Celiac Trunk SA
1) A patient presenting with jaundice and epigastric pain is diagnosed with pancreatic cancer. Which of the following structures has most likely become compressed by the tumor? A. Bile duct+ B. Common hepatic duct C. Left hepatic duct D. Right hepatic duct E. Cystic duct
1) A patient presenting with jaundice and epigastric pain is diagnosed with pancreatic cancer. Which of the following structures has most likely become compressed by the tumor? A. Bile duct (CORRECT! because 1) backup of bile causes jaundice due to increased levels of bilirubin in the blood; 2) we will learn tomorrow that pain from liver/biliary duct pathology typically refers to the epigastric region of the abdomen; and 3) as the bile duct descends towards the 2nd part of the duodenum to deliver its contents at the major duodenal papilla it comes into direct contact with the head of the pancreas, which is nestled within the "C" shaped formed by the duodenum) B. Common hepatic duct (incorrect - the common hepatic duct is likely situated too far superior to the pancreas to be compressed by a pancreatic tumor) C. Left hepatic duct (incorrect - the left hepatic duct is situated too far superior to the pancreas to be compressed by a pancreatic tumor) D. Right hepatic duct (incorrect - the right hepatic duct is situated too far superior to the pancreas to be compressed by a pancreatic tumor) E. Cystic duct (incorrect - the cystic duct is situated too far superior to the pancreas to be compressed by a pancreatic tumor AND while cystic duct blockage would likely lead to cholecystitis (inflammation of the gallbladder) and induce pain in the epigastric region, it should not lead to jaundice as bile would still be able to flow freely from the liver to the duodenum)
10) A 55-year-old male patient who has been diagnosed with pancreatic cancer presents with jaundice, likely due to the compression/obstruction of the bile duct. Based on this finding, you suspect that the tumor is located in which portion of the pancreas? A. Head B. Body C. Tail D. Uncinate process
10) A 55-year-old male patient who has been diagnosed with pancreatic cancer presents with jaundice, likely due to the compression/obstruction of the bile duct. Based on this finding, you suspect that the tumor is located in which portion of the pancreas? A. Head (CORRECT! The head of the pancreas is situated in close proximity to the bile duct) B. Body (incorrect - the body is not situated immediately adjacent to the bile duct) C. Tail (incorrect - the tail extends to and makes contact with the spleen in the LUQ—which is far away from the bile duct) D. Uncinate process (incorrect - this portion of the pancreas is tucked behind the superior mesenteric vessels)
11) Predict the potential consequences of a gallstone becoming lodged within the hepatopancreatic ampulla A. pancreatitis (inflammation of the pancreas) B. a reflux of bile into the main pancreatic duct C. jaundice due to excess levels of bilirubin in the blood D. a backup of pancreatic digestive enzymes E. all of the above
11) Predict the potential consequences of a gallstone becoming lodged within the hepatopancreatic ampulla A. pancreatitis (inflammation of the pancreas) (correct - answers B and D would both lead to pancreatitis) B. a reflux of bile into the main pancreatic duct (correct - a stone lodged in the ampulla would impede bile from being delivered to the duodenum, and a reflux of bile into the main pancreatic duct could indeed occur) C. jaundice due to excess levels of bilirubin in the blood (correct - a stone lodged in the ampulla would impede bile from being delivered to the duodenum, thus causing its backup and subsequent jaundice) D. a backup of pancreatic digestive enzymes (correct - a stone lodged in the ampulla would impede pancreatic digestive enzymes from being delivered to the duodenum, thus causing its backup and subsequent inflammation of the pancreas) E. all of the above (CORRECT!)
