9.1 - Anatomy of the Liver, Gallbladder, Spleen & Pancreas Flashcards
3 functions of the liver?
An accessory digestion gland, the liver performs a wide range of functions, such as:
- Synthesis of bile
- Glycogen storage
- Clotting factor production
Where is the liver located?
(Surface anatomy)
Location: superficial, in right upper quadrant of the abdominal cavity, deep to ribs 7-11.
What are the 2 surfaces of the liver?
What is the bare area of the liver?
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Diaphragmatic surface – the anterosuperior surface of the liver.
- It is smooth and convex, fitting snugly beneath the curvature of the diaphragm.
- The posterior aspect of the diaphragmatic surface is not covered by visceral peritoneum, and is in direct contact with the diaphragm itself (known as the ‘bare area’ of the liver).
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Visceral surface – the posteroinferior surface of the liver.
- With the exception of the fossa of the gallbladder and porta hepatis, it is covered with peritoneum.
- It is moulded by the shape of the surrounding organs, making it irregular and flat.
- It lies in contact with the right kidney, right adrenal gland, right colic flexure, transverse colon, first part of the duodenum, gallbladder, esophagus, and stomach.
Diaphragmatic surface: anterior, superior & some posterior, smooth, dome-shaped, divided into R & L lobe by the Falciform & coronary ligaments.
Visceral surface: posteroinferior, impressions from contact w/ other organs (gastric, gallbladder, renal, colic (right colic flexure & transverse colon), duodenal, oesophageal).
What are the 4 ligaments of the liver?
- What does the falciform ligament attach? What does its free edge attach?
- What is the name of the umbilical vein remnant?
- What does the lesser omentum connect?
- Which 2 ligaments does the lesser omentum consist of?
- Which ligament surrounds the portal triad?
- Falciform ligament – this sickle-shaped ligament attaches the anterior surface of the liver to the anterior abdominal wall. Its free edge contains the ligamentum teres, a remnant of the umbilical vein.
- Coronary ligament (anterior and posterior folds) – attaches the superior surface of the liver to the inferior surface of the diaphragm and demarcates the bare area of the liver. The anterior and posterior folds unite to form the triangular ligaments on the right and left lobes of the liver.
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Triangular ligaments (left and right):
- The left triangular ligament is formed by the union of the anterior and posterior layers of the coronary ligament at the apex of the liver and attaches the left lobe of the liver to the diaphragm.
- The right triangular ligament is formed in a similar fashion adjacent to the bare area and attaches the right lobe of the liver to the diaphragm.
- Lesser omentum – Attaches the liver to the lesser curvature of the stomach and first part of the duodenum. It consists of the hepatoduodenal ligament (extends from the duodenum to the liver) and the hepatogastric ligament (extends from the stomach to the liver). The hepatoduodenal ligament surrounds the portal triad.
What are the hepatic recesses? (3)
- Clinical significance?
- Which will fill up in a bedridden pt with ascites?
Hepatic Recesses = anatomical spaces between the liver and surrounding structures. They are of clinical importance as infection may collect in these areas, forming an abscess.
- Subphrenic spaces – located between the diaphragm and the anterior and superior aspects of the liver. They are divided into a right and left by the falciform ligament.
- Subhepatic space – a subdivision of the supracolic compartment (above the transverse mesocolon), this peritoneal space is located between the inferior surface of the liver and the transverse colon.
- Morison’s pouch – a potential space between the visceral surface of the liver and the right kidney. This is the deepest part of the peritoneal cavity when supine (lying flat), therefore pathological abdominal fluid such as blood or ascites is most likely to collect in this region in a bedridden patient.
What are the hepatic recesses? (3)
- Clinical significance?
- Which will fill up in a bedridden pt with ascites?
Hepatic Recesses = anatomical spaces between the liver and surrounding structures. They are of clinical importance as infection may collect in these areas, forming an abscess.
- Subphrenic spaces – located between the diaphragm and the anterior and superior aspects of the liver. They are divided into a right and left by the falciform ligament.
- Subhepatic space – a subdivision of the supracolic compartment (above the transverse mesocolon), this peritoneal space is located between the inferior surface of the liver and the transverse colon.
- Morison’s pouch – a potential space between the visceral surface of the liver and the right kidney. This is the deepest part of the peritoneal cavity when supine (lying flat), therefore pathological abdominal fluid such as blood or ascites is most likely to collect in this region in a bedridden patient.
What is the fibrous capsule around the liver known as?
Glisson’s capsule
What are the 4 anatomical lobes of the liver?
Anatomical lobes of the liver
Attachment of falciform ligament & the left sagittal fissure separates large right lobe from small left lobe = anatomical lobes
On the visceral surface, the R & L sagittal fissures are course each side of, and the porta hepatis separates, the quadrate lobe (inferior & anterior) & caudate lobe (posterior & superior) = accessory lobes.
