07-06 GIT Gx Liver & Hepatobiliary

Question 1

The Cantlie’s line is an oblique plane extending from the ___ to the ___

Answer 1

center of the gallbladder bed to the the inferior vena cava

Question 2

The right hemiliver comprises segments

Answer 2

5, 6, 7, 8

Question 3

The left medial section is Couinaud’s segment

Answer 3

4

Question 4

The superior border of Calot’s triangle is formed by the

Answer 4

inferior surface of the liver

Question 5

Liver receives 75% of blood flow from the

Answer 5

portal vein

Question 6

location of the liver

Answer 6

It lies in the RUQ of the abdomen (~7-11th rib)

Question 7

true or false. Easily palpable at the subcostal margin in normal individuals

Answer 7

false

Question 8

weight of the liver

Answer 8

around 1200 – 1800gms in a normal individual

Question 9

Majority of the blood from the small and large intestines is transmitted to the liver thru the

Answer 9

portal vein

Question 10

it is a potential space above and anterior the diaphragmatic surface of the liver

Answer 10

Sub-phrenic recess of the liver

Question 11

Sub-phrenic recess of the liver is divided into Left and Right recesses by the

Answer 11

falciform ligament

Question 12

it is a “dependent area” in the abdomen where one would look for free intraperitoneal fluid

Answer 12

Sub-phrenic recess of the liver

Question 13

true or false. sub-phrenic recess of the liver is the area where “pneumoperitoneum” in Upright chest x-rays is most evident

Answer 13

false

Question 14

it is the potential space between the liver and right kidney

Answer 14

Morison pouch

Question 15

Morison pouch contains the “Bare area” of the liver. true or false

Answer 15

true

Question 16

Morison pouch. Free blood in the peritoneal cavity is usually evident in this area on ultrasound or CT scan. true or fase

Answer 16

true

Question 17

Morison pouch is lined/surrounded by peritoneum

Answer 17

false

Question 18

Boundaries of the “Bare Area” of the liver, EXCEPT: A. Coronary ligaments
B. Left triangular ligament
C. Falciform ligament
D. Right triangular ligament

Answer 18

C. Falciform ligament

Question 19

Portal Hepatis contains

Answer 19

bile duct,
hepatic artery,
hepatic portal vein

Question 20

The portal vein is usually formed by the union of:

Answer 20

Superior mesenteric vein & Splenic vein

Question 21

Which of the following is NOT TRUE about the hepatic veins:
A. Funnels blood from the central veins of the liver into the inferior vena cava B. there are 3x: Right, Middle and Left
C. They are intersegmental, draining the segments adjacent to each
D. Lies in the porta hepatis

Answer 21

all are true

Question 22

The Right sagittal fissure of the liver is formed by:

Answer 22

Gallbladder & Inferior vena cava

Question 23

Calot’s Triangle is important because it is the usual location of:

Answer 23

Cystic artery

Question 24

The valves of Heister are mucosal folds in the

Answer 24

cystic duct

Question 25

The cystic artery usually arises from the

Answer 25

right hepatic artery

Question 26

The Ligamentum venosum

Answer 26

is the remnant of the ductus venosus which shunts blood into the inferior vena cava

Question 27

Which of the following statements is NOT TRUE about the Functional Lobes of the liver? A. There are 8 functional segments of the liver B. These segments are not well demarcated from each other C. Each segment has its own supply from the portal vein and hepatic artery D. Each segment is drained by individual hepatic ducts and veins

Answer 27

D. Each segment is drained by individual hepatic ducts and veins

Question 28

A "Left lateral segmentectomy" of the liver entails the removal of which functional lobes:

Answer 28

2 & 3

Question 29

Which of the following is NOT TRUE about the Caudate lobe: A. it is also known as the Quadrate lobe B. it receives its own blood supply from the hepatic artery and portal vein C. it is often drained by its own hepatic veins which drain directly into the inferior vena cava D. Corresponds to segment 1 of the functional divisions of the liver

Answer 29

A. it is also known as the Quadrate lobe

Question 30

the liver is covered by peritoneum EXCEPT in this surface

Answer 30

posterior

Question 31

the liver is anatomically divided into right and left lobes by the

Answer 31

falciform ligament

Question 32

the liver is functionally or surgically divided into right and left lobes by the

Answer 32

Cantlie's line

Question 33

each liver segment is individually supplied and drained by the ff structures EXCEPT: a) portal vein b) hepatic vein c) segmental brances of the hepatic artery d) tributaries of the bile duct

Answer 33

b) hepatic vein

Question 34

bare area of the liver

Answer 34

diaphragmatic surface

Question 35

Morison pouch is aka

Answer 35

Hepatorenal recess

Question 36

superior extensions of the peritoneal cavity (greater sac); exist between diaphragm and the anterior and superior aspects of the diaphragmatic surface of the liver

Answer 36

subphrenic recesses

Question 37

subphrenic recesses is separated into right and left recesses by the

Answer 37

falciform ligament

Question 38

fluid draining from the omental bursa flows into recess

Answer 38

hepatorenal recess (Morison pouch)

Question 39

visceral surface of the liver is also covered with visceral peritoneum EXCEPT

Answer 39

fossa for gallbladder and | porta hepatis

Question 40

a transverse fissure that contains the portal triad

Answer 40

porta hepatis

Question 41

continuous groove formed anteriorly by the fissurefor the round ligament and posteriorly by the fissure for the ligamentum venosum

Answer 41

umbilical (left sagittal) fissure

Question 42

fibrous remnant of the "umbilical vein", which carried well-oxygenated and nutrient-rich blood from the placenta to the fetus

