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Anatomy > 19. Abdomen Viscera > Flashcards

19. Abdomen Viscera Flashcards

1
Q

The liver is the larges gland of the body and after the skin is the largest single organ. Who much of the body weight does it account for?

A

2.5% in the adult and approximately 5% in a mature foetus, where it also serves as a haematopoietic organ.

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2
Q

What are the key functions of the liver?

A
  1. Multiple metabolic activities
  2. stores glycogen
  3. secretes bile
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3
Q

Describe the passage of bile.

A
  • Bile passes from the liver via the biliary ducts to the right and left hepatic ducts to enter the common hepatic duct.
  • This unites with the cystic duct to form the (common) bile duct to the major hepatopancreatic ampulla
  • This opens into the duodenum via the major duodenal papilla.
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4
Q

What is the role of the gallbladder?

A

To store and concentrate the bile by absorbing water and salts.

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5
Q

Where is the liver positioned?

A
  • It lies mainly in the RUQ and is protected by the thoracic cage and the diaphragm.
  • It lies deep to ribs 7-11 on the right side and crosses the midline towards the left nipple
  • It occupies most of the right hypochondrium and upper epigastrium and extends into the left hypochondrium.
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6
Q

Outline the surfaces of the liver.

A
  • It has a convex diaphragmatic surface that incorporates the anterior, superior and some posterior aspects
  • Its flat, or even concave visceral surface that is posterior-inferior.
  • The inferior border follows the right costal margin, inferior to the diaphragm and separates the diaphragmatic and visceral surfaces anteriorly by its sharp inferior border.
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7
Q

From full expiration, how much movement might you expect the liver to make during full inspiration?

A

• From 4-8cm in the midline and 6-12 in the right midclavicular line.

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8
Q

TEST YOURSELF FIG2.63 P.268

A

TEST YOURSELF FIG2.63 P.268

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9
Q

Describe the diaphragmatic surface of the liver with respect to the structures that are in close proximity.

A

It is smooth and dome shaped where it is related to the concavity of the inferior surface of the diaphragm, which separates it from the pleura, lungs, pericardium and heart.

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10
Q

What forms the subphrenic recesses?

A

Superior extensions of the peritoneal cavity (greater sac).

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11
Q

Where are the subphrenic recesses located?

A

Between the diaphragm and the anterior and superior aspects of the diaphragmatic surface of the liver.

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12
Q

What separates the right and left subphrenic recesses?

A

They are separated by the falciform ligament, which extends between the liver and the anterior abdominal wall.

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13
Q

Where is the subhepatic space?

A

It is the portion of the supracolic compartment of the peritoneal cavity immediately inferior to the liver.

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14
Q

What are two other names for the hepatorenal recess?

A

The hepatorenal pouch and morrisons pouch.

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15
Q

Where is the hepatorenal pouch?

A

It is the posterosuperior extension of the suhepatic space, lying between the right part of the visceral surface of the liver and the right kidney and suprarenal gland.

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16
Q

What is the significance of the hepatorenal recess?

A

It is a gravity dependent part of the peritoneal cavity so fluid may collect there in the supine position as it drains form the omental bursa.

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17
Q

What does the hepatorenal recess communicate with?

A

Anteriorly the right subphrenic recess.

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18
Q

What is the significance of all the recesses in the peritoneal cavity?

A

The are potential spaces only containing just enough fluid to lubricate the adjacent peritoneal membranes.

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19
Q

TEST YOURSELF FIG2.64 P.269

A

TEST YOURSELF FIG2.64 P.269

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20
Q

What is the diaphragmatic surface of the liver covered with?

A

Visceral peritoneum, with the exception of the bare area of the liver, where it lies in direct contact with the diaphragm.

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21
Q

What structures demarcate the bare area of the liver?

A

It is demarcated by the reflection of the peritoneum from the diaphragm by the anterior (upper) and posterior (lower) layers of the coronary ligament and as they converge to the meet on the right to form the right triangular ligament and diverge on the left to enclose the triangular bare area.

