Liver, Biliary, Pancreas, Spleen

1.A 43-year-old fair lady reported to surgery outpatient department with a history of intense pain in the upper-right side of the abdomen, often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes to several hours. She also had pain between the shoulder blades or below the right shoulder. She could correlate the attacks often occurred after a particularly fatty meal and almost always happen at night. Other symptoms included abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion. On examination, Murphy’s sign was positive liver function tests were mildly abnormal. Ultrasound revealed presence of stones in gall bladder.  What is murphy’s sign.  Gross anatomy of extrahepatic biliary apparatus with neat labelled diagram.  Arterial supply of extrahepatic biliary apparatus.  Histology of gall bladder with neat labelled diagram.  Relations of the inferior surface of liver

2.A 30-year-old man came with history of upper abdominal pain and vomiting. On examination tenderness in the epigastric region was noted.

• a) Which is the organ involved
• b) Write about the external features of the organ
• c) Write about the peritoneal and visceral relations of the organ
• d) Write on the blood supply of the organ

3.Describe the pancreas under following headings: • Situation and parts. • Relations. • Duct system. • Blood supply. • Lymphatic drainage. • Development

4.A 55-year-old male presented to the casuality with vomiting of blood. On clinical examination there was an enlarged organ in his right hypochondrium. Also delated veins were visible in the umbilical region. With your knowledge in anatomy answer the following questions  Name the organ enlarged  What could be the reason for vomiting of blood and delated veins in umbilical region.  Give the important relations of the organ  Give the blood supply of the organ  Microscopic structure of the organ

5.A 50 years old man came to the casualty with complaints of pain in the abdomen. Diagnostic tests revealed abnormal liver function tests. Answer the following:  extent and parts of liver  relations  peritoneal reflections  blood supply  applied aspects

6.A 65-year old man presented with dilated veins around the umbilicus and vague pain in the epigastric region. He also had a history of bleeding per rectum. Radiological examination revealed an abnormal growth of the ‘head and neck’ of the pancreas. Based on your anatomical knowledge answer the following questions. • Name the structure that would have been compressed by the pancreatic growth to cause the clinical findings. • Give the formation, course, relations and termination of the structure. • Name all the possible sites, where there could be dilated veins, giving the names of the veins involved with reasons and clinical implications • What are the other structures that are likely to be compressed by the growth • Mention the sources of development of the pancreas

1.Describe pancreas under the following headings: Development, blood supply and ducts of pancreas

2.Describe the gross features and relations of components of extrahepatic biliary apparatus

3.Spleen – surfaces, relations and blood supply

4.Pancreas – parts, relations and blood supply

5.Extra hepatic biliary apparatus

1.Porta hepatis

2.Spleen-gross anatomy, relations , development and applied anatomy

1.Visceral surface of liver

2.Two true ligaments of liver

3.Name the fissures of liver

4.Bile duct

1.Classic liver lobules are described as hexagonal prisms that surround which of the following anatomic structures

• a) Central vein
• b) Hepatic artery
• c) Portal triad
• d) Portal vein

2.All the following arteries supply the pancreas EXCEPT

• a) Superior pancreaticoduodenal artery
• b) Inferior pancreaticoduodenal artery
• c) Splenic artery
• d) Left gastric artery

3.Crypts of Lieberkuhn are present in

• a) Stomach
• b) Liver
• c) Small intestine
• d) Pancreas

4.Jaundice in this boy is due to obstruction of

• a) Common bile duct
• b) Major pancreatic duct
• c) Common hepatic duct
• d) Cystic duct

5.Tail of the pancreas lies in the

• a) Gastrosplenic ligament
• b) Lienorenal ligament
• c) Gastrophrenic ligament
• d) Transverse mesocolon

6.The part of pancreas developing from the ventral pancreatic bud

• a) Tuber omentale
• b) Upper part of head of pancreas
• c) Uncinate process
• d) Tail of pancreas