Answer 42

round ligament of the liver (L. ligamentum teres hepatis)

Question 43

fibrous remnant of the fetal "ductus venosus", which shunted blood from the umbilical vein to the IVC, short-circuiting the liver

Answer 43

ligamentum venosum

Question 44

which functional lobe is segment I

Answer 44

caudate lobe

Question 45

the left and right livers are subdivided into medial and lateral divisions by ___

Answer 45

right portal and umbilical fissures

Question 46

a "transverse hepatic plane" at the level of the horizontal parts of the right and left branches of the portal triad subdivides 3 of the 4 (all but the _____), creating six hepatic segments, each receiving tertiary branches of the triad

Answer 46

left medial division

Question 47

hepatic artery, branch of the ___, may be divided into ___

Answer 47

celiac trunk; common hepatic artery and hepatic artery proper

Question 48

common hepatic duct is joined by the ___ to form the bile duct

Answer 48

cystic duct

Question 49

circular muscle around the distal end of the bile duct is thickened to form the

Answer 49

sphincter of the bile duct (L. ductus choledochus)

Question 50

blood supply of the proximal part of the bile duct

Answer 50

cystic artery

Question 51

blood supply of the middle part of the bile duct

Answer 51

right hepatic artery

Question 52

blood supply of the retroduodenal part of the bile duct

Answer 52

posterior superior pancreaticoduodenal artery and | gastroduodenal artery

Question 53

venous drainage from the proximal part of the bile duct and hepatic ducts

Answer 53

usually enter the liver directly

Question 54

venous drainage from the distal part of the bile duct

Answer 54

posterior superior pancreaticoduodenal vein >>> which empties into hepatic portal vein or one of its tributaries

Question 55

lymphatic vessels from the bile duct passes to the

Answer 55

cystic lymph nodes (near the neck of the gallbladder) >>> lymph nodes of the omental fissure >> hepatic lymph node of the omental foramen >>> hepatic lymph nodes efferent lymphatic vessels from the bile duct passes to the celiac lymph nodes

Question 56

storage area which can hold up to 50mL bile

Answer 56

gallbladder

Question 57

3 parts of the gallbladder

Answer 57

fundus, body, neck

Question 58

main portion of the gallbladder that contacts the visceral surface of the liver, transverse colon, and superior part of the duodenum

Answer 58

body of gallbladder

Question 59

part of gallbladder where stones are usually stuck

Answer 59

neck of the gallbladder

Question 60

connects the neck of the gallbladder to the common hepatic duct

Answer 60

cystic duct

Question 61

connects with the common hepatic duct to form the bile duct

Answer 61

cystic duct (has anatomical variants)

Question 62

blood supply of the gallbladder

Answer 62

cystic artery

Question 63

cystic artery commonly arises from the ____ in the triangle between the common hepatic duct, cystic duct, and visceral surface of the liver called ___

Answer 63

right hepatic artery; cystohepatic triangle (of Calot)

Question 64

venous drainage from the neck of the gallbladder and cystic duct

Answer 64

cystic veins

Question 65

small and usually multiple veins that enter the liver directly or drain through the hepatic portal vein to the liver

Answer 65

cystic veins

Question 66

veins from the fundus and body of the gallbladder

Answer 66

pass directly into the visceral surface of the liver and drain into the hepatic sinusoids

Question 67

lymphatic drainage of the gallbladder

Answer 67

hepatic lymph nodes >> cystic lymph nodes efferent lymphatic vessels from these nodes pass tot he celiac lymph nodes

Question 68

sympathetic nerve supply of gallbladder and cystic duct

Answer 68

celiac (nerve) plexus

Question 69

parasympathetic nerve supply of the gallbladder and cystic duct

Answer 69

vagus nerve

Question 70

somatic afferent fibers of the gallbladder and cystic duct (nerve supply)

Answer 70

right phrenic nerve

Question 71

innervation of the gallbladder and cystic duct

Answer 71

celiac (nerve) plexus, vagus nerve, right phrenic nerve

Question 72

parasympathetic stimulation of nerves of gallbladder causes

Answer 72

contractions of the gallbladder and relaxation of the sphincters at the hepatopancreatic ampulla (stimulated by hormone cholecystokinin, CCK - produced by duodenal walls in response to arrival of fatty meal)

Question 73

part of the gallbladder that may be palpated in the right border of the right rectus muscle and at the tip of the 9th costal cartilage

Answer 73

fundus

Question 74

part of the hepatobiliary tree that run along the hepatoduodenal ligament

Answer 74

common bile duct

Question 75

which part of the common bile duct lies behind the firs part of the duodenum

Answer 75

2nd

Question 76

hepatocystic triangle is an important part of gall bladder surgery.. used to identify

Answer 76

cystic artery

Question 77

inflammation of the subdiaphragmatic parietal peritoneum due to an acute cholecystitis may manifest as pain in the shoulder due to the irritation of

Answer 77

phrenic

Question 78

obstruction of the portal circulation may lead to varicosities in the systemic circulation. The appearance of "caput medusa" is a manifestation of varicosity involving which collateral portal circulation?

Answer 78

paraumbilical

Question 79

main channel of portal venous system

Answer 79

hepatic portal vein

Question 80

hepatic portal vein is the union of

Answer 80

superior mesenteric and splenic veins + inferior mesenteric vein (IMV) in 1/3 of individuals

Question 81

in most people IMV enters the

Answer 81

splenic vein (60%) or the SMV (40%)