Pancreas and Spleen — MCQs
CT scan of abdomen showing a structure branching within the liver. Identify the structure.
Exocrine pancreatic insufficiency is seen in:
Gastrosplenic ligament contains ?
Which structure is located immediately posterior to the head of the pancreas?
What is the most common infection that occurs after splenectomy?
Posterior relations of the head of the pancreas are all EXCEPT:
Which of the following structures is separated from the left kidney by a peritoneal layer?
Short gastric arteries are branches of which vessel?
Ligament which prevents the spleen from falling in left iliac fossa -
Which of the following structures is not related to the third part of the duodenum?
Pancreas and Spleen Indian Medical PG Practice Questions and MCQs
Question 1: CT scan of abdomen showing a structure branching within the liver. Identify the structure.
- A. Portal vein (Correct Answer)
- B. Superior vena cava
- C. Inferior vena cava
- D. Splenic vein
Explanation: ***Portal vein*** - The image shows a **branching vessel within the liver parenchyma**. The **portal vein** enters the liver at the porta hepatis and branches extensively to supply the liver with nutrient-rich, deoxygenated blood from the gastrointestinal tract. - On a CT scan, the portal vein and its branches appear as prominent, contrast-filled structures centrally located within the liver, consistent with the identified structure. *Superior Vena Cava* - The **superior vena cava** is located in the **chest**, superior to the diaphragm, and drains blood from the upper body into the right atrium; it does not branch within the liver. - This vessel would not be visible in an abdominal CT slice at this level and does not show intrahepatic branching. *Inferior Vena Cava* - The **inferior vena cava (IVC)** is a large vessel located **posterior to the liver**, collecting deoxygenated blood from the lower body and liver (via hepatic veins) before emptying into the right atrium. - While it is in the abdomen, it does not branch within the liver parenchyma in the same manner as the portal vein; rather, **hepatic veins** drain into it from the liver. *Splenic Vein* - The **splenic vein** runs along the **posterior aspect of the pancreas** and eventually joins with the superior mesenteric vein to form the portal vein outside the liver. - It does not enter or branch within the liver itself; its location is too far posterior and outside the liver to match the structure indicated.
Question 2: Exocrine pancreatic insufficiency is seen in:
- A. Shwachman-Diamond syndrome (Correct Answer)
- B. Rubinstein-Taybi syndrome
- C. Seckel syndrome
- D. Diamond-Blackfan syndrome
Explanation: ***Shwachman-Diamond syndrome*** - This syndrome is characterized by **exocrine pancreatic insufficiency**, neutropenia, skeletal abnormalities, and growth retardation. - The pancreatic insufficiency leads to **malabsorption** and **steatorrhea** due to insufficient production of digestive enzymes. *Rubinstein-Taybi syndrome* - This syndrome is characterized by broad thumbs and great toes, intellectual disability, and distinctive facial features, but not primarily by exocrine pancreatic insufficiency. - It is caused by mutations in the **CREBBP** or **EP300** genes, which are not directly involved in pancreatic function. *Seckel syndrome* - This is a rare genetic disorder characterized by **primordial dwarfism**, microcephaly, and intellectual disability. - While it affects growth and development, it is not typically associated with exocrine pancreatic insufficiency. *Diamond-Blackfan syndrome* - This syndrome primarily involves **pure red cell aplasia**, leading to severe anemia. - Although it can have various congenital anomalies, **exocrine pancreatic insufficiency** is not a characteristic feature of this condition.
Question 3: Gastrosplenic ligament contains ?
- A. Splenic vessels
- B. Tail of pancreas
- C. Short gastric artery (Correct Answer)
- D. Portal vein
Explanation: ***Short gastric artery*** - The **short gastric arteries** are branches of the **splenic artery** and supply the **fundus** and upper part of the **greater curvature** of the stomach. - These vessels travel within the **gastrosplenic ligament** (or gastrosplenic omentum), connecting the greater curvature of the stomach to the hilum of the spleen [1]. *Splenic vessels* - The **splenic artery** and **vein** primarily travel within the **splenorenal ligament** (or lienorenal ligament), connecting the spleen to the posterior abdominal wall. - These major vessels supply and drain the spleen itself, not typically running within the gastrosplenic ligament [1]. *Tail of pancreas* - The **tail of the pancreas** is typically located within the **splenorenal ligament**, closely associated with the **hilum of the spleen** [1]. - It does not extend into the gastrosplenic ligament, which connects the stomach to the spleen. *Portal vein* - The **portal vein** is a major vessel formed by the confluence of the **splenic vein** and **superior mesenteric vein**, and it is located in the **hepatoduodenal ligament** (part of the lesser omentum) along with the hepatic artery and common bile duct. - This vessel is far removed from the gastrosplenic ligament, which is situated between the stomach and spleen.