12) Predict the potential consequences of a gallstone becoming lodged within the cystic duct A. pancreatitis (inflammation of the pancreas) B. cholecystitis (inflammation of the gallbladder) C. jaundice due to excess levels of bilirubin in the blood D. a backup of pancreatic digestive enzymes E. all of the above
12) Predict the potential consequences of a gallstone becoming lodged within the cystic duct A. pancreatitis (inflammation of the pancreas) (incorrect - this should not directly affect the pancreas) B. cholecystitis (inflammation of the gallbladder) (CORRECT! A gallstone that becomes lodged in the cystic duct will block the flow of bile to and from the gallbladder, thus resulting in inflammation of the gallbladder. In this situation, the bile already present in the gallbladder would remain in the gallbladder, while the bile produced by the liver (and not yet needed by the gut) would not be able to enter the gallbladder to be stored but would still be able to make its way to the duodenum C. jaundice due to excess levels of bilirubin in the blood (incorrect - this should not cause jaundice because the flow of bile in the common hepatic and bile ducts would not be impeded and thus bile could still flow freely to the duodenum) D. a backup of pancreatic digestive enzymes (incorrect - this should not directly affect the pancreas) E. all of the above
13) A 55 year-old male with a history of duodenal ulcers was brought in for emergency surgery to control for severe hemorrhage into the peritoneal cavity. The surgeons found that an ulcer had perforated the posterior wall of the 1st part of the duodenum, resulting in the erosion of a vessel passing behind it. Which of the following vessels is the most likely source of the hemorrhage? A. Gastroduodenal a. B. Left gastric a. C. Left gastro-omental a. D. Splenic a. E. Right gastric a.
13) A 55 year-old male with a history of duodenal ulcers was brought in for emergency surgery to control for severe hemorrhage into the peritoneal cavity. The surgeons found that an ulcer had perforated the posterior wall of the 1st part of the duodenum, resulting in the erosion of a vessel passing behind it. Which of the following vessels is the most likely source of the hemorrhage? A. Gastroduodenal a. (CORRECT! remember that upon branching from the common hepatic a., the gastroduodenal a. descends in the region just posterior to the first part of the duodenum) B. Left gastric a. (incorrect - this artery courses along the left aspect of the lesser curvature of the stomach) C. Left gastro-omental a. (incorrect - this artery courses along the left aspect of the greater curvature of the stomach) D. Splenic a. (incorrect - this artery courses immediately posterior to the stomach and lesser omentum) E. Right gastric a. (incorrect - this artery courses along the right aspect of the lesser curvature of the stomach)
14) Emergency surgery was performed and the above vessel (answer to question #13) was ligated near its point of origin in order to stop the bleeding. Which of the following organs could potentially be affected by this ligation? A. liver B. jejunum C. gallbladder D. pancreas E. spleen
14) Emergency surgery was performed and the above vessel (answer to question #13) was ligated near its point of origin in order to stop the bleeding. Which of the following organs could potentially be affected by this ligation? A. liver (incorrect - the gastroduodenal a. does not supply the liver; rather, it is supplied by the common/proper/left/right hepatic aa.) B. jejunum (incorrect - the gastroduodenal a. does not supply the jejunum; rather, it is supplied by branches of the SMA) C. gallbladder (incorrect - the gastroduodenal a. does not supply the gallbladder; rather, it is supplied by the cystic a. branch of the right hepatic a.) D. pancreas (CORRECT! remember that the superior pancreaticoduodenal branches of the gastroduodenal a. supply a portion of the pancreas) E. spleen (incorrect - the gastroduodenal a. does not supply the spleen; rather, it is supplied by branches of the splenic a.)
15) Based on your knowledge of the anastomotic networks associated with the abdominal viscera, which of the following arteries represents a potential source of collateral circulation to the (regions of the) organs supplied by the gastroduodenal a.? A. superior mesenteric a. B. splenic a. C. left gastric a. D. A and B above E. all of the above
15) Based on your knowledge of the anastomotic networks associated with the abdominal viscera, which of the following arteries represents a potential source of collateral circulation to the (regions of the) organs supplied by the gastroduodenal a.? A. superior mesenteric a. (correct - the inferior pancreaticoduodenal branches of the SMA anastomose with the superior pancreaticoduodenal branches of the gastroduodenal a. and can thus provide a collateral source of blood supply) B. splenic a. (correct - the left gastroomental branch of the splenic a. anastomoses with the right gastroomental branch of the gastroduodenal a. and can thus provide a collateral source of blood supply)) C. left gastric a. (incorrect - the left gastric a. does supply the stomach, but it supplies the lesser curvature region, which is not part of the territory of the gastroduodenal a.) D. A and B above (CORRECT!) E. all of the above
