal trunks.
Sensory fibers: Travel with right phrenic nerve (referred pain to right shoulder).
Liver divided into eight functional segments (Couinaud’s classification) based on branching of hepatic artery, portal vein, and bile ducts.
Right functional lobe: Segments V–VIII
Left functional lobe: Segments II–IV
Segment I: Caudate lobe (independent drainage).
Each segment has its own vascular inflow, outflow, and biliary drainage → allows segmental resection.
Identify porta hepatis: transverse fissure on inferior surface transmitting portal triad—
Hepatic artery (left)
Portal vein (behind)
Bile duct (right)
Posterior to porta: caudate lobe and inferior vena cava.
Ligaments: Falciform, coronary, triangular (right and left), and lesser omentum.
Cirrhosis: Fibrosis and nodular regeneration → portal hypertension, ascites, varices.
Hepatomegaly: Infections (malaria, hepatitis), congestion, or malignancy.
Portal hypertension: Causes esophageal, umbilical, and rectal varices.
Jaundice: Accumulation of bilirubin due to liver, bile duct, or hemolytic pathology.
Liver biopsy: Needle inserted in right 8th or 9th intercostal space in midaxillary line.
Referred pain: Right shoulder (via phrenic nerve).
Trauma: Can cause dangerous intra-abdominal bleeding due to high vascularity.
Capsule: Thin connective tissue (Glisson’s capsule) covering liver surface.
Lobule: Hexagonal structural unit with:
Central vein in center.
Portal triads (branch of portal vein, hepatic artery, and bile duct) at each corner.
Hepatocytes: Radiating plates of polygonal cells forming sinusoids.
Kupffer cells: Phagocytic macrophages lining sinusoids.
Bile canaliculi: Between hepatocytes, draining bile into ductules → hepatic ducts.
Blood flow: Periphery → center; Bile flow: Center → periphery.
Derived from hepatic diverticulum of foregut endoderm.
Cranial part: Forms liver and intrahepatic bile ducts.
Caudal part: Forms gallbladder and cystic duct.
Mesoderm of septum transversum contributes hematopoietic cells, Kupffer cells, and connective tissue.
FGF (Fibroblast Growth Factor) from cardiac mesoderm induces hepatic bud formation.
BMP (Bone Morphogenetic Protein) from septum transversum enhances hepatic specification.
HNF (Hepatocyte Nuclear Factors) regulate differentiation of hepatocytes.
Proliferation and growth: Controlled by VEGF, HGF (hepatocyte growth factor), and EGF.
Vascular invasion of hepatic sinusoids occurs early under VEGF influence.
Largest gland; intraperitoneal except bare area.
Dual blood supply: portal vein and hepatic artery.
Functional lobes defined by vascular segmentation.
Develops from foregut endoderm and septum transversum mesoderm.
Clinically vital in portal hypertension, cirrhosis, jaundice, and trauma.
“1 × 3 × 5 × 7 × 9 × 11 rule”
1 inch thick
3 inches wide
5 inches long
Weight: 7 ounces
Lies between: 9th and 11th ribs
Mnemonic: “DAV”
D → Hepatic Ducts
A → Hepatic Artery
V → Portal Vein
Left lobe: Segments II, III, IV
Right lobe: Segments V, VI, VII, VIII
Caudate lobe: Segment I (independent venous drainage)
Main duct: Wirsung (W → Wide/main)
Accessory duct: Santorini (S → Secondary/Small)
Spleen
A collection of lymphoid tissue with rich vascular supply.
Moves up and down with respiration.
Mesodermal in origin.
In splenectomy, before cutting the lienorenal ligament, the tail of pancreas and splenic vessels must be identified and preserved.
Enlarged spleen moves downward and obliquely toward right iliac fossa; descent limited by phrenicocolic ligament.
Pancreas
Mainly develops from dorsal pancreatic bud; the ventral bud forms uncinate process and part of head.
Islets of Langerhans are maximum in the tail of the pancreas.
Portal vein is formed by union of splenic and superior mesenteric veins behind the neck of the pancreas.
