USMLE Step 1 Review 04 14 Anatomy Pancreas

USMLE Step 1 Review 04 14 Anatomy Pancreas

 

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Let’s continue our USMLE Review with Anatomy from the Gold Standard USMLE Step 1 Audio Review program.

Play USMLE Audio MP3 04 14 Anatomy Pancreas Below

 

Begin 04 14 Anatomy Pancreas Transcription

Let’s go back to the pancreas.

What is the pancreas’s relationship to the peritoneum?

  • It is retroperitoneal.

What organ does the neck, body, and tail of the pancreas lie deep to?

  • The stomach.

Two general categories of glands are in the pancreas?

  • Exocrine and endocrine.

About what volume of an alkaline mixture of enzymes do the exocrine glands pour into the duodenum every 24 hours?

  • About two liters.

What is the name of the main duct going down the length of the pancreas from the tail all the way through the head to the common bile duct, which carries the pancreatic secretions?

  • The principal pancreatic duct.

And what’s the other name for it?

  • The duct of Wirsung. Sometimes a smaller duct comes off superiorly and goes to the duodenum by itself.

What is this called?

  • The accessory pancreatic duct.

And what’s the other name?

  • Duct of Santorini.

Now the head of the pancreas is enclosed by what curve?

  • The inside curve of the duodenum. The head of the pancreas itself curves around two structures.

What are they?

  • The superior mesenteric artery and vein.

What branches come off the superior mesenteric artery and vein just after they emerge under the neck of the pancreas?

  • The middle colic artery and vein.

And the part of the head of the pancreas that wraps down under the superior mesenteric artery and vein is called what?

  • The uncinate process of the pancreas.

Or what’s the other name?

  • The lingula of the pancreas.

Which part of the pancreas bulges upward into the omental bursa toward the lesser omentum?

  • The omental tuber of the body.

Because the pancreas is only loosely connected to the posterior wall of the trunk what causes it to move?

  • Respiration.

Not talking about the peritoneum, what is the pancreas covered by?

  • Connective tissue.

And what is the pancreas divided into?

  • Lobules.

By what structure is the tail of the pancreas secured?

  • By the splenorenal ligament.

And what peritoneal structure runs over the head of the pancreas along the anterior head of the pancreas?

  • The transverse mesocolon. Thus the anterior surface of the pancreas is divided into two parts.

Where does the upper part lie?

  • Within the posterior wall of the omental bursa.

And where does the inferior part lie?

  • It faces the free abdominal cavity.

In either case what is the relationship of the upper and lower parts of the anterior face of the pancreas to the peritoneum?

  • They are both retroperitoneal.

Now the transverse mesocolon runs down the length of the pancreas and on the right what marks the end of the run of the origin of the transverse mesocolon?

  • The descending portion of the duodenum where it cuts across all the way to the right aspect of the descending portion.

What other root of a peritoneal structure cuts across a portion of the pancreas and intersects the root of the transverse mesocolon?

  • The root of the mesentery.

And where do these two intersect, the root of mesentery and the root of the transverse mesocolon?

  • Where the superior mesenteric artery and vein come out from underneath the pancreas above the lingula below and the neck above.

And what structure lies just lateral to the left of this?

  • The duodenojejunal flexure.

Remembering the kinds of glands that the salivary glands divided into, what type of gland is the pancreas?

  • It is a purely serous gland.

In terms of which the manner in which the pancreatic serous glands secrete, how are they different from the salivary glands?

  • The pancreatic serous glands have no myoepithelial.

And their secretions therefore is determined by?

  • Fluid pressure.

And what kind of structure is the first part of the pancreatic serous glands?

  • Acini.

And what are the two parts of the way the excretory ducts are arranged?

  • Long intercalated ducts.

Which lead into?

  • Major excretory ducts.

What four types of digestive enzymes are produced by the exocrine cells, the serous glands of the pancreas?

  • Lipases, amylases, peptidases, and nucleases.

Now the ductal cells of the pancreatic glands secrete about how much pancreatic juice everyday?

  • 1200 to 1500 milliliters.

Containing a high concentration of what?

  • Bicarbonate.

And the purpose of the bicarbonate?

  • To neutralize the gastric acid in the duodenum.

In what form are the pancreatic proteases secreted?

  • In their inactive, zymogen form.

And what are these two zymogens?

  • Trypsinogen, chymotrypsinogen.

And what converts trypsinogen to trypsin?

  • Enterokinase.

Also called?

  • Enteropeptidase.

And what else can convert trypsinogen to trypsin?

  • Trypsin itself.

And what converts the chymotrypsinogens to chymotrypsins?

  • Trypsin.

And what is secreted at the same time as these pancreatic pro-enzymes that protects the pancreas from autodigestion?

  • Trypsin inhibitor.

The pancreatic lipases are secreted in what three active forms?

  • Lipase, cholesterol lipase, phospholipase.

Now the enzymes that hydrolyze water-insoluble esters require what else to work?

  • Bile salts.

****END OF TRANSCRIPTION****

 

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