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X. MRCS: Anatomy > Abdomen: Liver, Biliary System, Pancreas > Flashcards

Abdomen: Liver, Biliary System, Pancreas Flashcards

1
Q

Lobes of the liver

A

Right lobe
Left lobe
Caudate lobe
Quadrate lobe

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2
Q

Caudate lobe

A

Upper aspect of visceral surface.

Lies between IVC and fossa produced by ligamentum venosum

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3
Q

Quadrate lobe

A

Lower aspect of visceral surface

Lies between gallbladder and fossa produced by ligamentum teres

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4
Q

Glisson’s capsule

A

Fibrous cover of the liver

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5
Q

Ligaments of the liver

A

Falciform ligament
Coronary ligament
Triangular ligaments (left and right)
Lesser omentum (hepatogastric/hepatoduodenal)

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6
Q

Falciform ligament

A

Sickle shaped
Attaches to anterior surface of liver to anterior abdominal wall
Free edge contains ligamentum teres (umbilical vein remnant)

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7
Q

Coronary ligament

A

Superior surface of liver to inferior surface of diaphragm.
Demarcates bare area of liver.
Anterior and posterior folds unite to form triangular ligaments on right and left lobes

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8
Q

Triangular ligaments (left and right)

A

Left: attaches left lobe to diaphragm
Right: attaches right lobe to diaphragm

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9
Q

Lesser omentum

A

Attaches liver to lesser curve of stomach (hepatogastric ligament)
and first part of duodenum (hepatoduodenal ligament).
Demarkation of epiploic foramen (of Winslow)

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10
Q

Hepatic recesses

A

Subphrenic spaces
Subherpatic space
Morison’s pouch

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11
Q

Subhepatic spaces

A

Between diaphragm and anterior/superior aspects of liver

Divided into right and left by falciform ligament

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12
Q

Subhepatic space

A

subdivision of supra colic compartment (above transverse mesocolon
Between inferior surface of liver and transverse colon

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13
Q

Morison’s pouch

A

Potential space between visceral surface of liver and right kidney
Deepest part of peritoneal cavity when supine

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14
Q

Blood supply to the liver

A

Hepatic artery proper (25%): branch of coeliac axis

Hepatic portal vein (75%)

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15
Q

Branches of the hepatic portal vein

A 
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
Cystic vein
Left gastric vein
Right gastric vein
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16
Q

Venous drainage from the Liver

A

Interlobular veins drain into collecting veins

Collecting veins form hepatic veins which drain into IVC

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17
Q

Innervation to the liver

A

Hepatic plexus:
Sympathetic (coeliac plexus)
Parasympathetic (vagus nerve)

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18
Q

Lymphatic drainage of the liver

A

Anterior: hepatic lymph nodes
Posterior: phrenic and posterior mediastinal nodes

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19
Q

Functions of the liver

A 
Production of bile
Production of proteins
Production of cholesterol
Conversion of glucose - glycogen
Regulation of blood amino acid levels
Processing haemoglobin
Conversion of ammonia to urea
Cleaning blood of poisonous substances
Immune system
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20
Q

Bile

A

Produced by hepatocytes
Stored in gallbladder
Functions: absorption of fats
Made of: bile salts, cholesterol, bilirubin

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21
Q

Bile salts

A

Primary bile salts: Cholesterol broken down to cholic acid and chenodeoxycholic acid by 7a-hydroxylase

Secondary bile acids: dehydroxilated in intestines

Liver conjugates glycine/taurine to create 8 different bile salts

22
Q

Conjugation of Bilirubin

A

RBCs broken down by macrophages (mononuclear phagocyte system: spleen/liver/lymph nodes)
Haemoglobin –> Haem + Fe2+
Haem (ham oxidase) –> biliverdin
Biliverdin (biliverdin reductase) –> unconjugated bilirubin
UC bilirubin (+albumin) –> taken to liver
Hepatocytes conjugate bilirubin with glucoronic acid (uridine glucoronyl transferase).