Liver
Largest gland of the body.
Kept in position by hepatic veins (upper group) draining into inferior vena cava.
Has eight functional segments (Couinaud classification).
Bare area is one of the sites of portosystemic anastomoses.
Enlarges downward into right iliac fossa during hepatomegaly.
Gallstones risk factors:
“Four F’s – Female, Forty, Fertile, Fat.
Portal triad contents (in hepatoduodenal ligament):
“DAVE” – Duct, Artery, Vein, Epiploic foramen (behind).
Case:
A young boy is kicked by his classmate in the left upper abdomen. Shortly afterward, he faints due to internal bleeding.
Questions:
What organ is likely to be ruptured?
What precaution is necessary during its removal?
Answer:
The organ most likely ruptured is the spleen, leading to massive internal hemorrhage because of its high vascularity.
The treatment is splenectomy (removal of the spleen).
Surgical Precautions during Splenectomy:
The spleen must be carefully freed from its peritoneal attachments:
Gastrosplenic ligament — contains short gastric vessels (must be ligated before division).
Lienorenal ligament — contains splenic artery, splenic vein, and tail of pancreas.
These structures should be identified and preserved before cutting the ligaments.
Careless incision can injure the tail of the pancreas, leading to pancreatic leakage or fistula formation.
Clinical Insight:
Ruptured spleen commonly follows blunt trauma to the left hypochondrium.
The condition presents with hypotension, tachycardia, and Kehr’s sign (left shoulder pain due to diaphragmatic irritation).
Early diagnosis and prompt management are life-saving.
1. Traumatic Splenic Rupture
A child falls on his left side and suddenly becomes pale with hypotension.
→ Explanation: The spleen is highly vascular; rupture causes massive intraperitoneal hemorrhage.
→ Sign: Kehr’s sign – referred pain to left shoulder via phrenic nerve (C3–C5).
→ Treatment: Splenectomy after securing short gastric and splenic vessels.
2. Accessory Spleen
During splenectomy, a second small splenic tissue is found near the tail of pancreas.
→ Explanation: Accessory spleen (10–15% cases) arises from lobulated embryonic spleen; may hypertrophy after splenectomy.
3. Splenomegaly in Malaria
A patient with chronic malaria shows palpable spleen reaching the right iliac fossa.
→ Reason: Congestive enlargement due to repeated parasitic invasion.
→ Direction of enlargement: Downward and medially, limited by phrenicocolic ligament.
4. Hypersplenism
A patient with portal hypertension shows anemia and leucopenia.
→ Mechanism: Overactive spleen destroys blood cells due to chronic congestion.
5. Wandering Spleen
A woman presents with an abdominal mass shifting on posture change.
→ Cause: Lax or absent splenic ligaments; torsion may cause infarction.
6. Acute Pancreatitis
A middle-aged man with gallstones develops severe epigastric pain radiating to the back.
→ Cause: Blockage of pancreatic duct; activation of enzymes leads to autodigestion.
→ Referred pain: To the back and left shoulder (retroperitoneal organ, T6–T10).
7. Carcinoma of Head of Pancreas
An elderly male has painless jaundice, clay-colored stool, and palpable gallbladder.
→ Mechanism: Tumor compresses bile duct → obstructive jaundice (Courvoisier’s sign).
8. Pancreatic Pseudocyst
A patient recovering from pancreatitis presents with an epigastric swelling.
→ Reason: Leakage of pancreatic juice forming fibrous-walled pseudocyst behind stomach.
9. Annular Pancreas
A newborn shows bilious vomiting.
→ Cause: Ventral pancreatic bud encircles duodenum → constriction → duodenal obstruction.
10. Pancreatic Pain Referred to Back
Due to pancreas lying retroperitoneally over T12–L1 vertebrae, pain radiates to back and left shoulder.
11. Cirrhosis of Liver
A chronic alcoholic presents with ascites and spider angiomas.
→ Explanation: Fibrosis leads to portal hypertension, collateral formation, and venous congestion.