16) You suspect that a patient with a history of chronic alcoholism and a confirmed diagnosis of cirrhosis of the liver is suffering from portal hypertension (increased pressure in the hepatic portal system). Which of the following might you expect to find upon examining the patient. A. esophageal varices B. internal hemorrhoids C. caput medusae D. all of the above E. none of the above
16) You suspect that a patient with a history of chronic alcoholism and a confirmed diagnosis of cirrhosis of the liver is suffering from portal hypertension (increased pressure in the hepatic portal system). Which of the following might you expect to find upon examining the patient. A. esophageal varices B. internal hemorrhoids C. caput medusae D. all of the above (CORRECT! all of these are manifestations of portal hypertension-induced dilation of veins situated at sites of portacaval anastomosis) E. none of the above
17) What is the most likely location that inflammatory fluid originating in the lesser sac would pool in an individual that is in a supine position? A. Hepatorenal recess B. Left paracolic gutter C. Vesicouterine pouch D. Subphrenic recess E. None of the above
17) What is the most likely location that inflammatory fluid originating in the lesser sac would pool in an individual that is in a supine position? A. Hepatorenal recess (CORRECT! recall that the hepatorenal recess is the part of the greater peritoneal sac situated immediately adjacent to the omental foramen (the opening of the lesser sac into the greater sac) AND that it is the lowest portion of the peritoneal cavity in an individual that is lying down on his/her back - for these reasons, the inflammatory fluid would naturally pool in this region) B. Left paracolic gutter C. Vesicouterine pouch D. Subphrenic recess E. None of the above
18) In the event that this individual transitions from a supine to upright position, what would the most likely route/path of inflammatory fluid flow be in a MALE? A. Left paracolic gutter à Rectovesical pouch B. Left paracolic gutter à Rectouterine pouch C. Right paracolic gutter à Rectovesical pouch D. Right paracolic gutter à Rectouterine pouch E. Right paracolic gutter à omental bursa
18) In the event that this individual transitions from a supine to upright position, what would the most likely route/path of inflammatory fluid flow be in a MALE? A. Left paracolic gutter à Rectovesical pouch B. Left paracolic gutter à Rectouterine pouch C. Right paracolic gutter à Rectovesical pouch (CORRECT! the superior aspect of the right paracolic gutter is situated adjacent to the hepatorenal pouch and would transmit fluid down into the pelvis where it would settle in the rectovesical pouch. The rectovesical pouch, which is formed as the peritoneum extends anteriorly from the rectum to cover a portion of the urinary bladder, is the inferior-most recess of the MALE peritoneal cavity in an upright position) D. Right paracolic gutter à Rectouterine pouch E. Right paracolic gutter à omental bursa
19) In the event that this individual transitions from a supine to upright position, what would the most likely route/path of inflammatory fluid flow be in a FEMALE? A. Left paracolic gutter à Rectovesical pouch B. Left paracolic gutter à Rectouterine pouch C. Right paracolic gutter à Rectovesical pouch D. Right paracolic gutter à Rectouterine pouch E. Right paracolic gutter à Vesicouterine pouch
19) In the event that this individual transitions from a supine to upright position, what would the most likely route/path of inflammatory fluid flow be in a FEMALE? A. Left paracolic gutter à Rectovesical pouch B. Left paracolic gutter à Rectouterine pouch C. Right paracolic gutter à Rectovesical pouch D. Right paracolic gutter à Rectouterine pouch (CORRECT! the superior aspect of the right paracolic gutter is situated adjacent to the hepatorenal pouch and would transmit fluid down into the pelvis where it would settle in the rectouterine pouch (which is formed as the peritoneum extends anteriorly from the rectum to cover a portion of the uterus) -- the inferiormost recess of the FEMALE peritoneal cavity in an upright position) E. Right paracolic gutter à Vesicouterine pouch
2) As a result of the branching pattern of the common hepatic artery, a drop of blood coursing within it (under normal, nonpathological conditions) could potentially reach all of the following organs, EXCEPT for the: A. Pancreas B. Spleen C. Gallbladder D. Stomach E. Duodenum
2) As a result of the branching pattern of the common hepatic artery, a drop of blood coursing within it (under normal, nonpathological conditions) could potentially reach all of the following organs, EXCEPT for the: A. Pancreas (incorrect - the superior pancreaticoduodenal aa. arise from the gastroduodenal a., which is a branch of the common hepatic a.) B. Spleen (CORRECT! Under normal conditions, the spleen receives blood supply from the splenic a. only) C. Gallbladder (incorrect - the cystic a. arises from the right hepatic a., which branches from the hepatic artery proper, which is a continuation of the common hepatic artery after it has given rise to its gastric and gastroduodenal branches) D. Stomach (incorrect - the right gastric a. is a direct branch of the common hepatic a., while the right gastroomental a. is the continuation of the gastroduodenal a. ., which is a branch of the common hepatic a.)) E. Duodenum (incorrect - the superior pancreaticoduodenal aa. branch from the gastroduodenal a., which is a branch of the common hepatic a.)
