Abdomen 3 Flashcards
which bones protect the liver?
Rib 7-11
Which arteries run in the lesser curvature to supply the stomach?
Left and right gastric arteries (which are branches of the coeliac trunk and branch of hepatic artery proper)
where is the SMA/SMV in relation to duodenum?
anterior to the 3rd inferior part of the duodenum
Identify the recesses of the liver and what is their significance?
Subphrenic Space = Gap between diaphragm and liver
Hepatorenal pouch of Morrison = Kidney and Liver
Subhepatic space = Below liver
Areas where fluid can accumulate, e.g. pus which may form an abscess. These spaces are in communication with each other and therefore infection can track around the peritoneal cavity e.g. Perforated appendix or peptic ulcer.
A chronic alcoholic comes into your clinic with dilated veins of the abdominal wall.
* As a doctor you must consider how this has occurred.
Obstruction of blood through liver will cause increased pressure in hepatic portal vein
This can cause enlargement of the spleen and caput medusa
(swelling of blood vessels due to increased pressure in portosystemic anastomoses)
caput medusa
Varicose enlargement of epigastric veins of the abdominal wall due to Portal Hypertension.
If we split the abdomen into 9 segments.
Which segment would we find the liver?
Is the liver intraperitoneal or retroperitoneal?
3
Right and left hypochondrium and epigastrium
intraperitoneal (except bare area)
Liver
surfaces
anatomical lobes (where are they??)
and functionality of the lobes
diaphragmatic - anterior
visceral - posterior
Gross anatomical lobes - when liver is flipped over
* Right lobe
* Left lobe
* Caudate lobe
* Quadrate lobe - at teh bottom always
(Caudate and quadrate are described as arising from right lobe)
Functionally:
* Caudate lobe is an independent lobe.
* Quadrate lobe to be considered part of left lobe
How is the liver divided into functional segments?
Why is this important clinically?
8 segments are based on distribution of portal venous branches
Each segment has its own portal blood supply
Thus we can remove parts of the liver without affecting the rest - CANCER, important surgically as removal of one segment will not affect the other segments- surgical resection surgery
What in the liver is equivalent to the hilum of the lung?
Which surface of the liver is it located on?
Porta hepatis (entrance and exit point of portal triad)
Located on the visceral surface
What is present in the porta hepatis
Portal triad (Common bile duct, common hepatic artery + hepatic portal vein)
Also left and right hepatic duct and cystic duct
Note the impressions on the visceral surface of the liver
What are all the ligaments of the liver (remnant ones)?
- falciform - liver to abomen wall connection
- round ligament - runs anteriorly, remnant of umbilical vein which carried O2 blood from placenta
- ligamentum venosum - remnant of ductus venosum, runs on visceral surface and used to be to shunt blood into IVC
What is the bare area of the liver?
clin relevance
No peritoneum on top surface of liver
Fence by the anterior and posterior coronary ligament which meet as the left and right triangular ligament
As a result of massive embryonic growth of liver in ventral mesogastrium
What is the clinical significance of the bare area?
Spread of infection from thorax to abdomen
Can also be a site of portal venous anastamoses
remnants of ligamentum venosum and round ligament?
- ductus venosus
- umbillical vein
label what you can
What is the Pringle maneuver?
Haemostat is used to clamp the hepatoduodenal ligament
Stops bleeding through common hepatic artery and hepatic portal vein during liver surgeries
Explain the blood supply in the liver?
dual blood supply?
Hepatic artery proper and hepatic portal vein will enter and be processed by sinusoids
The sinusoids will form central veins which will form hepatic veins
3 hepatic veins will join directly into the IVC and enter into the right atrium
liver recieves dual blood supply from vessels in teh portal hepatis
1 - portal hepatic vein - brings in 75% of blood to liver - from GIT - brings very nutrient rich blood, formed by superior mesenteric artery and splenic artery behind neck of pancreas
2 - proper hepatic artery - 25% blood of liver supply
all blood is then processed by sinusoids and taken into hepatic veins then IVC then right atrium
How many hepatic veins are there?
3; right, middle, and left
These will join directly into the IVC and enter into the right atrium
What forms the hepatic portal vein?
entry into liver to be processed in sinusoids
Blood from spleen and midgut through splenic vein (IMA) and superior mesenteric
How does blood from the hindgut enter the hepatic portal circulation.
What is an exception to this?
Via the inferior mesentaric which will enter into the splenic vein
1/3 of individuals, will enter directly into the hepatic portal vein
What are portosystemic anastomoses?
Collateral circulation between systemic (into ivc) and portal (into liver) circulation
(two options one to heart one to liver)
What are sites of portosystemic anastomoses? hint: OOO
O oesopphagus, O umbillicus bc its round, O anus bc its round
Oesophageal veins
Portal - left gastric
Systemic - Azygous
Peri-umbilical region
Portal - paraumbilical
Systemic - Epigastric
Anal canal
Portal - Inferior mesentaric vein
Systemic - Inferior and middle rectal veins
what are all teh ligaments of the liver (peritineum) formed from embryonic growth of liver in ventral mesogastrium
falciform
left and right triangular
anterior and posterior coronary
these form bare area
Gall bladder function
Stores extra bile for lipid digestion
Describe the flow of bile into the duodenum from the liver and gall bladder
Coming from liver: Left and right hepatic will form the common hepatic
Coming from gall bladder: Cystic duct
Common hepatic + cystic = form common bile duct which will empty into the duodenum
Label the diagram of the biliary tree
Spiral valve of gall bladder
Spiral folds
Opens cystic duct to release bile
What are common sites of obstruction for gall stones?
Hepatopancreatic ampulla of vater
Cystic duct
Hartmann’s pouch (infundibulum)
What are gallstones? and where do they commonly happen
Stasis of bile forming cholesterol or pigemented crystals
Can result in jaundice when bile does not leave the gallbladder and enters the blood
infundibulum
What artery supplies the gallbladder and where does it arise?
Cystic artery –>Right hepatic artery