5. Structure of the liver, gall bladder, biliary tree & pancreas.pptx Flashcards
Bile production vs storage location?
Bile production: Liver
Bile storage and concentration: Gall bladder
What is Glisson’s capsule?
Deep to its peritoneal covering, the liver is completely surrounded by Glisson’s capsule, a thin connective tissue layer that sends extensions into the organ, in between the lobules
Liver arterial supply?
Venous drainage?
The liver is supplied by the (hepatic) portal vein bringing absorbed nutrients from the stomach and intestine; and the hepatic artery which supplies the hepatocytes (liver cells) with oxygen.
Venous drainage is by hepatic veins that enter the inferior vena cava.
Bile drainage from liver to gall bladder?
Bile is drained via canaliculi that lie between the hepatocytes into bile ductules and eventually into bile ducts.
4 liver function?
- Synthesis and secretion of bile.
- Storage of glucose, glycogen, proteins, vitamins and fats.
- Detoxification of metabolic waste.
- Synthesis of blood clotting and anticoagulant factors (fibrinogen and prothrombin).
Constituents of bile
Bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water and electrolytes.
Where do bile pigments derive from?
What is the role of KUPFFER CELLS?
Bile pigments are derived as the breakdown products of haemoglobin.
Kupffer cells play a role in their formation. Bile salts
are responsible for the detergent and emulsifying effect of bile on fats, they also increase the absorption of fats by the small intestine.
What is the name of the liver functional unit?
Liver lobule
What is the structure of a liver lobule?
Sheets of cells (hepatocytes) radiate outwards from the central vein, which forms the central axis of the lobule.
Sinusoids lie between the sheets and carry blood from the hepatic artery and portal vein (now mixed oxygenated and de-oxygenated blood) to the central vein.
Bile flow is in the opposite direction, in the canaliculi between the hepatocytes.
The bare area of the liver is between which two ligaments?
The coronary and triangular “ligaments” on posterior liver surface
What/where are the 4 lobes of the liver?
Anterior: Left, right (separated by falciform ligament, quadrate
Posterior: Caudate *next to IVC)
What structure make up the portal triad>
Portal vein
Hepatic artery
Hepatic (biliary) ducts
Liver divisions
Anatomically?
Functionally?
Anatomically:
-Right lobe (larger)
(Divided by the falciform ligament and lesser omentum)
-Left lobe
Functionally by vascular distribution:
- Caudate and quadrate lobe are part of left
- Divided by the fossa for the gall bladder and iVC
What are the couinaud segments of the liver related to/
The functions of the liver segments
What are liver ligaments?
Reflections of peritoneum that surround the bare area.
On the left, the coronary ligaments form the left triangular ligament, while on the right, they form the right triangular ligament
Liver lymph drainage?
The lymph vessels leave the liver and enter several lymph nodes in the porta hepatis
The efferent vessels pass to the coeliac nodes
A few vessels pass from the bare area of the liver through the diaphragm to the posterior mediastinal lymph nodes.
How is jaundice cause from lymph drainage of liver
Retrograde tumour spread from the coeliac nodes may involve the hepatic nodes in the porta hepatis and obstruct the bile ducts to cause jaundice
Liver nerve supply?
Sympathetic nerves form the coeliac plexus (foregut, therefore greater splanchnic nerve, T 5 to 9)
The anterior vagal trunk gives rise to a large parasympathetic hepatic branch, which passes directly to the liver
Structure of gall bladder?
Rounded fundus
Body that is its major part Neck that narrows towards the cystic duct
How does bile reach GIT from gall bladder
`the cystic duct combines with the common hepatic duct to form the bile duct and enter the 2nd part of the duodenum with the pancreatic duct at the ampulla of Vater
How is the cystic duct lumen held up?
The mucous membrane of the cystic duct is raised to form a spiral fold that is continuous with a similar fold in the neck of the gallbladder The fold is commonly known as the “spiral valve (of Heister)”, the function of which is to keep the lumen constantly open.
Blood supply of gall bladder?
Arterial: Cystic artery, a branch of the right hepatic artery
Venous: Drains directly into the portal vein
Lymph drainage of gall bladder?
To a cystic lymph node neck GB neck.
- -> Hepatic nodes
- -> Coeliac nodes
Nerve supply of gallbladder?
Sympathetic:
-Foregut (T5-9)
Parasympathetic:
-Vagal fibres from the coeliac plexus.
What is used to surgically locate the cystic artery?
Bounded by?
The Calot's hystohepatic triangle Bounded by: -The edge of the right lobe of the liver -The common hepatic duct -The cystic duct
Referred pain from gall bladder?
Referred pain from the gallbladder is usually to the epigastrium (T7 to 9), but irritation of adjacent peritoneum may involve the phrenic nerve (C3, 4, 5) giving referred pain to the right shoulder tip, via C3, 4 in the supraclavicular nerves
Cause for painless, continues jaundice?
Carcinoma of the head of the pancreas may obstruct the bile duct causing painless, continuous jaundice
Where does common bile duct enter duodenum?
At the major duodenal papilla
What does the ERCP test stand for and identify?
Endoscopic, retrograde, cholangio pancreaticogram (ERCP) with stones in the gall bladder
Where does the transpyloric place lie?
What structures lie on it?
The Transpyloric Plane at L1 is midway between the jugular notch and the pubic symphysis, and through the tips of the 9th costal cartilages
List of structures that lie on it:
- Fundus of gall bladder
- Pylorus
- Neck of pancreas
- Formation of portal vein
- Hilum of kidney (right lower than left)
- Spinal cord ends at L1/2
- Aorta and origin of SMA
- IVC
- 2nd part of duodenum
Functions of the pancreas?
Exocrine and endocrine functions: digestive pro-enzymes secreted via pancreatic duct to 2nd part of duodenum; insulin and glucagon from the islets of Langerhans
Journey of pancreatic duct?
The pancreatic duct begins in the tail of the pancreas and joins the bile duct at the hepatopancreatic ampulla (of Vater), that opens as the major duodenal papilla
What are the 3 sphincters that make up the sphincter of Oddi?
1 around the end of the pancreatic duct (to control flow but prevent bile entering the pancreas)
1 around the end of the bile duct
1 around the combined ducts
Blood supply of the pancreas?
- Coeliac trunk FOREGUT
- Gastroduodenal (direct to pancreas)
- Superior pancreaticoduodenal (to Ant and Post branches)
- Splenic –> Greater and Dorsal Pancreatic branches - Superior mesenteric artery MIDGUT
- Inferior pancreaticoduodenal (to Ant and Post branches)
Mirrored by veins. Draining to portal vein although the portal vein is the mirror of the gasproduodenal artery.
Affect on gallbladder of cholecystokinin?
Contraction which is produced but he mucous membrane of the duodenum on arrival of fatty food from stomach.
Lymph drainage of the pancreas?
Along arteries
Efferent vessels drain into the coeliac and superior mesenteric lymph nodes
Nerve supply of the pancreas?
Comes with arteries and is vagus (PS) + T7-9 and T10-11