20) Which of the following statements is INCORRECT? A. The splenic artery courses within the splenorenal ligament B. The cystic artery passes through the cystohepatic triangle of Calot C. The bile duct courses within the hepatoduodenal ligament D. The hepatic artery proper courses within the hepatoduodenal ligament E. The inferior vena cava courses within the hepatoduodenal ligament
20) Which of the following statements is INCORRECT? A. The splenic artery courses within the splenorenal ligament (this is a correct anatomical description/relationship) B. The cystic artery passes through the cystohepatic triangle of Calot (this is a correct anatomical description/relationship) C. The bile duct courses within the hepatoduodenal ligament (this is a correct anatomical description/relationship) D. The hepatic artery proper courses within the hepatoduodenal ligament (this is a correct anatomical description/relationship) E. The inferior vena cava courses within the hepatoduodenal ligament (CORRECT! this statement is incorrect—the vein that courses in the hepatoduodenal ligament is the hepatic portal vein, not the IVC)
21) All of the following structures are considered to be intraperitoneal, EXCEPT for the? A. 3rd part of the duodenum B. spleen C. liver D. stomach E. jejunum
21) All of the following structures are considered to be intraperitoneal, EXCEPT for the? A. 3rd part of the duodenum (CORRECT! remember that while the 1st part of the duodenum is intraperitoneal, the remaining portions (2nd, 3rd and 4th parts) are situated behind the peritoneum) B. spleen (incorrect - this is an intraperitoneal organ) C. liver (incorrect - this is an intraperitoneal organ) D. stomach (incorrect - this is an intraperitoneal organ) E. jejunum (incorrect - this is an intraperitoneal organ)
22) The ________________________ prevents inflammatory fluid that has collected within the region of the spleen from flowing through the ________________________ down into the pelvic region. A. Gastrophrenic ligament; right paracolic gutter B. Gastrosplenic ligament; left paracolic gutter C. Phrenicocolic ligament; left paracolic gutter D. Hepatoduodenal ligament; right paracolic gutter E. Splenorenal ligament; hepatorenal recess
22) The ________________________ prevents inflammatory fluid that has collected within the region of the spleen from flowing through the ________________________ down into the pelvic region. A. Gastrophrenic ligament; right paracolic gutter B. Gastrosplenic ligament; left paracolic gutter C. Phrenicocolic ligament; left paracolic gutter (CORRECT! Recall that in addition to cradling and supporting the inferior aspect of the spleen, this peritoneal ligament, which spans between the diaphragm and left colic (splenic) flexure also acts as a barrier to the flow of inflammatory fluid) D. Hepatoduodenal ligament; right paracolic gutter E. Splenorenal ligament; hepatorenal recess
23) The most inferior cul de sac (space/pouch) of the greater peritoneal sac in the FEMALE is the: A. rectovesical pouch B. rectouterine pouch C. vesicouterine pouch D. hepatorenal recess E. subphrenic recess
23) The most inferior cul de sac (space/pouch) of the greater peritoneal sac in the FEMALE is the: A. rectovesical pouch (incorrect - this is the most inferior recess of the peritoneal cavity in the MALE) B. rectouterine pouch (CORRECT!) C. vesicouterine pouch D. hepatorenal recess E. subphrenic recess
24) Inflammatory fluid that originates within the lesser sac and runs through the omental foramen (of Winslow) would then IMMEDIATELY enter the: A. right paracolic gutter B. left paracolic gutter C. hepatorenal recess D. rectouterine pouch E. vesicouterine pouch
24) Inflammatory fluid that originates within the lesser sac and runs through the omental foramen (of Winslow) would then IMMEDIATELY enter the: A. right paracolic gutter B. left paracolic gutter C. hepatorenal recess (CORRECT! the hepatorenal recess is the part of the greater peritoneal sac situated immediately adjacent to the omental foramen, thus fluid originating in the lesser sac and flowing through the omental foramen would end up in this recess) D. rectouterine pouch E. vesicouterine pouch
25) Each of the following arterial branches is correctly paired with its (direct) artery of origin EXCEPT: A. superior pancreaticoduodenal: gastroduodenal B. left gastroomental: splenic C. right gastric: celiac trunk D. right gastroomental: gastroduodenal E. esophageal: left gastric
25) Each of the following arterial branches is correctly paired with its (direct) artery of origin EXCEPT: A. superior pancreaticoduodenal: gastroduodenal B. left gastroomental: splenic C. right gastric: celiac trunk (CORRECT! The right gastric a. is not a direct branch of the celiac trunk; rather it arises from the common hepatic a. branch of the celiac trunk) D. right gastroomental: gastroduodenal E. esophageal: left gastric
