1.

A patient was diagnosed with bleeding ulcer of the lesser curvature

of the stomach. Which artery is most likely involved?
Gastroduodenal
Left gastric
Left gastro-omental (epiploic)
Right gastro-omental (epiploic)
Short gastrics
2. Which is a derivative of the dorsal mesogastrium?
Falciform ligament
Hepatoduodenal ligament
Hepatogastric ligament
Greater omentum
Lesser omentum
3. The spleen:
Develops in the dorsal mesogastrium
Develops in the ventral mesogastrium
Develops in both the dorsal and ventral mesogastria
Is always retroperitoneal
Becomes retroperitoneal during its development
4. During a full workup on a 2-month-old infant with a history of
intermittent gastrointestinal pain and vomiting, physicians
discovered that the cause was lack of emptying of the stomach.
They immediately suspected that the cause was a spasmodic
contraction of which of the following parts of the stomach?
cardiac notch
fundus
lesser curvature

pylorus
rugae
5. In order to do a vagotomy (section of vagal nerve trunks) to reduce
the secretion of acid by cells of the stomach mucosa in patients
with peptic ulcers, one needs to cut the gastric branches and retain
vagal innervation to other abdominal organs. Where would a
surgeon look for these branches in relation to the stomach?
along the gastroepiploic vessels
along the greater curvature
along the lesser curvature
in the base of the omental apron
in the gastrocolic ligament
6. While performing a splenectomy (removal of the spleen) following
an automobile accident, the surgeons were especially attentive to
locate and preserve the tail of the pancreas which is closely
associated with the spleen. This they found in the:
gastrocolic ligament
gastrosplenic ligament
phrenicocolic ligament
splenorenal ligament
transverse mesocolon
7. Which of the following structures does not lie at least partially in
the retroperitoneum?
adrenal gland
duodenum
kidney
pancreas
spleen

8. Which ligament is a derivative of the dorsal mesogastrium?
Coronary
Falciform
Hepatoduodenal
Hepatogastric
Gastrocolic
9. A 60-year-old male executive who had a history of a chronic
duodenal ulcer was admitted to the ER exhibiting signs of a severe
internal hemorrhage. He was quickly diagnosed with perforation of
the posterior wall of the first part of the duodenum and erosion of
an artery behind it by the gastric expellent. The artery is most likely
the:
Common hepatic
Gastroduodenal
Left gastric
Proper hepatic
Superior mesenteric
10. A twenty-year-old woman was broad-sided on the driver side
by an SUV and was taken to the hospital emergency room.
Examination showed low blood pressure and tenderness on the
left mid-axillary line. Also, a large swelling was felt protruding
downward and medially below the left costal margin. X-rays
revealed that her 9th and 10th ribs were fractured near their angles
on the left side. The abdominal organ most likely to be injured by
the fracture is:
Descending colon
Left kidney
Pancreas

Spleen
Stomach
11. You are observing an operation to remove the left suprarenal
gland. To expose the gland the surgeon mobilizes the descending
colon by cutting along its lateral attachment to the body wall and
dissecting medialward in the fusion fascia behind it. Suddenly the
operative field is filled with blood. The surgeon realizes he has
failed to cut a mesenteric attachment between the left colic flexure
and another organ. As a result of the traction, the surface of the
organ tore. Which organ was injured?
Duodenum
Kidney
Liver
Spleen
Suprarenal gland
12. A patient presented with a swollen spleen, which protruded
medially toward the umbilicus in the abdomen. A vertical and
downward expansion of the spleen was resisted by the:
Tail of the pancreas
Left colic flexure
Left kidney
Left renal artery
Stomach
13. During emergency surgery, it was found that a chronic
gastric ulcer had perforated the posterior wall of the stomach and
eroded a large artery running immediately posterior to the
stomach. The artery is the:
Gastroduodenal
Common hepatic

Left gastroepiploic
Splenic
Superior mesenteric
14. The spleen contacts all of the following organs EXCEPT:
Jejunum
Kidney
Left colic flexure
Tail of the pancreas
Stomach
15. Which is not a boundary of the epiploic (omental) foramen?
Aorta
Caudate lobe of the liver
First part of the duodenum
Hepatoduodenal ligament
16. In order to approach the area posterior to the stomach, a
surgeon decided to go through the lesser omentum. Before
incising the mesentery she was careful to find and preserve a
nerve lying in the upper portion of the hepatogastric ligament, i.e.,
the
Celiac branch of the anterior vagal trunk
Celiac branch of the posterior vagal trunk
Greater splanchnic branch to the right suprarenal gland
Hepatic branch of the anterior vagal trunk
Hepatic branch of the posterior vagal trunk
17. Which of the following is NOT in contact with the spleen?
Colon
Diaphragm

