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BS VI, Quiz 2 > 1. Anatomy > Flashcards

1. Anatomy Flashcards

1
Q 
The LIVER
• \_\_\_\_ gland
• 2nd largest \_\_\_\_
• Multiple physiological
functions
A

largest

organ

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2
Q

The liver occupies much of the ____ of the abdomen…

… largely protected by elements of the thoracic cage including both ____ and ____

A

upper right quadrant
ribs
costal cartilages

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3
Q

The liver moves with the
excursions of the ____
and is located more ____ when one is erect because of gravity

A

diaphragm

inferiorly

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4
Q

The liver bud arises from the embryonic ____ and grows into the ____
of the developing stomach and duodenum…

A

foregut

ventral mesentery

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5
Q

TWO remnants of ventral mesentery persist in the developed human

  • ____:
  • ____
  • ____
A

falciform ligament
ligamentum teres hepatis
round ligament of the liver

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6
Q

The round ligament of the liver (ligamentum teres hepatis) is the remnant of the ____

A

fetal umbilical vein

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7
Q

Roughly half of the highly oxygenated, nutrient-rich blood returning under high pressure from the placenta bypasses the hepatic sinusoids via the ____

A

ductus venosus

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8
Q

TWO remnants of ventral mesentery persist in the developed human

  • ____

The free edge of
the lesser omentum contains the ____

A

lesser omentum

hepatic triad

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9
Q

The LESSER OMENTUM is comprised of two distinct portions

  • ____
  • ____ contains the hepatic triad
A

hepatogastric ligament

hepatoduodenal ligament

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10
Q

HEPATIC (Portal) TRIAD

  • ____
  • ____
  • ____
A

proper hepatic artery
common bile duct
hepatic portal vein

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11
Q

Branches of the vascular elements of the triad enter the liver through a transverse fissure in the ____ surface known as the
____

A

visceral

porta hepatis

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12
Q

Arterial blood to the liver is derived from the ____

  • ____
  • ____
A

celiac trunk
proper hepatic artery
common hepatic

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13
Q

The COMMON BILE DUCT

is formed at the confluence of the ____ and ____ Ducts

A

common hepatic

cystic

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14
Q

The
HEPATIC
PORTAL VEIN
drains the abdominal gut from the ____ to the ____

A

distal esophagus

superior rectum

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15
Q

he liver is often described as “wedge-shaped” in sagittal section, featuring two surfaces…

A convex
____ SURFACE

A relatively flat, concave ____ SURFACE

… separated anteriorly by a sharp ____ following the
____ costal margin

A

diaphragmatic
visceral
inferior border
right

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16
Q

The diaphragmatic surface of the liver is covered with serous peritoneum, except posteriorly at the so-called ____

A

bare area

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17
Q

The bare area is
in contact with the ____ surface of the diaphragm

Though the bare area
is covered by the fibrous
coat of ____ which surrounds the entire organ, the absence of ____ here is significant…

A

hepatic
glisson’s capsule
peritoneum

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18
Q

The DIAPHRAGMATIC
SURFACE is smooth and ____-shaped where it relates to the concavity of the underside of the ____

These anatomical lobes, separated by the ____, are only secondarily related to the liver’s internal architecture

A

dome
diaphragm
falciform ligament

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19
Q

Retraction and elevation of the inferior border enables clearer visualization of the ____

A

visceral surface

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20
Q

VISCERAL SURFACE

  • ____ lobe
  • ____ lobe

Quadrate and Caudate lobes are part of the anatomical ____ lobe

Between the quadrate and caudate lobes lies the ____

A

quadrate
caudate
right
porta hepatis

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21
Q

With gallbladder retracted, the ____ is exposed

Also passing through the porta hepatis are:
• ____
• ____ vessels

A

gallbladder fossa
hepatic nerve plexus
lymphatic

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22
Q

POSTERIOR VIEW OF LIVER

Note once again the remnants of the foetal circulation

  • ____
  • ____
A

ligamentum venosum

ligamentum teres hepatis

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23
Q

At the porta hepatis, elements of the ____ begin to divide, reflecting the functional segmentation of the organ

Most notable
is the bifurcation of the ____ into the ____ arteries

A

triad
proper hepatic artery
left and right

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24
Q

The liver has functionally independent LEFT and RIGHT parts, also known as the left and right ____ lobes, each of which receives its own primary branch of the proper hepatic ____ and the hepatic ____ which continue in turn to divide

A

portal
hepatic
portal vein

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25
Q

Whereas the
falciform ligament
clearly demarcates the boundary between the left and right ____ lobes…

CANTLIE’S LINE, extending from the ____ posteriorly to the middle of the ____ anteriorly, demarcates the approximate boundary between the ____ (portal) lobes.