26) Upon examination of a 1 month old infant with a history of intermittent gastrointestinal pain and vomiting, physicians discovered that the cause of these clinical signs/symptoms was a lack of emptying of the stomach. They immediately suspected stenosis (narrowing) of the ______________________ region of the stomach, which regulates the passage of food from the stomach to the duodenum. A. cardiac B. fundus C. lesser curvature D. pylorus E. rugae
26) Upon examination of a 1 month old infant with a history of intermittent gastrointestinal pain and vomiting, physicians discovered that the cause of these clinical signs/symptoms was a lack of emptying of the stomach. They immediately suspected stenosis (narrowing) of the ______________________ region of the stomach, which regulates the passage of food from the stomach to the duodenum. A. cardiac B. fundus C. lesser curvature D. pylorus (CORRECT! The pyloric region of the stomach contains the pyloric sphincter, which is a strong sphincter muscle that functions to regulate the passage of food from the stomach into the duodenum) E. rugae
conditions) could potentially reach which of the following organs? A. Spleen B. Stomach C. Pancreas D. A and B E. All of the above
3) As a result of the branching pattern of the splenic artery, a drop of blood coursing within it (under normal, non-pathological conditions) could potentially reach which of the following organs? A. Spleen (correct - the splenic artery is the main source of blood supply to the spleen) B. Stomach (correct - the splenic artery gives rise to short gastric branches (to the fundus) and the left gastroomental a. (to the greater curvature of the stomach)) C. Pancreas (correct - the splenic artery gives rise to numerous pancreatic branches as it courses toward the spleen in a retroperitoneal position just superior to the pancreas) D. A and B E. All of the above (CORRECT!)
4) As a result of the branching pattern of the gastroduodenal artery, a drop of blood coursing within it (under normal, nonpathological conditions) could potentially reach which of the following organs? A. Duodenum B. Stomach C. Pancreas D. A and B E. All of the above
4) As a result of the branching pattern of the gastroduodenal artery, a drop of blood coursing within it (under normal, nonpathological conditions) could potentially reach which of the following organs? A. Duodenum (correct - the superior pancreaticoduodenal aa. and retroduodenal arteries arise from the gastroduodenal a.) B. Stomach (correct - the right gastroomental a. is the continuation of the gastroduodenal a. after it has given branches to the duodenum and pancreas) C. Pancreas (correct - the superior pancreaticoduodenal aa. arise from the gastroduodenal a.) D. A and B E. All of the above (CORRECT!)
5) To relieve portal hypertension in a patient with advanced cirrhosis, a surgeon plans to anastomose the hepatic portal vein to the inferior vena cava in order to bypass the liver. The anatomical site that facilitates this planned anastomosis is located in the: A. Rectouterine Pouch (of Douglas) B. Cystohepatic Triangle (of Calot) C. Rectovesical pouch D. Omental Foramen (of Winslow) E. Subhepatic recess
5) To relieve portal hypertension in a patient with advanced cirrhosis, a surgeon plans to anastomose the hepatic portal vein to the inferior vena cava in order to bypass the liver. The anatomical site that facilitates this planned anastomosis is located in the: A. Rectouterine Pouch (of Douglas) (incorrect - this pouch is down in the pelvis, very far from the IVC and portal vein) B. Cystohepatic Triangle (of Calot) (incorrect - this triangle is traversed by the cystic a.) C. Rectovesical pouch (incorrect - this pouch is down in the pelvis, very far from the IVC and portal vein) D. Omental Foramen (of Winslow) (CORRECT! remember that the structures that comprise the portal triad (the portal vein, hepatic artery proper and bile duct) are transmitted by the hepatoduodenal ligament, which forms the anterior border of the omental foramen. And recall that the IVC is situated behind the peritoneum (retroperitoneal), forming the posterior boundary of the omental foramen. E. Subhepatic recess (incorrect)
6) This is due to the fact that the _________________ forms the posterior boundary of this anatomical site (the answer to question #5), while the ______________________ forms its anterior boundary A. Inferior vena cava; hepatic portal vein B. Hepatic portal vein; inferior vena cava