23
Q

Conjugated bilirubin

A

More soluble and goes into intestine
Gut bacteria –> urobilinogen (stercobilinogen)
urobilinogen/stercobilinogen (oxidised) –> stercobilin (what makes faeces brown)

24
Q

Enterohepatic circulation

A

Urobilinogen (in kidneys) –> urobilin
Urobilin is water soluble and excreted in urine
Urobilinogen can be recycled and taken back to liver via portal circulation

25
Q

Pre-hepatic Jaundice

A

Increased presence of unconjugated bilirubin

Liver is unable to conjugate leading to increased unconjugated bilirubin in blood

26
Q

Hepatic Jaundice

A

Decreased ability of liver to conjugate bilirubin

Increased conjugated and unconjugated bilirubin in blood

27
Q

Post-hepatic jaundice

A

Blockage of bile ducts

Backflow of conjugated bilirubin into blood

28
Q

Parts of the pancreas

A 
Head
Ucinate process
Neck
Body
Tail
29
Q

Anatomical relations of the pancreas

A

Stomach: separated by the lesser sac. Stomach and pylorus lie anterior to pancreas
Duodenum: C shaped duodenum curves around head of pancreas. 1st part of D anterior, 2nd part lateral
Transverse mesocolon: attaches to anterior surface of pancreas
Common bile duct: descends behind head of pancreas before opening into 2nd part of D.
Spleen: located posteriorly and laterally. Lienorenal ligament formed from peritoneum and connects spleen to tail

30
Q

Anatomic relations to pancreas: major vessels

A

Aorta and IVC pass posterior to head of pancreas
SMA lies behind the neck and anterior to uncinate
Splenic and SMV unit to form hepatic portal vein posterior to the neck
Splenic artery traverses superior border of pancreas

31
Q

Head of pancreas

A

Widest part, lies in C-shaped duodenum and connected to it by connected tissue

32
Q

Uncinate process of pancreas

A

Projection arising from lower part of head of pancreas

Lies posterior to SMA

33
Q

Neck of pancreas

A

Located between head and body. Overlies SMA, which form groove in its posterior aspect

34
Q

Body of pancreas

A

centrally located. Crossing midline of human body to lie behind stomach and left of SMA

35
Q

Tail of pancreas

A

Left end of pancreas.
Lies with close proximity of hilum of spleen.
Only part of pancreas that is intraperitoneal

36
Q

Exocrine pancreas

A

Lobulated, serous gland.
Produces digestive enzyme precursors.
Composed of 1 million acini (‘berry-like’ clusters of cells)

37
Q

Duct system of pancreas

A

Acini connected by short intercalated ducts.
Intercalated ducts unite to drain into network of intralobular collecting ducts.
intralobular ducts drain into main pancreatic duct
Pancreatic duct runs the length of pancreas and unites with common bile duct forming hepatopancreatic ampulla of vater. Secretions are controlled by sphincter of Oddi

38
Q

Blood supply to pancreas

A 
Pancreatic branches of splenic artery (Coeliac axis)
Superior pancreaticoduodenal (branch of gastroduodenal, common hepatic, coeliac axis)
inferior pancreaticoduodenal (SMA)
39
Q

Venous drainage from pancreas

A

Superior mesenteric vein

Branches into the splenic vein

40
Q

Lymphatic drainage of the pancreas

A

Pancreaticosplenal nodes and pyloric nodes

41
Q

Exocrine functions of the pancreas

A

Enzyme secretion: proteases, pancreatic lipase, amylase

Bicarb secretion

42
Q

Bicarbonate production by the pancreas

A

In the pancreatic duct cells
CO2 + H2O (carbonic anhydrase) = HCO3- + H+
H+ ions are transported out of the pancreatic duct cells into the blood in exchange for Na+ (H+/Na+ antiporter)
HCO3- moved into duct (in exchange for Cl-)

43
Q

Regulation of pancreatic secretion

A

Vagus nerve (smell/seeing food, stomach stretch)
Secretin (released by S cells in response to acidic chyme)
Cholecystokinin (released by I cells in response to fatty acids and protein in chyme, and low pH)

44
Q

Parts of the gallbladder

A

Fundus
Body
Neck

45
Q

Anatomic relations of the gallbladder

A

Anterior & superior: inf border of liver and anterior abdominal wall
Posterior: transverse colon and proximal duodenum
Inferior: biliary tree and remaining parts of duodenum

46
Q

Parts of the biliary tree

A 
Common hepatic duct
Cystic duct
Common bile duct
Pancreatic duct
Hepatopancreatic ampulla of vater
47
Q

Blood supply to the gallbladder

A

Cystic artery (branch of right hepatic artery)

48
Q

Venous drainage from the gall bladder

A

Neck: Cystic vein, drains directly into portal vein

Fundus and body: directly drains into hepatic sinusoids

49
Q

Innervation of the gallbladder

A

Parasympathetic: vagus

Sympathetic/sensory: coeliac plexus

50
Q

Effect of Cholecystokinin on the gallbladder

A

CCK stimulates contraction of the gallbladder to release additional stored bile into duodenum

X. MRCS: Anatomy (18 decks)

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