A

anatomical
inferior vena cava
gallbladder fossa
functional

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26
Q

CANTLIE’S LINE is of significance in performing

____ after which significant regeneration occurs

A

partial hepatectomy

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27
Q

The two PORTAL LOBES (aka left and right livers) are further divided into ____ vascular segments, each of which is served by a branch of the left or right hepatic ____ as well as a branch of the ____

A

eight
artery
portal vein

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28
Q

While the microanatomy of the hepatic lobule, the “functional unit” of the liver, will be presented by others…

… each lobule is comprised of millions of ____, the basic metabolic cells of the liver that detoxify ____ and produce ____.

A

hepatocytes
blood
bile

29
Q

The sinusoids are lined with resident macrophages known as ____

Between hepatocytes,
____
mix oxygen-rich blood from the hepatic artery with nutrient rich blood from the portal vein

A

kupffer cells

hepatic sinusoids

30
Q

The contents of the hepatic sinusoids drain toward numerous ____ of the liver lobules, tributaries of the ____

A

hepatic sinusoids

hepatic veins

31
Q

Three HEPATIC VEINS usually drain parts of the adjacent vascular segments, and open into the ____

  • ____
  • ____
  • ____
A

inferior vena cava
right hepatic vein
middle hepatic vein
left hepatic vein

32
Q

Posterior view

HEPATIC VEINS open into the ____

A

inferior vena cava

33
Q

The green arrows indicate the flow of bile from hepatocytes through ____ to ____

A

bile canaliculi

biliary ducts

34
Q

The biliary ducts converge until each functional segment is drained by a branch of either the ____

Right and left hepatic ducts converge as they approach the ____ to form the ____

A

right or left hepatic duct
porta hepatis
common hepatic duct

35
Q

The CYSTIC DUCT communicates between the ____ and the ____

A

common hepatic duct

gallbladder

36
Q

Surrounded by peritoneum, the gallbladder is bound to the ____ of the visceral surface of the liver

The hepatic surface of the gallbladder is attached to ____

A

gallbladder fossa

glisson’s capsule

37
Q

GALL BLADDER
A ____ shaped structure

Ca. 10 cm. in length Ca. 25 cm. in diameter

Stores and concentrates ____ produced by the liver.

 Releases concentrated bile
to the \_\_\_\_ when
needed to emulsify fat in preparation for absorption
distally in the intestines
upon stimulation by \_\_\_\_ and \_\_\_\_
A 
pear
bile
duodenum
vagal efferents
cholecystokinin (CCK)
38
Q

The FUNDUS of the gallbladder normally lies adjacent to the tip of the ____ cartilage in the ____ line

The convergence of the ____ and ____ forms the COMMON BILE DUCT

A

ninth costal cartilage
right mid-clavicular
cystic
common hepatic ducts

39
Q

The common bile duct descends posterior to the ____ part of the duodenum in proximity to the ____

A

superior (first)

gastroduodenal artery

40
Q

Cystic artery
Crosses the ____ triangle
Is ligated in ____

Gastroduodenal artery may bleed profusely as a result of ____

A

hepatocystic
cholecystectomy
peptic ulcer disease

41
Q

The common bile duct
then descends either
in a groove on the posterior aspect of the ____ OR in the substance of the ____ itself

A

head of the pancreas

pancreatic head

42
Q

Embedded in the pancreatic head, the ____ and ____ parallel each other before converging and merging
to form a dilation, the ____

A

common bile duct
main pancreatic duct
hepatopancreatic ampulla (of vater)

43
Q

Bile and pancreatic secretions drain into the ____ part of the duodenum at the ____

A

second

major duodenal papilla

44
Q

Why may gallbladder pain be (Biliary Colic) be
referred to the
“shoulder pad” region?

• Pain associated with inflammation of the gallbladder / often secondary to cholelithiasis (gallstones) not only experienced along right costal margin, but also in the shoulder pad area
• Has to do with the innervation of the gallbladder
• Specifically: diaphragm, pericardium, pleura = ____ nerve
• Somatic afferent fibers that contribute to innervate of pericardium, pleura in the thorax and peritoneum in the abdominal cavity that will help bind the gallbladder to the
glalbladder fossa on visceral surface of liver
• Experience of pain resulting from afferents from the ____ nerve, referral to ____
dermatome to shoulder pad region = explains why we see gallbladder pain possibly in the right side in the supraclavicular area

A

phrenic
phrenic
D4

45
Q

The liver is a major ____ producing organ, responsible for 25-50% of the lymph carried in the thoracic duct

____ and ____ lymphatics drain to HEPATIC NODES accompanying the portal triad

Hepatic nodes in turn drain to the ____

From which efferent vessels drain directly to the ____

A 
lymph
anterior superficial
deep
celiac nodes
cisterna chyli
46
Q

POSTERIOR SUPERFICIAL lymphatics drain to ____ NODES around the caval foramen which drain to ____