12. Portal Hypertension
Patient shows distended abdominal veins radiating from the umbilicus (“Caput medusae”).
→ Cause: Blockage of portal venous flow due to cirrhosis.
→ Sites of portosystemic anastomoses: Lower esophagus, umbilicus, rectum, retroperitoneum.
13. Liver Trauma
A road accident victim with right hypochondrial injury shows internal bleeding.
→ Cause: Laceration of liver parenchyma → profuse hemorrhage due to dual blood supply.
14. Hepatomegaly in Congestive Cardiac Failure
→ Mechanism: Venous backflow causes congestion → tender, enlarged liver (“nutmeg liver”).
15. Liver Abscess
A patient with high fever and right upper quadrant tenderness.
→ Cause: Amoebic infection through portal vein; abscess in right lobe.
→ Referred pain: Right shoulder via phrenic nerve.
16. Gallstones and Jaundice
→ Pathway: Stone in cystic duct → obstructed bile flow → jaundice, pale stools, dark urine.
→ Pain location: Right hypochondrium, radiating to right shoulder.
17. Referred Pain to Right Shoulder
→ Reason: Liver, gallbladder, and diaphragm share sensory fibers of the right phrenic nerve (C3–C5).
18. Hepatic Carcinoma
A cirrhotic patient develops a firm nodular mass in right hypochondrium.
→ Spread: Commonly metastasizes via hepatic veins to lungs.
19. Portal Vein Thrombosis
Patient presents with splenomegaly and ascites but normal hepatic function tests.
→ Mechanism: Thrombosis before liver blocks portal inflow → prehepatic portal hypertension.
20. Neonatal Jaundice (Physiologic and Pathologic)
→ Cause: Immature hepatocytes fail to conjugate bilirubin efficiently.
→ Pathologic type: Hemolytic disease, biliary atresia, or intrahepatic infection.
These twenty scenarios together cover:
Spleen: trauma, ligaments, enlargement, accessory spleen.
Pancreas: inflammation, cancer, development, ductal anatomy.
Liver: portal hypertension, cirrhosis, referred pain, trauma, and jaundice.
1. Describe the spleen under the following headings:
a. Situation
b. Gross anatomy
c. Relations and functions
d. Clinical anatomy
2. Describe the pancreas under the following headings:
a. Parts
b. Ducts
c. Blood supply
d. Development
e. Clinical anatomy
3. Write short notes on:
a. Hilum of spleen and its contents
b. Head of pancreas
c. Bare area of liver
d. Relations of the inferior surface of liver
e. Porta hepatis
These questions test core structural and functional anatomy while integrating important clinical points such as:
Hilum of spleen and its vascular content (splenic artery and vein).
Head of pancreas (relations to duodenum and bile duct).
Bare area of liver (its surgical and clinical significance in infection spread).
Porta hepatis (arrangement of ducts, arteries, and veins — DAV mnemonic).
1. Blood supply of the liver is:
a. 80% arterial, 20% venous
b. 70% arterial, 30% venous
✅ c. 80% venous, 20% arterial
d. 60% arterial, 40% venous
Explanation:
About 80% of hepatic blood flow comes from the portal vein (venous) and 20% from the hepatic artery (arterial).
2. Accessory pancreatic duct is also called:
a. Wirsung duct
✅ b. Santorini duct
c. Henson’s duct
d. Hoffmann’s duct
Explanation:
The accessory pancreatic duct (duct of Santorini) drains into the minor duodenal papilla, while the main duct (Wirsung) opens into the major duodenal papilla.
3. The bare area of liver is:
a. Covered by visceral peritoneum
✅ b. A non-peritoneal area in contact with diaphragm
c. Occupied by falciform ligament
d. Found on inferior surface
Explanation:
The bare area lies on the posterior surface of the liver, devoid of peritoneum, and directly contacts the diaphragm.
4. The portal vein is formed by the union of:
a. Superior and inferior mesenteric veins
✅ b. Superior mesenteric vein and splenic vein
c. Splenic and left gastric veins
d. Inferior mesenteric and left gastric veins
Explanation:
The portal vein forms behind the neck of pancreas by the union of splenic vein and superior mesenteric vein.