Question 4: Which structure is located immediately posterior to the head of the pancreas?
- A. Portal vein (Correct Answer)
- B. Splenic artery
- C. Inferior mesenteric vein
- D. Coeliac trunk
Explanation: ***Portal vein*** - The **portal vein** is formed by the union of the **splenic vein** and the **superior mesenteric vein** (SMV) posterior to the **neck** of the pancreas [1]. - It then runs in a **groove on the posterior surface** of the head of the pancreas, lying anterior to the **inferior vena cava** (IVC). - Among the given options, the portal vein has the most direct posterior relationship to the head of the pancreas. *Splenic artery* - The **splenic artery** runs along the **superior border** of the pancreas, following its body and tail. - It does not lie posterior to the head of the pancreas. - It is a branch of the **celiac trunk** and supplies the spleen. *Inferior mesenteric vein* - The **inferior mesenteric vein** typically drains into the **splenic vein** or the junction of the splenic and superior mesenteric veins. - It ascends **anterior** to the left kidney and does not lie immediately posterior to the head of the pancreas. *Coeliac trunk* - The **celiac trunk** originates from the **abdominal aorta** at the level of T12-L1 vertebra. - It lies **superior and anterior** to the pancreas, giving off the splenic artery, common hepatic artery, and left gastric artery. - It is not located posterior to the head of the pancreas.
Question 5: What is the most common infection that occurs after splenectomy?
- A. Pneumococcus (Correct Answer)
- B. Meningococcus
- C. Staphylococcus
- D. Corynebacterium
Explanation: ***Pneumococcus*** - Patients who have undergone a splenectomy are at significantly increased risk of developing **overwhelming post-splenectomy infection (OPSI)**, with *Streptococcus pneumoniae* (Pneumococcus) being the most common causative organism. - The spleen plays a crucial role in clearing **encapsulated bacteria**, and its absence leaves the individual vulnerable to these infections. *Meningococcus* - While *Neisseria meningitidis* (Meningococcus) is also an encapsulated bacterium and can cause severe infections in asplenic patients, it is **less common** than Pneumococcus as the primary cause of OPSI. - Vaccination against Meningococcus is recommended for splenectomized patients, but *Pneumococcus* remains the leading concern. *Staphylococcus* - *Staphylococcus* species, such as *Staphylococcus aureus*, are common causes of various infections but are generally **not encapsulated bacteria** in the same way *Streptococcus pneumoniae* is. - The spleen's primary role in clearing encapsulated organisms means that *Staphylococcus* infections are **not the most common or characteristic** post-splenectomy infection. *Corynebacterium* - *Corynebacterium* species are typically associated with infections like **diphtheria** or **opportunistic infections** in immunocompromised individuals. - They are **not encapsulated bacteria** and do not represent the most common encapsulated bacterial infection seen after splenectomy.
Question 6: Posterior relations of the head of the pancreas are all EXCEPT:
- A. Inferior vena cava
- B. Aorta
- C. Common bile duct
- D. First part of duodenum (Correct Answer)
Explanation: ***First part of duodenum*** - The **first part of the duodenum** is an **anterior relation** to the head of the pancreas, not a posterior one. - It lies in front of the superior part of the pancreatic head and the neck of the pancreas. - The head of the pancreas sits within the C-shaped curve of the duodenum, with the first part crossing anteriorly. *Inferior vena cava* - The **inferior vena cava (IVC)** lies directly **posterior** to the head of the pancreas. - This close anatomical relationship explains why pancreatic tumors can compress or invade the IVC. - Important surgical landmark during pancreaticoduodenectomy. *Aorta* - The **aorta** is situated **posterior** to the head of the pancreas, specifically behind the uncinate process and body. - The **left renal vein** crosses between the aorta and the superior mesenteric artery, also lying posterior to the pancreatic head. - Critical relationship for vascular assessment in pancreatic pathology. *Common bile duct* - The **common bile duct** runs in a **groove on the posterior surface** of the head of the pancreas or is embedded within its substance. - It descends posterior to the first part of the duodenum and through/behind the pancreatic head before entering the second part of the duodenum at the ampulla of Vater. - While intimately related to the pancreatic head, it runs in the **posterior aspect**, making it a posterior relation.
Question 7: Which of the following structures is separated from the left kidney by a peritoneal layer?
