3.b) The liver, biliary apparatus and spleen Flashcards
What ligaments can the lesser omentum be divided into?
Hepatoduodenal Ligament
Gastrohepatic Ligament
Which ligaments suspend the spleen?
Splenorenal ligament (posterior) Gastrosplenic ligament (anterior)
In which mesentery does the liver develop?
Ventral foregut mesentery
What connects the liver to the anterior abdominal wall?
Falciform Ligament
What connects the liver to the lesser curvature of the stomach?
Lesser Omentum
What is the region of the liver that makes direct contact with the diaphragm called?
Bare area of the liver
Which ribs are the liver deep to?
Deep to ribs 7-11
Which abdominal regions do the liver extend across?
The top 3:
right hypochondriac
epigastric
left hypochondriac
What is the structure at the end of the falciform ligament called and how did it originate?
Ligamentum Teres
It is a remnant of the umbilical vein
What are the ligaments on the superior surface of the liver called?
Coronary Ligament (anterior and posterior) Left and Right Triangular Ligaments
What defines the anatomical boundary (dividing the liver into anatomical lobes)?
The fissures of the foetal veins
What are the 2 accessory lobes of the liver and where are they located?
Quadrate: located between the gallbladder and the fissure of the ligamentum teres
Caudate: located between the IVC and the fissure of the ligamentum venosum
Porta hepatis divides the caudate and quadrate lobes.
What is the ligament on the posterior end of the inferior aspect of the liver?
Ligamentum venosum: remnant of the ductus venosum
What divides the liver into right and left functional lobes?
A line between the gallbladder and the IVC
What is special about the caudate lobe?
It is functionally separate from the right and left lobes.
It is supplied by right and left hepatic arteries
What vessels make up porta hepatis?
Common bile duct and lymphatics
Hepatic artery
Hepatic portal vein
What are the 2 parts of the coronary ligament?
Anterior and Posterior
Describe the anatomical relations of the liver
Covered by costal margin except in upper epigastrium
Convex diaphragmatic surface
Complex visceral surface in contact with stomach, duodenum, right kidney and colon
Where is the liver palpated?
right hypochondriac region
Blood supply to functional right and left vascular lobes of the liver
Right hepatic artery: Right lobe
Left hepatic artery: Left lobe, Caudate lobe, Quadrate lobe
How many segments is the liver comprised of?
8
Each has its own blood supply, drainage and bile duct
How many divisions of the celiac trunk? What are they?
3
Splenic artery
Left gastric artery
Common hepatic artery
What does the common hepatic artery split into?
Gastroduodenal artery
Right gastric artery
Hepatic artery proper
What does the Hepatic artery proper divide into?
Right and left hepatic arteries
What join to form the hepatic portal vein?
Splenic vein
Superior mesenteric vein
What connects the venous drainage of the liver to the IVC?
3 short hepatic veins
What are the 4 sites of portal-systemic anastomosis? (systemic : portal)
Oesophageal Veins : Left Gastric Vein
Inferior Rectal Vein : Superior Rectal Vein
Epigastric Veins : Paraumbilical Vein
Retroperitoneal Veins : Visceral Veins
What is the significance of these portal-systemic anastomosis?
If there is a blockage causing hepatic portal tension, these sites of porto-systemic anastomoses could dilate, rupture and bleed heavily
At which of the portal-systemic anastomoses is haemorrhage common?
Oesophagus
Rectum
Describe the structure of the biliary tree.
Cystic duct from the gallbladder joins the hepatic duct (from the right and left hepatic ducts) to form the common bile duct
Where does the common bile duct and pancreatic duct join and where do they enter into the duodenum?
Join at Ampulla of Vater
Enter duodenum at Major Duodenal Papilla
What sphincter guards the ampulla of vater?
Sphincter of oddi
Presence of sphincters in pancreatic and bile duct
There are separate sphincters for the bile duct and pancreatic duct
What do neoplasms of the head of the pancreas result in?
Obstruction of pancreatic and bile duct exits
What forms the common hepatic duct?
Left and right hepatic ducts
What forms the common bile duct?
Common hepatic duct Cystic duct (from gall bladder)
What is the clinical significance of the proximity of the gallbladder to the first part of the duodenum?
Gallstones can press on the duodenum and ulcerate causing a cholecystoduodenal fistula (gall stone will enter duodenum)
What is the largest lymphoid organ in the body?
Spleen
The spleen lies on the underside of which ribs?
9-11
left ribs
What does traumatic rupture of the spleen cause?
Severe haemorrhage
Can’t be repaired, must be removed
Describe the appearance of the superior border of the spleen
Knuckled
What lies in the splenorenal ligament?
Tail of pancreas and splenic artery
What does the gastrosplenic ligament carry?
Blood vessels from splenic artery (short gastric vessels) to the left side of the stomach