5. The spleen is related posteriorly to which ribs?
a. 6th to 8th
b. 7th to 9th
✅ c. 9th to 11th
d. 10th to 12th
Explanation:
The spleen lies under cover of the 9th–11th ribs in the left hypochondrium.
6. Islets of Langerhans are maximum in:
a. Head of pancreas
b. Body of pancreas
✅ c. Tail of pancreas
d. Neck of pancreas
Explanation:
Endocrine tissue (Islets of Langerhans) is densest in the tail region of the pancreas.
7. Which structure passes through porta hepatis?
a. Hepatic veins
✅ b. Hepatic artery, portal vein, and bile ducts
c. Cystic duct only
d. Hepatic lymph nodes
Explanation:
The porta hepatis transmits:
Hepatic ducts (anterior),
Hepatic artery (middle),
Portal vein (posterior).
Mnemonic: DAV — Duct, Artery, Vein.
8. Which ligament prevents the spleen from descending downward?
a. Gastrosplenic
✅ b. Phrenicocolic ligament
c. Lienorenal ligament
d. Splenocolic ligament
Explanation:
The phrenicocolic ligament acts as a shelf supporting the spleen inferiorly.
9. The hepatic veins drain directly into:
✅ a. Inferior vena cava
b. Portal vein
c. Hepatic sinusoids
d. Hepatic artery
Explanation:
Three hepatic veins (right, middle, left) open directly into the inferior vena cava near the diaphragm.
10. The head of pancreas is related to which part of duodenum?
a. First part
b. Third part
✅ c. Second part
d. Fourth part
Explanation:
The head of pancreas lies in the C-shaped curve of the second part of duodenum.
1. Which of the following ligaments contains the tail of the pancreas?
a. Gastrosplenic ligament
✅ b. Lienorenal (splenorenal) ligament
c. Hepatoduodenal ligament
d. Phrenicocolic ligament
Explanation:
The tail of pancreas lies in the lienorenal ligament along with splenic vessels.
2. The spleen is derived from which embryonic layer?
a. Endoderm
b. Neural crest
✅ c. Mesoderm
d. Ectoderm
Explanation:
Unlike other abdominal viscera (endodermal origin), the spleen develops from mesenchymal condensation in the dorsal mesogastrium.
3. The hepatic segments are based on the branching pattern of:
a. Hepatic veins
b. Inferior vena cava
✅ c. Portal vein, hepatic artery, and bile ducts
d. Lymphatic drainage
Explanation:
Liver segmentation follows the distribution of the portal triad structures, not venous drainage alone.
4. The pancreatic duct opens with the bile duct into the duodenum at:
a. Minor duodenal papilla
✅ b. Major duodenal papilla
c. Ampulla of Vater only
d. Foramen of Winslow
Explanation:
The main pancreatic duct (Wirsung) and bile duct unite to form the hepatopancreatic ampulla (of Vater), which opens at the major duodenal papilla.
5. Which of the following is NOT a peritoneal ligament of the liver?
a. Falciform ligament
b. Coronary ligament
✅ c. Lienorenal ligament
d. Right triangular ligament
Explanation:
The lienorenal ligament belongs to the spleen, not the liver.
6. The chief cell type in pancreatic islets responsible for insulin secretion is:
a. Alpha cell
✅ b. Beta cell
c. Delta cell
d. PP cell
Explanation:
Beta cells (70% of islet cells) secrete insulin, which lowers blood glucose levels.
7. The bile duct passes through which surface of the head of pancreas?
a. Anterior
✅ b. Posterior
c. Superior
d. Inferior
Explanation:
The bile duct runs in a groove or canal on the posterior surface of the head of pancreas.
8. A stab wound in the 9th intercostal space in midaxillary line on left side is likely to injure:
✅ a. Spleen
b. Kidney
c. Pancreas
d. Stomach
Explanation:
The spleen lies between the 9th and 11th ribs along the 10th rib axis.
