Answer to Tutti Frutti
Correct answer is D, the head of the pancreas. Note that this is a posterior view of the abdominal content after removing it from the abdominal cavity. Removal of the abdominal viscera is a general exercise performed in the gross anatomy laboratory to gain better access to the retroperitoneal organs. Also, pathologists would remove the viscera as part of their routine examination of the diseased. The symptoms described for Chuck are classic signs of pancreatic cancer in the head of the pancreas, not the tail. While pain in the epigastric region and back could be due to either the tail or the head, the yellow color in the eyes, the sign of jaundice, is one of the first signs of pancreatic cancer in the head region. The growing pancreatic tumor can block emptying of the bile duct and the bile escapes into the circulation leading to the yellow tint of the skin. A tumor in the tail would likely not lead to jaundice until much later. A tumor in the liver can also cause jaundice, but generally not until much later in the course of the disease. Also, referred pain from the liver is felt in the right shoulder region (if it irritates the diaphragm) or the right flank. If a gall stone exits the gall bladder and blocks the bile duct, it can lead to jaundice. Again, however, pain from the gall bladder would be felt in the right shoulder region (if it irritates the diaphragm), or the right flank. Pain from the spleen is felt in the midaxillary line on the left side. Rare cases of unknown etiology of spleen disease have been reported to cause some jaundice, but the location of the pain is what excludes the spleen in this case.
= Liver
= Spleen
= Tail of pancreas
= Head of pancreas
= Gall bladder
Answer to this question is based on material presented in lectures 7 of the Abdomen Lecture Series.