What is the Microscopic structure of the liver?
- Cells of liver?
- Structural units of liver?
- 3 structures of portal triad?
Microscopic
Microscopically, the cells of the liver (known as hepatocytes) are arranged into lobules. These are the structural units of the liver.
Each anatomical lobule is hexagonal-shaped and is drained by a central vein. At the periphery of the hexagon are three structures collectively known as the portal triad:
- Arteriole – a branch of the hepatic artery entering the liver.
- Venule – a branch of the hepatic portal vein entering the liver.
- Bile duct – branch of the bile duct leaving the liver.
The portal triad also contains lymphatic vessels and vagus nerve (parasympathetic) fibres.
What is the vasculature of the liver?
Dual blood supply:
- Portal vein (from the SMV & splenic vein)- 75% blood supply to liver
- Common hepatic artery (from coeliac trunk)- 25% blood supply to liver
- Venous drainage via middle, left & right hepatic veins to IVC he liver has a unique dual blood supply:
- Hepatic artery proper (25%) – supplies the non-parenchymal structures of the liver with arterial blood. It is derived from the coeliac trunk.
- Hepatic portal vein (75%) – supplies the liver with partially deoxygenated blood, carrying nutrients absorbed from the small intestine. This is the dominant blood supply to the liver parenchyma, and allows the liver to perform its gut-related functions, such as detoxification.
Venous drainage of the liver is achieved through hepatic veins. The central veins of the hepatic lobule form collecting veins which then combine to form multiple hepatic veins. These hepatic veins then open into the inferior vena cava.
What is the vasculature of the liver?
Dual blood supply:
- Portal vein (from the SMV & splenic vein)- 75% blood supply to liver
- Common hepatic artery (from coeliac trunk)- 25% blood supply to liver
- Venous drainage via middle, left & right hepatic veins to IVC he liver has a unique dual blood supply:
- Hepatic artery proper (25%) – supplies the non-parenchymal structures of the liver with arterial blood. It is derived from the coeliac trunk.
- Hepatic portal vein (75%) – supplies the liver with partially deoxygenated blood, carrying nutrients absorbed from the small intestine. This is the dominant blood supply to the liver parenchyma, and allows the liver to perform its gut-related functions, such as detoxification.
Venous drainage of the liver is achieved through hepatic veins. The central veins of the hepatic lobule form collecting veins which then combine to form multiple hepatic veins. These hepatic veins then open into the inferior vena cava.
Which veins drain into the hepatic portal vein?
SMV & IMV & Splenic
What are the functional subdivisions of the liver?
What are the functional subdivisions of the liver?
What is the porta hepatis?
5 contents?
Porta hepatis: transverse fissure where structures enter/ leave liver
- Portal vein
- Hepatic artery
- Lymphatic vessels
- Hepatic nerve plexus
- Hepatic ducts
Where is the gallbladder located?
The gallbladder is a gastrointestinal organ located within the right hypochondrial region of the abdomen. This intraperitoneal, pear-shaped sac lies within a fossa formed between the inferior aspects of the right and quadrate lobes of the liver.
What is Calots triangle?
- Borders? (medial, inf, sup)
- Contents?
Borders
- Medial – common hepatic duct.
- Inferior – cystic duct.
- Superior – inferior surface of the liver.
Contents
- Right hepatic artery – formed by the bifurcation of the proper hepatic artery into right and left branches.
- Cystic artery – typically arises from the right hepatic artery and traverses the triangle to supply the gall bladder.
- Lymph node of Lund – the first lymph node of the gallbladder.
- Lymphatics
Anatomical structure of the gallbladder - 3 divisions?
Where do gallstones often lodge?
- Fundus – the rounded, distal portion of the gallbladder. It projects into the inferior surface of the liver in the mid-clavicular line.
- Body – the largest part of the gallbladder. It lies adjacent to the posteroinferior aspect of the liver, transverse colon and superior part of the duodenum.
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Neck – the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree.
- The neck contains a mucosal fold, known as Hartmann’s Pouch. This is a common location for gallstones to become lodged, causing cholestasis.
What is the biliary tree? What is its course?
Which sphincter regulates the major duodenal papilla?
The Biliary Tree = a series of gastrointestinal ducts allowing newly synthesised bile from the liver to be concentrated and stored in the gallbladder (prior to release into the duodenum).
Bile is initially secreted from hepatocytes and drains from both lobes of the liver via canaliculi, intralobular ducts and collecting ducts into the left and right hepatic ducts. These ducts amalgamate to form the common hepatic duct, which runs alongside the hepatic vein.