- A. Pancreas
- B. Jejunum (Correct Answer)
- C. Splenic flexure
- D. Splenic vessels
Explanation: ***Jejunum*** - The **jejunum**, being part of the intraperitoneal small intestine, is separated from the left kidney by a layer of **peritoneum** as it lies anterior to the kidney. - While the left kidney is retroperitoneal, the jejunum is intraperitoneal and separated by the **peritoneum** that lines the posterior abdominal wall. - This is the **most consistent and complete peritoneal separation** among the options. *Pancreas* - The **pancreas** (tail and body) lies anterior to the left kidney and is **retroperitoneal** [1]. - It is not separated from the left kidney by a peritoneal layer; instead, it is situated in the **anterior pararenal space** along with the kidney [1]. - Only the anterior surface of the pancreas is covered by peritoneum. *Splenic flexure* - While the **splenic flexure** is intraperitoneal and technically has peritoneum between it and the kidney, it often has **direct contact** with the kidney's lower pole via peritoneal reflections [2]. - The **phrenicocolic ligament** creates a shelf-like structure that can bring the splenic flexure into close proximity with the kidney. - The peritoneal separation is **less consistent** compared to the jejunum, making it a less ideal answer. *Splenic vessels* - The **splenic vessels** (artery and vein) run along the superior border of the pancreas, anterior to the left kidney, within the **retroperitoneal space** [1]. - These vessels are located in the **anterior pararenal space** and are not separated from the kidney by peritoneum [1].
Question 8: Short gastric arteries are branches of which vessel?
- A. Celiac artery
- B. Splenic artery (Correct Answer)
- C. Left gastroepiploic artery
- D. Right gastroepiploic artery
Explanation: Splenic artery - The **short gastric arteries** originate directly from the terminal portion of the **splenic artery** near the splenic hilum. - They supply the superior part of the **greater curvature** of the stomach. *Celiac artery* - The **celiac artery** is the main trunk from which the splenic artery, common hepatic artery, and left gastric artery branch. - It does not directly give rise to the short gastric arteries. *Left gastroepiploic artery* - The **left gastroepiploic artery** is a branch of the **splenic artery** but does not give rise to the short gastric arteries. - It supplies the greater curvature of the stomach, traveling inferiorly. *Right gastroepiploic artery* - The **right gastroepiploic artery** is a branch of the **gastroduodenal artery**, which in turn comes from the common hepatic artery. - It supplies the greater curvature of the stomach from the right side and is unrelated to the short gastric arteries.
Question 9: Ligament which prevents the spleen from falling in left iliac fossa -
- A. Phrenicocolic ligament (Correct Answer)
- B. Lienorenal ligament
- C. Upper pole of right kidney
- D. Sigmoid colon
Explanation: ***Phrenicocolic ligament*** - The **phrenicocolic ligament** is a fold of peritoneum that extends from the left colic flexure to the diaphragm, under the spleen. - It forms a shelf that **supports the spleen** and prevents it from descending into the left iliac fossa. *Lienorenal ligament* - The **lienorenal (splenorenal) ligament** connects the hilum of the spleen to the posterior abdominal wall (specifically over the left kidney) [1]. - While it helps to anchor the spleen, its primary role is not preventing caudal displacement, but rather containing the **splenic artery and vein** and the tail of the pancreas [1]. *Upper pole of right kidney* - The **right kidney** is located on the opposite side of the abdominal cavity from the spleen. - It plays no role in supporting the spleen or preventing its descent. *Sigmoid colon* - The **sigmoid colon** is a part of the large intestine located in the left lower quadrant of the abdomen and pelvis. - It is situated far below the spleen and has no direct anatomical connection or supporting role for the spleen.
Question 10: Which of the following structures is not related to the third part of the duodenum?
- A. Superior mesenteric vessels
- B. Right ureter
- C. Head of pancreas
- D. Quadrate lobe of liver (Correct Answer)
Explanation: ***Quadrate lobe of liver*** - The **quadrate lobe of the liver** is located on the visceral surface of the liver, bounded by the gallbladder fossa, ligamentum teres, and porta hepatis. [1] - It is anatomically related to the **first part of the duodenum** and the pylorus, but has **no direct relationship** with the retroperitoneal **third part of the duodenum**, which lies at the L3 vertebral level. [2] - The third part of the duodenum is too inferior and posterior to have any relationship with the quadrate lobe. *Superior mesenteric vessels* - The **superior mesenteric artery** and **vein** cross **anteriorly** to the **third part of the duodenum** as it runs horizontally from right to left. - The duodenum passes between the aorta posteriorly and the superior mesenteric vessels anteriorly, creating a potential site for compression (**superior mesenteric artery syndrome**). *Right ureter* - The **right ureter** is a **posterior relation** of the **third part of the duodenum**, as both structures are retroperitoneal. [2] - The ureter descends on the psoas major muscle, passing behind the third part of the duodenum during its course toward the pelvis. *Head of pancreas* - The **head of pancreas**, specifically the **uncinate process**, lies **superior and posterior** to the **third part of the duodenum**. - The uncinate process hooks around posteriorly to the superior mesenteric vessels and has an intimate relationship with the third part of the duodenum.
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