6) This is due to the fact that the _________________ forms the posterior boundary of this anatomical site (the answer to question #5), while the ______________________ forms its anterior boundary A. Inferior vena cava; hepatic portal vein (CORRECT!) B. Hepatic portal vein; inferior vena cava
7) A 26-year-old male presents to the emergency department after being involved in a motor vehicle collision where he was impacted from the left (driver's) side of the car while driving. He complains of tenderness in the left upper quadrant of the abdomen and you find that he has fractured his 9th left rib. Based on this information, what abdominal organ has likely been damaged as a result of the fracture? A. Liver B. Spleen C. Gallbladder D. Pancreas E. Sigmoid colon
7) A 26-year-old male presents to the emergency department after being involved in a motor vehicle collision where he was impacted from the left (driver's) side of the car while driving. He complains of tenderness in the left upper quadrant of the abdomen and you find that he has fractured his 9th left rib. Based on this information, what abdominal organ has likely been damaged as a result of the fracture? A. Liver (incorrect - the liver is more associated with the RUQ and right ribs) B. Spleen (CORRECT! The spleen is situated in the LUQ, under cover of the 9th-11th ribs) C. Gallbladder (incorrect - the gallbladder is more associated with the RUQ) D. Pancreas (incorrect - the pancreas is situated deep within the cavity - unlikely to be associated with a rib fracture) E. Sigmoid colon (incorrect - the sigmoid colon is situated on the left aspect of the abdomen, but more inferiorly within the cavity and thus unlikely to be damaged by a rib fracture)
8) The uncontrolled bleeding that can occur as a result of a ruptured spleen often necessitates removal of the spleen (splenectomy) in order to prevent fatality due to blood loss. In order to safely remove the spleen, its major source of blood supply (the splenic branches of the splenic vessels) must be ligated. Within which of the following sites might these vessels be found coursing? A. Gastrosplenic ligament B. Splenorenal ligament C. hepatogastric ligament D. hepatoduodenal ligament E. phrenicocolic ligament
8) The uncontrolled bleeding that can occur as a result of a ruptured spleen often necessitates removal of the spleen (splenectomy) in order to prevent fatality due to blood loss. In order to safely remove the spleen, its major source of blood supply (the splenic branches of the splenic vessels) must be ligated. Within which of the following sites might these vessels be found coursing? A. Gastrosplenic ligament (incorrect - the short gastric branches of the splenic vessels pass through this ligament en route to the fundus of the stomach, but the branches of the splenic artery to the spleen course within the spenorenal ligament) B. Splenorenal ligament (CORRECT! remember that the splenic vessels initially course retroperitoneally along the posterior wall and then their splenic branches traverse the splenorenal ligament to access the spleen) C. hepatogastric ligament (incorrect - the splenic vessels do not course within this ligament) D. hepatoduodenal ligament (incorrect - the splenic vessels do not course within this ligament; rather the structures that comprise the portal triad are conveyed by this ligament) E. phrenicocolic ligament (incorrect - the splenic vessels do not course within this ligament; rather this ligament serves to cradle, support the inferior aspect of the spleen)
9) What additional structure can also be found passing through the above ligament (answer to question #8) in close proximity to the splenic vessels at it extends towards and makes contact with the spleen? A. Head of the pancreas B. Tail of the pancreas C. 1st portion of the duodenum D. quadrate lobe of the liver E. fundic portion of the stomach
9) What additional structure can also be found passing through the above ligament (answer to question #8) in close proximity to the splenic vessels at it extends towards and makes contact with the spleen? A. Head of the pancreas (incorrect - the head of the pancreas is the portion of the pancreas that is situated furthest away from the spleen; it is nestled within the C-shape formed by the duodenum) B. Tail of the pancreas (CORRECT! remember that the tail of the pancreas extends to and makes contact with the spleen by passing through the splenorenal ligament alongside the splenic vessels) C. 1st portion of the duodenum (incorrect -the 1st part of the duodenum is not situated in close proximity to the spleen) D. quadrate lobe of the liver (incorrect -the quadrate lobe of the liver is not situated in close proximity to the spleen) E. fundic portion of the stomach (incorrect -the fundus of the stomach is situated in close proximity to the spleen; however it does not pass through the splenorenal ligament)