Duodenum
Pancreas
Stomach
18. The fundus of the stomach receives its arterial supply from
the:
Common hepatic
Inferior phrenic
Left gastroepiploic
Right gastric
Splenic
19. During an emergency splenectomy, the surgeon accidentally
tore the gastrosplenic ligament and its contents. The artery (ies)
likely to be damaged in this event is (are) the:
Left gastric
Splenic
Short gastric
Middle colic
Caudal pancreatic
20. While performing emergency surgery to control hemorrhage
brought on by arterial erosion caused by a duodenal ulcer,
surgeons ligated the badly damaged gastroduodenal artery near
its origin, which affected all of its branches as well. Assuming
"average anatomy", in which of the following arteries would blood
now flow in retrograde fashion (backwards) from collateral
sources?
Left hepatic
Right gastroepiploic
Short gastric

Left gastric
Omental branches

1. The correct answer is: left gastric
The left gastric artery is the artery that supplies the lesser curvature of
the stomach (along with the right gastric artery.) These two arteries
would be most likely to cause bleeding at the lesser curvature of the
stomach. The left gastric is one of the three arteries that comes off of the
celiac trunk. The left and right gastro-omental arteries are the two
arteries that supply the greater curvature of the stomach. The
gastroduodenal artery is a branch off the common hepatic artery that
supplies the duodenum, head of the pancreas, and the greater curvature
of the stomach. The short gastric arteries are 4 or 5 small arteries from
the splenic artery that supply the fundus of the stomach.

2. The correct answer is: greater omentum
During the development of the gut, there are two mesogastria attaching
to the developing stomach: the dorsal mesogastrium and the ventral
mesogastrium. Different organs begin to develop in each mesogastrium-
-the spleen and pancreas develop in the dorsal mesogastrium and the
liver develops in the ventral mesogastrium. So, the structures involving
the spleen and the posterior part of the developing stomach (which
becomes the greater curvature) are derived from the dorsal
mesogastrium. These include: the greater omentum (gastrophrenic
ligament, gastrosplenic ligament, gastrocolic ligament) and splenorenal
ligament. The structures involved with the liver and its attachment to the
stomach wall form the ventral mesogastrium. These include the lesser
omentum (hepatogastric ligament, hepatoduodenal ligament) and the
ligaments of the liver (falciform ligament, coronary ligaments, right and

left triangular ligaments). Of the answer choices, only the greater
omentum is part of the dorsal mesogastrium.

3. The correct answer is: develops in the dorsal mesogastrum
The spleen and pancreas develop behind the stomach in the dorsal
mesogastrium; the liver develops in the ventral mesogastrium. The
spleen is not a retroperitoneal organ--it is covered by visceral
peritoneum on all its surfaces.

4. The correct answer is: pylorus
Pyloric stenosis is a congenital disorder in which the pylorus is thickened
causing obstruction of the gastric outlet to the duodenum. This problem
is more commonly seen in males. Symptoms like projectile vomiting
appear several weeks after birth.

5. The correct answer is: splenorenal ligament
The splenorenal ligament is the peritoneal structure that connects the
spleen to the posterior abdominal wall over the left kidney. It also
contains the tail of the pancreas. The gastrocolic ligament connects the
greater curvature of the stomach with the transverse colon. The
gastrosplenic ligament connects the greater curvature of the stomach
with the hilum of the spleen. The phrenicolic ligament connects the
splenic flexure of the colon to the diaphragm. Finally, the transverse
mesocolon connects the transverse colon to the posterior abdominal
wall.


6. The correct answer is: splenorenal ligament
The splenorenal ligament is the peritoneal structure that connects the
spleen to the posterior abdominal wall over the left kidney. It also
contains the tail of the pancreas. The gastrocolic ligament connects the
greater curvature of the stomach with the transverse colon. The
gastrosplenic ligament connects the greater curvature of the stomach
with the hilum of the spleen. The phrenicolic ligament connects the
splenic flexure of the colon to the diaphragm. Finally, the transverse
mesocolon connects the transverse colon to the posterior abdominal
wall.