As the common hepatic duct descends, it is joined by the cystic duct – which allows bile to flow in and out of the gallbladder for storage and release. At this point, the common hepatic duct and cystic duct combine to form the common bile duct.
The common bile duct descends and passes posteriorly to the first part of the duodenum and head of the pancreas. Here, it is joined by the main pancreatic duct, forming the hepatopancreatic ampulla (commonly known as the ampulla of Vater) – which then empties into the duodenum via the major duodenal papilla. This papilla is regulated by a muscular valve, the sphincter of Oddi.
Blood supply to gallbladder?
Venous drainage?
The arterial supply to the gallbladder is via the cystic artery – a branch of the right hepatic artery (which itself is derived from the common hepatic artery, one of the three major branches of the coeliac trunk).
Venous drainage of the neck of the gallbladder is via the cystic veins, which drain directly into the portal vein. Venous drainage of the fundus and body of the gallbladder flows into the hepatic sinusoids.
Which clinical signs are seen with blockage of common hepatic duct/bile duct/cystic duct?
Gallstone in:
In the common hepatic duct or bile duct = obstructive jaundice
In the cystic duct = pain (no jaundice)
Define the following terms:
- Cholelithiasis
- Biliary colic
- Cholecystitis
- Choledocholithiasis
- Cholangitis
What is Charcot’s Triad?
Charcot’s triad is the manifestation of biliary obstruction with upper abdominal pain, fever and jaundice.
Explain the anatomical basis of pain caused by gall bladder disease.
Pain felt Right tip of shoulder
What are the 2 functions of the pancreas?
Where is it located?
What is the level of the transpyloric plane?
Intraperitoneal or retro?
The pancreas is an abdominal glandular organ with both digestive (exocrine) and hormonal (endocrine) functions.
The pancreas is an oblong-shaped organ positioned at the level of the transpyloric plane (L1). With the exception of the tail of the pancreas, it is a retroperitoneal organ, located deep within the upper abdomen in the epigastrium and left hypochondrium regions.
What are the 5 parts of the pancreas?
- Head - widest part, it lies within the C-shaped curve of the duodenum and is connected to it by CT.
- Uncinate process – a projection arising from the lower part of the head and extending medially to lie beneath the body of the pancreas. It lies posterior to the superior mesenteric vessels.
- Neck – located between the head and the body of the pancreas. It overlies the superior mesenteric vessels which form a groove in its posterior aspect.
- Body – centrally located, crossing the midline of the human body to lie behind the stomach and to the left of the superior mesenteric vessels.
- Tail – the left end of the pancreas that lies within close proximity to the hilum of the spleen. It is contained within the splenorenal ligament with the splenic vessels. This is the only part of the pancreas that is intraperitoneal.
Arterial supply & venous drainage of the pancreas?
splenic artery
The head is additionally supplied by the superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively.
Venous drainage of the head of the pancreas is into the superior mesenteric branches of thehepatic portal vein. The pancreatic veins draining the rest of the pancreas do so via the splenic vein.
What are the causes of pancreatitis?
(GET SMASHED)
What are the 2 ligaments of the spleen?
- Which vessels run in the splenorenal ligament? What else is in here?
- What is between these 2 ligaments?
- Gastrosplenic ligament – anterior to the splenic hilum, connects the spleen to the greater curvature of the stomach.
- Splenorenal ligament – posterior to the splenic hilum, connects the hilum of the spleen to the left kidney. The splenic vessels and tail of the pancreas lie within this ligament.
Between these 2 ligaments is the lesser sac.
What is the arterial supply of the spleen?
What is t
What is the venous drainage of the spleen?
The spleen is a highly vascular organ. It receives most of its arterial supply from the splenic artery. This vessel arises from the coeliac trunk, running laterally along the superior aspect of the pancreas, within the splenorenal ligament. As the artery reaches the spleen, it branches into five vessels – each supplying a different part of the organ.
These arterial branches do not anastomose with each other – giving rise to vascular segments of the spleen. This enables a surgeon to remove one of these segments without affecting the others (a procedure known as a subtotal splenectomy).
Venous drainage occurs through the splenic vein. It combines with the superior mesenteric vein to form the hepatic portal vein.
Relations of spleen?
Spleen Relations:
- Stomach anteriorly – gastric impression
- Diaphragm posteriorly (separates it from the pleura, lungs & ribs.
- Colic flexure inferiorly (sharp bend b/w TC & DC) – colic impression.
- Left kidney medially – renal impression.
What are the 2 surfaces of the spleen?
Diaphragmatic (lateral): round/ convex outer surface pushed against the diaphragm.
Visceral (medial) surface: splenic hilum- where splenic branches of the splenic artery (largest branch of coeliac trunk) & splenic vein (joins SMV to form portal vein) & tail of the pancreas is.
3 Impressions of spleen?
Renal
Gastric
Colic