9. The ligamentum teres hepatis is a remnant of:
a. Umbilical vein
✅ b. Left umbilical vein
c. Ductus venosus
d. Umbilical artery
Explanation:
The ligamentum teres is the fibrosed remnant of the left umbilical vein carrying oxygenated blood from placenta to fetus.
10. The ligamentum venosum represents:
✅ a. Ductus venosus of the fetus
b. Umbilical vein
c. Right hepatic vein
d. Umbilical artery
Explanation:
The ductus venosus shunted blood from umbilical vein to inferior vena cava in the fetus; postnatally it becomes the ligamentum venosum.
11. Which lobe of the liver lies between inferior vena cava and ligamentum venosum?
a. Quadrate lobe
✅ b. Caudate lobe
c. Right lobe
d. Left lobe
Explanation:
The caudate lobe occupies this area on the posterior surface.
12. Which of the following veins drain directly into the inferior vena cava?
a. Splenic veins
✅ b. Hepatic veins
c. Portal veins
d. Superior mesenteric vein
Explanation:
The hepatic veins open directly into the inferior vena cava at the posterior surface of the liver.
13. Which is the most common site of referred pain in gallbladder disease?
✅ a. Right shoulder and tip of scapula
b. Left shoulder
c. Umbilicus
d. Suprapubic region
Explanation:
Gallbladder pain is referred via phrenic nerve (C3–C5) to the right shoulder tip.
14. The spleen enlarges in the following direction:
✅ a. Downward, forward, and medially
b. Upward and outward
c. Downward and backward
d. Horizontally
Explanation:
Due to its oblique orientation along the 10th rib, enlargement occurs downward and medially toward the umbilicus.
15. The hepatic veins lack:
a. Valves
b. Smooth muscle
✅ c. Both a and b
d. Endothelium
Explanation:
Hepatic veins are thin-walled and valveless, allowing free communication with the inferior vena cava.
16. The ligament connecting liver to anterior abdominal wall is:
✅ a. Falciform ligament
b. Coronary ligament
c. Lesser omentum
d. Hepatorenal ligament
17. The pancreatic head is supplied mainly by branches of:
✅ a. Gastroduodenal and superior mesenteric arteries
b. Splenic and inferior mesenteric arteries
c. Left gastric and celiac trunk
d. Right gastric and renal arteries
18. Which part of pancreas lies intraperitoneally?
a. Head
b. Body
✅ c. Tail
d. Uncinate process
19. Which peritoneal fold transmits the portal triad?
✅ a. Hepatoduodenal ligament
b. Gastrosplenic ligament
c. Lienorenal ligament
d. Falciform ligament
20. The chief function of bile is:
✅ a. Emulsification of fats
b. Protein digestion
c. Enzyme activation
d. Vitamin synthesis
These MCQs cover:
Structural anatomy (lobes, ligaments, ducts)
Embryological derivatives
Relations and applied anatomy
Blood and lymphatic supply
Common pathologies and referred pain
Q1. Where is the spleen situated?
In the left hypochondrium, along the axis of the 10th rib, between the fundus of stomach and diaphragm.
Q2. What is the peritoneal covering of spleen?
It is completely covered by peritoneum, except at the hilum.
Q3. What is the rule of 1×3×5×7×9×11?
The spleen measures 1 inch thick, 3 inches wide, 5 inches long, weighs 7 ounces, and lies between the 9th and 11th ribs.
Q4. What ligaments attach the spleen?
Gastrosplenic ligament – connects spleen to stomach.
Lienorenal ligament – connects spleen to left kidney.
Phrenicocolic ligament – supports spleen inferiorly.
Q5. Why does splenomegaly move obliquely downward?
Because the spleen lies obliquely along the 10th rib and its descent is limited by the phrenicocolic ligament.
Q6. What is an accessory spleen?
Small additional splenic nodules near the hilum or tail of pancreas, occurring in about 10% of individuals.
Q7. What is the most common cause of splenic rupture?
Blunt trauma to left upper abdomen or lower ribs causing subcapsular hematoma and rupture.
Q8. What is Kehr’s sign?