A

phrenic

mediastinal nodes

47
Q

The HEPATIC PLEXUS consists of:

Preganglionic parasympathetics
from the ____ and ____ trunks

Postgangionic sympathetics
arising from the
____

A

anterior
posterior vagal

celiac ganglia

48
Q

Celiac ganglia

The significance of both efferent and afferent components of the hepatic plexus will presumably be presented in subsequent lectures

Recall that Pregangionic sympathetic inputs to the CELIAC GANGLIA arise from the ____ nerves

A

greater thoracic splanchnic

49
Q

The pancreas:

• Component of the ____ of the abdomen

A

upper left quadrant

50
Q

The pancreas lies on the posterior abdominal wall, posterior to the ____, between the ____ on the right and the ____ on the left

A

stomach
duodenum
spleen

51
Q

Removal of the ____ enables clearer visualization of the pancreas

A

stomach

52
Q

The PANCREATIC HEAD is embraced by the ____ curve of the duodenum…

…while the he TAIL of the PANCREAS is like a dagger pointed at the ____

A

S-shaped

splenic hilum

53
Q

Pancreatic juice produced by the exocrine pancreas includes
• ____
• ____ ions (to neutralize gastric acid)
and is carried to the small intestine by the ____ and ____ pancreatic ducts

A

digestive enzymes
bicarbonate
major
minor

54
Q

The
PANCREAS
is derived
from the fusion of embryonic ____ AND ____ primordia

A

foregut

midgut

55
Q

Note in this view why cancer of the ____ accounts
for most cases of extrahepatic obstruction of the biliary ducts, producing symptoms which will presumably be discussed in subsequent lectures

The ____ marks the
boundary between foregut and midgut derivatives

  • Santorini’s duct
  • Wirsung’s duct = ____ duct
A

pancreatic head
major duodenal papilla
main pancreatic

56
Q

We have already discussed the relations of the pancreas to the ____

A

extrahepatic bile ducts

57
Q

As we look at the uncinate process and the neck of the pancreas = superior mesenteric artery and vein
*remember:
• Superior mesenteric artery = blood supply to ____ derivatives
• Superior mesenteric vein = major tributary of the ____

A

midgut

hepatic portal vein

58
Q

Note the potential for
COLLATERAL CIRCULATION
around the duodenum and pancreatic head between the
____ and ____ circulations

A 
celiac (foregut)
superior mesenteric (midgut)
59
Q

Similarly, autonomic elements derived from both the
____ and ____ plexuses contribute to the innervation of the pancreas

Though parasympathetic elements are ____,
most pancreatic secretion
is ____ mediated

A

celiac
superior mesenteric
secretomotor
hormonally

60
Q

While details of the lymphatic drainage of the pancreas are unlikely to be significant to the dental practitioner, the fact that the pancreas drains to relatively inaccessible nodes deep in the abdomen, and that pancreatic cancer typically metastasizes to the liver early, explains why surgical resection of the cancerous pancreas is nearly ____

A

futile

61
Q

Pancreatic pain = area of ____ region
Pain doesn’t necessarily reflect cancer - but could reflect inflammatory, cysts, but either way will occur in the epigastric
____ region along the posterior abdominal wall

A

epigastric

mid-thoracic

62
Q

The HEPATIC PORTAL SYSTEM drains the GI tract from the ____ through the ____ as well as ____, pancreas and ____

A

lower esophagus
superior rectum
spleen
gallbladder

63
Q

The ____ is normally formed deep to the neck of the pancreas by the confluence of two veins

So pancreatic
neck pathology
may impede
flow and
produce \_\_\_\_
  • Splenic
  • Superior mesenteric
A

hepatic portal vein

pre hepatic portal hypertension

64
Q

For reasons having to do primarily with the prenatal development of the GI tract, ____ exit between tributaries of the ____ and tributaries of the ____

A

anastomoses
portal system
caval system

65
Q

Sites of PORTO-CAVAL anastomosis

  1. ____
  2. PARAUMBILICAL
  3. ____
  4. RETRO-PERITONEAL
A

esophageal

rectal

66
Q

Dilation of these anastomoses resulting from ____ (also caused by ____ – involving the destruction of hepatocytes), may produce…

  1. ____
  2. ____
  3. ____
A 
portal hypertension
cirrhosis
esophageal varices
caput medusae
hemorrhoids
67
Q

Caput Medusae is normally accompanied by ____ which can make the patient unable to sit ____ in the dental chair

A

ascites

comfortably

68
Q

Hemorrhoids

____ and ____ veins drain to the ____ veins

A

middle
inferior rectal
iliac

69
Q

Rupture of ____ in the ____ submucosal plexus can produce extensive bleeding

A

esophageal varices

inferior

BS VI, Quiz 2 (3 decks)

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