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22
Q

The anterior layer of the coronary ligament is continuous on the left with what?

A

The right layer of the falciform ligament.

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23
Q

The posterior layer of the coronary ligament is continuous with what?

A

The right layer of the lesser omentum.

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24
Q

What is formed by the convergence of the left and right coronary ligaments and where does it occur?

A

The coronary ligaments meet to form the left triangular ligament near the apex (left extremity) of the wedge-shaped liver.

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25
Q

What significant structure traverses the bare area of the liver and where does it do this?

A

The IVC traverses the deep groove for the vena cava within the bare area of the liver.

26
Q

What covers the visceral surface of the liver?

A

Visceral peritoneum, with the exception of the fossa for the gallbladder and the porta hepatis.

27
Q

Describe the porta hepatis?

A

It is a transverse fissure where the vessels, nerves and ducts enter and leave the liver.

28
Q

What structures are associated with the porta hepatis?

A
  • The hepatic vessels (hepatic portal vein, hepatic artery and lymphatic vessels)
  • The hepatic nerve plexus
  • Hepatic ducts
29
Q

What is a distinguishing feature of the visceral surface of the liver in comparison to the diaphragmatic surface?

A

In contrast to the smooth diaphragmatic surface, the visceral surface bears multiple fissures and impressions from contact with other organs.

30
Q

What are the two sagittally oriented fissures of the liver and what are they linked by in the transverse plane?

A

Right sagittal fissure and the umbilical (left sagittal) fissure are linked by the transverse porta hepatis to form the letter “H” on the visceral surface.

31
Q

What forms the right sagittal fissure of the liver?

A

Anteriorly by the fossa for the gallbladder and posteriorly by the groove for the vena cava.

32
Q

What forms the umbilical (left sagittal) fissure

A

It is a continuous groove formed anteriorly the fissure for the round ligament and posteriorly by the fissure for the ligamentum venosum.

33
Q

What is the round ligament of the liver?

A

The round ligament or ligamentum teres hepatis is the fibrous remnant of the umbilical vein, which carried well oxygenated and nutrient rich blood from the placenta to the foetus.

34
Q

What structures course the free edge of the falciform ligament?

A

The round ligament and small para-umbilical veins.

35
Q

What is the ligamentum venosum?

A

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

36
Q

What structures make up the portal triad?

A

The bile duct, hepatic artery & hepatic portal vein

37
Q

What two structures form the lesser omentum?

A

The hepatoduodenal ligament that encloses the portal triad and the hepatogastric ligament.

38
Q

What is the hepatoduodenal ligament?

A

It is the thick, free edge of the lesser omentum that extends from the porta hepatis and the groove for the ligamentum venosum to the lesser curvature of the stomach.

39
Q

TEST YOURSELF FIG 2.65 P.270

A

TEST YOURSELF FIG 2.65 P.270

40
Q

TEST YOURSELF FIG 2.66 P. 271

A

TEST YOURSELF FIG 2.66 P. 271

41
Q

In addition to the fissures, impressions on (areas of) the visceral surface of the liver reflect its relationship to what SIX (6) structures?

A
  1. Right side of the anterior aspect of the stomach (gastric and pyloric areas)
  2. Superior part of the duodenum (duodenal area)
  3. Lesser omentum (extends into the fissure for the ligamentum venosum)
  4. Gallbladder (fossa for gallbladder)
  5. Right colic flexure and right transverse colon (colic area)
  6. Right kidney and suprarenal gland (renal and suprarenal areas)
42
Q

Externally, the liver is divided into what?

A

Two anatomical lobs and two accessory lobes by the reflections of peritoneum from its surface, the fissures formed in relation to those reflections and the vessels serving the liver and the gallbladder.

43
Q

What structure defines the separation of the left and right lobes of the liver?

A

The falciform ligament and the left sagittal fissure.

44
Q

What are the functional subdivisions of the liver?