Pain referred to left shoulder due to diaphragmatic irritation from splenic rupture (phrenic nerve involvement).
Q9. What type of gland is the pancreas?
It is a mixed gland — exocrine (digestive enzymes) and endocrine (hormones like insulin).
Q10. Which part of pancreas is intraperitoneal?
Only the tail of pancreas; the rest is retroperitoneal.
Q11. Where does the main pancreatic duct open?
Into the major duodenal papilla with the bile duct via the ampulla of Vater.
Q12. What is the accessory pancreatic duct?
It is the duct of Santorini, which opens at the minor duodenal papilla.
Q13. What is the blood supply of pancreas?
Head: Superior and inferior pancreaticoduodenal arteries.
Body and tail: Branches from splenic artery.
Q14. Which part of pancreas contains maximum islets of Langerhans?
The tail of the pancreas.
Q15. What is the relation of bile duct to the head of pancreas?
It runs behind the head of pancreas.
Q16. What are the endocrine secretions of pancreas?
Insulin (β-cells)
Glucagon (α-cells)
Somatostatin (δ-cells)
Pancreatic polypeptide (PP cells)
Q17. What is the weight of the liver?
Approximately 1.5 kg in males and 1.3 kg in females.
Q18. What is the largest lobe of liver?
The right lobe.
Q19. What divides the anatomical lobes of liver?
The falciform ligament on anterior surface and ligamentum teres on inferior surface.
Q20. What divides the functional lobes of liver?
The plane of the gallbladder fossa and inferior vena cava (Cantlie’s line).
Q21. What is the bare area of liver?
A non-peritoneal area on the posterior surface, directly contacting the diaphragm.
Q22. What passes through porta hepatis?
Hepatic ducts (anterior)
Hepatic artery (middle)
Portal vein (posterior)
Mnemonic: DAV.
Q23. What forms the portal vein?
Union of splenic vein and superior mesenteric vein behind neck of pancreas.
Q24. Into which vessel do the hepatic veins drain?
Directly into the inferior vena cava.
Q25. What is ligamentum teres hepatis derived from?
From the left umbilical vein of the fetus.
Q26. What is ligamentum venosum derived from?
From the ductus venosus of the fetus.
Q27. Name the functional segments of liver.
Eight Couinaud segments, each with independent vascular inflow and biliary drainage.
Q28. What is the main function of bile?
Emulsification of fats to aid digestion and absorption.
Q29. Why is right shoulder pain seen in liver disease?
Due to phrenic nerve irritation (C3–C5) from diaphragmatic inflammation.
Q30. What are common causes of hepatomegaly?
Cirrhosis, congestive heart failure, infection (malaria, hepatitis), and malignancy.
Q31. What is Glisson’s capsule?
The fibroelastic capsule of the liver that sends septa between lobules.
Q32. What is the classic liver lobule?
A hexagonal structure with a central vein and six portal triads at its corners.
Q33. What are Kupffer cells?
Specialized phagocytic macrophages lining hepatic sinusoids.
Q34. What are the two pancreatic buds and what do they form?
Dorsal bud: Body, tail, and upper head.
Ventral bud: Uncinate process and lower head.
Q35. From which part of the foregut does the liver develop?
From the hepatic diverticulum of foregut endoderm.
Q36. What is Courvoisier’s law?
In obstructive jaundice due to carcinoma of head of pancreas, gallbladder is palpable; but not in stone obstruction due to fibrosis.
Q37. What is the difference between physiological and pathological jaundice?
Physiological – transient in newborns;
Pathological – due to bile duct obstruction, liver disease, or hemolysis.
Q38. What are portosystemic anastomoses?
Venous communications between portal and systemic veins at:
Lower esophagus
Umbilicus
Anal canal
Retroperitoneal areas
Q39. What is the surgical importance of the caudate lobe?
It drains directly into the inferior vena cava and functions independently from right and left lobes.
Q40. What is the surface marking for the lower border of the liver?
From the right 5th rib in midaxillary line to the left 5th intercostal space near the midclavicular line.
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