7. The correct answer is: spleen
The spleen is the only organ listed which is covered entirely by visceral
peritoneum. About the other organs... The kidney and suprarenal glands
are retroperitoneal organs. This is different than the secondarily
retroperitoneal organs that started out in a mesentery and then got
pushed against the posterior wall. The kidneys and the suprarenal
glands began developing in the retroperitoneum and stayed there. The
duodenum and pancreas are partially peritonealized and partially
retroperitoneal. The first two centimeters of the superior duodenum is
peritonealized, but the rest of the duodenum, until the duodenojejunal
junction, is retroperitoneal. For the most part, the pancreas is
secondarily retroperitoneal, although the tail of the pancreas is
peritonealized, lying within the splenorenal ligament.

8. The correct answer is: Gastrocolic
Structures involving the spleen and posterior part of the developing
stomach (which becomes the greater curvature) are derived from the
dorsal mesogastrium. This includes the gastrocolic ligament (including
the omental apron), gastrophrenic ligament, gastrosplenic ligament, and

the splenorenal ligament. The liver develops in the ventral
mesogastrium. This means that any structures involving the liver and its
attachment to the lesser curvature of the stomach or the body wall will
be derivatives of the ventral mesogastrium. This includes the coronary
ligament, the falciform ligament, the left and right triangular ligaments,
the hepatogastric ligament, and the hepatoduodenal ligament.

9. The correct answer is: Gastroduodenal
For a good understanding of this question, take a look at Netter Plate
290. The gastroduodenal artery is a branch of the common hepatic
artery; it descends behind the first part of the duodenum. So, if an ulcer
destroyed the posterior wall of the duodenum, gastric juices could
escape and destroy the gastroduodenal artery. The common hepatic
artery is a branch of the celiac trunk found superior to the duodenum.
The left gastric artery is a branch of the celiac trunk which supplies the
left side of the lesser curvature of the stomach. The proper hepatic
artery is a branch of the common hepatic artery; it travels superiorly from
the common hepatic artery to give off the right, middle, and left hepatic
arteries. Finally, the superior mesenteric artery originates from the aorta
at the bottom of the L1 level, posterior to the pancreas. It travels over the
3rd part of the duodenum and supplies the intestines, up to the last third
of the transverse colon.

10. The correct answer is: Spleen
The spleen is usually well protected by the 9th through 12th ribs on the
left side. But, if one or more of these ribs gets fractured, the spleen is the
first organ to be ruptured. The spleen can also be damaged if there is
blunt trauma to the abdomen or a sudden increase in intraabdominal
pressure. This patient has several symptoms of a ruptured spleen--she
has tenderness on the left posterior axillary line and hypotension.
(Because of its spongy parenchyma and thin capsule, a ruptured spleen
will bleed profusely and a patient may become hypotensive.) The

stomach, splenic flexure of the colon, tail of the pancreas, left kidney,
and suprarenal gland are in the same quadrant of the abdomen, and
they are also at risk for injury. But, you should remember that the spleen
is at greatest risk because of its close relationship with the 9th through
12th ribs.

11. The correct answer is: Spleen
The spleen is a peritonealized organ that is attached to the left colic
flexure. It could tear if there was too much traction while pulling the
descending colon away from the body wall. Another clue in this scenario
that points to a ruptured spleen is the large amount of blood that fills the
operative field. The spleen is covered by a very thin capsule, and it has
a soft and pulpy parenchyma. So, when it is ruptured, the spleen bleeds
profusely. The duodenum and liver are not associated with the left colic
flexure. The kidney and suprarenal glands are retroperitoneal organs
that are not associated with any mesenteric attachment.

12. The correct answer is: Left colic flexure
The left colic flexure, also called the splenic flexure, is the point where
the colon takes a sharp downward turn. This flexure is the point where
the transverse colon ends and the descending colon begins. It is located
immediately inferior to the spleen, so an enlarged spleen must move
medially to avoid this colic flexure. The stomach lies medial to the
speen, and the tail of the pancreas inserts into the hilum of the spleen.
These organs would not prevent the spleen from descending inferiorly.
The kidney and left renal artery are retroperitoneal organs; they would
not obstruct movement of the spleen.

13. The correct answer is: Splenic

Netter Plate 288 will help you to understand this answer. The splenic
artery is a branch of the celiac trunk. It passes deep to the stomach and
sends branches to the pancreas before reaching the spleen. If the
posterior wall of the stomach eroded, gastric juices could damage the
splenic artery. The gastroduodenal artery lies behind the first portion of
the duodenum. An ulcer in this portion of the duodenum might
jeopardize the gastroduodenal artery. The common hepatic artery is a
branch of the celiac trunk which runs superior to the lesser curvature of
the stomach. The left gastroepiploic artery runs on the left side of the
greater curvature of the stomach. Finally, the superior mesenteric artery
arises from the aorta at the L1 level, posterior to the pancreas. It crosses
over the third portion of the duodenum.