A
  • A functionally independent right and left livers (parts or portal lobes) that each has its own primary branch of the hepatic artery and portal vein and is drained by its own hepatic duct.
  • Thse can be further subdivided into four divisions and then into eight surgically resectable hepatic segments, each served independently by a secondary or tertiary branch of the portal triad respectively.
45
Q

What two organs have a dual blood supply of afferent vessels and what are the vessels?

A

The lungs and the liver wit ha dominant venous source and a lesser arterial one.

46
Q

What volume of blood is conveyed to the liver by the portal vein?

A

75-80%

47
Q

In comparison to blood from the systemic circuit, how much more oxygen is contained within portal blood?

A

About 40% more, which is sufficient to sustain the liver parenchyma (the hepatocytes).

48
Q

The portal vein carries what?

A

Virtually all of the nutrients absorbed by the alimentary tract to the sinusoids of the liver, with the exception of lipids, which are absorbed into the and bypass the liver via the lymphatic system.

49
Q

Arterial blood from the hepatic artery accounts for how much of the blood received by the liver and where is it distributed to?

A

20-25% of the blood supply and it is initially distributed to non-parenchymal structures, particularly the intrahepatic bile ducts.

50
Q

TEST YOURSELF FIG 2.60 P. 275

A

TEST YOURSELF FIG 2.60 P. 275

51
Q

The hepatic portal vein is a short wide vein formed by what and where is it positioned?

A

The superior mesenteric and splenic veins posterior to the neck of the pancreas and ascends anterior to the IVC as part of the portal triad in the hepatoduodenal ligament.

52
Q

The hepatic artery is what?

A

A branch of the celiac trunk that forms the common hepatic artery before it divides into the gastroduodenal artery and the hepatic artery proper.

53
Q

What is the lymphatic role of the liver?

A

It is a major lymph-producing organ with between one quarter and one half of the lymph entering the thoracic duct coming from the liver.

54
Q

Where are the lymphatic vessels of the liver?

A

They occur as superficial lymphatics in the subperitoneal fibrous capsule of the liver (Glisson capsule), which forms its outer surface and as deep lymphatics in the connective tissue which accompany the ramifications of the portal triad and hepatic veins.

55
Q

Where is most of the hepatic lymph formed and where is it distributed to?

A

In the perisinusoidal spaces (of Disse) and it drains to the deep lymphatics in the surrounding intralobular portal triads.

56
Q

Where does the superficial lymphatics from the anterior aspects of the diaphragmatic and visceral surfaces of the liver drain lymph to?

A

The hepatic lymph nodes scattered along the hepatic vessels and ducts in the lesser omentum which drain to celiac lymph nodes and then into the cisterna chyli, a dilated sac at the inferior end of the thoracic duct.

57
Q

Where does the superficial lymphatics from the posterior aspects of the liver drain lymph to?

A
  • The phrenic lymph nodes to join the deep lymphatics that have accompanied the hepatic veins as they converge on the IVC.
  • From here they accompany the IVC through the diaphragm to drain into the posterior mediastinal lymph nodes.
  • Efferent lymphatic vessels from mediastinal nodes join the right lymphatic and thoracic ducts.
58
Q

What are three other routes for hepatic lymphatic flow?

A
  1. From the posterior surface of the left lobe towards the oesophageal hiatus of the diaphragm to end in the left gastric lymph nodes
  2. From the anterior central diaphragmatic surface along the falciform ligament to the parasternal lymph nodes
  3. along the round ligament to the umbilicus and lymphatics of the anterior abdominal wall
59
Q

TEST YOURSELF FIG 2.70 P. 276

A

TEST YOURSELF FIG 2.70 P. 276

60
Q

The nerves of the liver are derived from where?

A

The hepatic plexus, the larges derivative of the celiac plexus.

61
Q

The hepatic plexus consists of what?

A
  • Sympathetic fibers from the celiac plexus and parasympathetic fibers from the anterior and posterior vagal trunks to accompany vessels and biliary ducts of the portal triad.
  • Other than vasoconstriction, their function is not clear.

Anatomy (6 decks)

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