14. The correct answer is: jejunum
The spleen is not in contact with the jejunum. The jejunum lies medial
and inferior to the spleen. The kidney is in contact with the
posteromedial surface of the spleen. The left colic flexure is in contact
with the inferomedial surface of the spleen. The tail of the pancreas
touches the hilum of the spleen. The stomach is in contact with the
anteromedial surface of the spleen. See Netter Plate 289 for a picture of
the different impressions on the spleen.

15. The correct answer is: Aorta
The epiploic (omental) foramen is a passageway between the greater
peritoneal sac and the lesser peritoneal sac. It is located posterior to the
hepatoduodenal ligament and the first part of the duodenum. The
caudate lobe of the liver forms the posterior wall of the epiploic foramen.
The aorta is retroperiteoneal, and it does not form a boundary of this
foramen.


16. The correct answer is: Hepatic branch of the anterior vagal trunk
The hepatic branch of the anterior vagal trunk travels in the upper
portion of the hepatogastric ligament. The posterior vagal trunk supplies
a celiac branch deep to the hepatogastric ligament. The greater thoracic
splanchnic branches to the suprarenal glands come off the greater
thoracic splanchnic nerves as they pass through the diaphragm. Then,
the greater thoracic splanchnic nerves continue on to synapse in the
celiac ganglia.

17. The correct answer is: Duodenum
The duodenum is not in contact with the spleen. The inferior portion of
the spleen contacts the left colic flexure. The superior portion of the
spleen contacts the diaphragm--the spleen is convexly curved to fit the
concavity of the diaphragm. The tail of the pancreas inserts into the
hilum of the spleen. The stomach contacts the anteriomedial portion of
the spleen. You should really know what organs contact the spleen and
where these organs contact the spleen!

18. The correct answer is: Splenic
As it enters the hilum of the spleen, the splenic artery gives off short
gastric arteries which supply blood to the fundus of the stomach. These
short gastric arteries travel in the gastrosplenic ligament to reach the
fundus. The common hepatic artery does not directly supply the
stomach--it gives off the gastroduodenal artery, which supplies the right
portion of the greater curvature of the stomach with the right gastro-
omental artery. The inferior phrenic artery is a branch of the aorta which
supplies blood to the diaphragm. The left gastro-omental artery is a
branch of the splenic artery which supplies the left half of the greater
curvature. The right gastric artery is a branch of the proper hepatic artery

which supplies the right half of the lesser curvature. See Netter Plate
290 to get a good picture of these arteries and their areas of distribution.

19. The correct answer is: Short gastric
The short gastric arteries branch from the splenic artery near the hilum
of the spleen. They travel in the gastrosplenic ligament to supply the
fundus of the stomach. So, these arteries might be damaged if the
gastrosplenic ligament was disrupted. The left gastric artery is a branch
of the celiac trunk which supplies the left half of the lesser curvature.
The splenic artery travels deep to the stomach to reach the hilum of the
spleen. Although its branches travel in the gastrosplenic ligament, the
splenic artery passes within the splenorenal ligament to reach the
splenic hilum, and it would not be damaged by an incision in
gastrosplenic ligament. The middle colic artery is a branch of the
superior mesenteric artery which supplies the transverse colon. The
caudal pancreatic artery is a branch of the splenic artery which supplies
the tail of the pancreas. It, along with most of the pancreas, is
retroperitoneal.

20.
The correct answer is: right gastroepiploic
If the gastroduodenal artery and its branches were ligated, blood would
flow in a retrograde direction from the left gastroepiploic artery, which is
a branch of the splenic artery, to the right gastroepiploic artery, a ligated
branch of the gastroduodenal artery. This flow from the left to right
gastroepiploic artery would allow blood to reach the entire greater
curvature of the stomach. Remember--there are many anastomoses
around the stomach that will allow this organ to receive blood even if one
branch is ligated.

The left hepatic artery is a branch of the proper hepatic artery; it supplies
blood to the left and quadrate lobes of the liver, as well as part of the
caudate lobe. The short gastric arteries are branches of the splenic
artery which supply the fundus of the stomach. The left gastric artery is a
branch of the celiac trunk which supplies the left portion of the lesser
curvature. Omental branches are branches of the left and right
gastroomental arteries which supply the greater omentum.