Abdomen, Pelvis and Perineum 2 Flashcards
Why is the liver an intraperitoneal organ?
it is covered on all sides by visceral peritoneum
What are the functions of the liver?
- clears the blood of harmful substances e.g alcohol
- produces cholesterol
- converts glucose to glycogen to aid with its storage
How does the liver aid digestion?
- Produces bile
- Bile aids with the break down of dietary fats and also assists with carrying waste out of the liver
What is the arterial supply of the liver?
Right and left hepatic arteries
What is the innervation of the liver?
- sympathetic = coeliac plexus
- parasympathetic = vagus fibres
What are the four lobes of the liver?
Right, left, quadrate and caudate
How many functional segments does the liver have?
8
Where is the liver located?
The highest part of the right abdominal cavity, beneath the diaphragm (RUQ)
What are the attachments of the liver?
Ligaments made of peritoneum
Where does the falciform ligament run from?
From the highest part of the liver to the hepatic notch (anterior border)
What is the falciform ligament?
- two layers of peritoneum
- anchors surface of liver to the abdominal wall and diaphragm
- demarcates the left and right lobes
Label this diagram
- Left lobe
- Falciform ligament
- Right lobe
- Gall bladder
- Inferior margin
What are the other ligaments of the liver?
- left and right triangular ligament
- coronary ligament
- ligamentum teres
- round ligament
What is the hilum/porta hepatis of the liver?
the site at which the hepatic portal vein, proper hepatic artery and the common hepatic duct enter/leave the liver
What is Glisson’s capsule?
- dense connective tissue layer underneath the visceral peritoneum of the liver
- pain from here is very well localised
What happens when the Glisson’s capsule is stretched?
Sharp pain over the right upper quadrant
What are the two surfaces of the liver?
- diaphragmatic (anterior)
- visceral (posterior)
What is the bare area of the liver?
- area that is not covered in peritoneum
- between liver and diaphragm
- borders are anterior and posterior coronary ligaments and left and right triangular ligaments
What is the gallbladder?
Storage site for bile
What type of organ is the gallbladder?
Intraperitoneal
What are the relations of the gallbladder?
- fundus projects below lower margin of the liver in line with the 9th costal cartilage
- in contact with the transverse colon and descending duodenum posteriorly
What is the blood supply of the gallbladder?
- cystic artery (branch of the right hepatic artery)
- cystic vein (drains directly into the hepatic portal vein)
Where is a gallstone most likely to become lodged in the gallbladder
Neck due to its narrow diameter
How does billiary colic present?
sharp pain in the epigastric and/or right hypochondrium region
What is the biliary tree?
series of ducts which stem from the liver and gallbladder to move bile towards the duodenum
What does the biliary tree join with?
Main pandreatic duct to form the hepatopancreatic ampulla
What is the function of the hepatopancratic ampulla?
Combines bile and pancreatic enzymes which are then drained into the descending duodenum
Label this diagram of the porta hepatis
- Hepatic duct
- Bile duct
- Portal artery
- Portal vein
How does bile leave the liver?
through the right and left hepatic ducts, which merge to form the common hepatic duct
Which ducts transport bile out of the gallbladder?
Cystic duct
Which ducts form the common bile duct
Common hepatic duct and cystic duct
What is the pancreas?
Endocrine and exocrine digestive organ
Where is the pancreas located?
- epigastric region and upper left quadrant
- transpyloric plane (L1-L2) behind stomach
Label 1-5
- Left lobe
- Hepatic portal vein
- Right proper hepatic artery
- Caudate lobe
- Left proper hepatic artery
Label 6-10
- Common hepatic duct
- Fissure of round ligament
- Gallbladder
- Quadrate lobe
- Right lobe
What is the hepatopancreatic duct?
Joining of the pancreatic and bile ducts
What does the hepatopancreatic duct drain into?
Duodenum via the major duodenal papilla
Is the pancreas retroperitoneal or intraperitoneal?
Retroperitoneal apart from tail
Label 1-5
- Tail
- Body
- Neck
- Head
- Uncinate process
Label 6-10
- Main pancreatic duct
- Major duodenal papilla
- Duodenum
- Common bile duct
- Main pancreatic duct
Label 11-14
- Hepatopancreatic ampulla
- Descending duodenum
- Major duodenal papilla
- Hepatopancreatic sphincter
What is the blood supply of the head of the pancreas?
Superior and inferior pancreaticoduodenal arteries
What are the features of pain from the pancreas?
- poorly localised
- often referred to the back
- often confused with pain from stomach or transverse colon
What can cancer at the head of the pancreas cause?
- obstructive jaundice
- tumour can compress the bile duct, backing up the biliary tree
What is the spleen?
- lymphoid organ
- not an accessory organ of the GIT (doesn’t aid with digestion)
Where is the spleen located?
- left hypochondrium, posterior to stomach
- in front of left ribs 9-11
Can you live without a spleen?
Yes, many of its functions are carried out by the liver
Is the spleen intraperitoneal or retroperitoneal?
Intraperitoneal
What is the spleen attached to and how?
- stomach and left kidney
- gastrosplenic and splenorenal ligaments
Label the diagram
- Superior border
- Inferior border
- Splenic artery
- Splenic vein
Where does the blood supply to the abdominal organs come from?
- Abdominal aorta (continuation of thoracic aorta)
- Inferior vena cava
Are the abdominal aorta and IVC intraperitoneal or retroperitoneal?
Retroperitoneal
Where are the abdominal aorta and IVC located?
- abdominal aorta is slightly left of the midline
- IVC is slightly right of the midline
Where does the abdominal aorta enter the abdominal cavity?
T12, behind the diaphragm
What are the three main branches of the abdominal aorta?
- coeliac trunk (foregut)
- superior mesenteric artery (midgut)
- inferior mesenteric artery (hindgut)
What does the coeliac trunk divide into?
- left gastric artery
- splenic artery
- common hepatic artery
- superior pancreaticoduoedenal artery
What does the common hepatic artery divide into?
- gastroduodenal artery
- proper hepatic artery
What can a ruptured ulcer in the stomach or first part of the duodenum cause?
- can erode through the organ walls and rupture nearby gastroduodenal artery
- leads to large amount of bleeding in the peritoneal cavity
What level does the coeliac trunk arise from?
T12
What does the superior mesenteric artery branch into?
- inferior pancreaticoduodenal artery
- jejunal and ileal arteries
- right colic artery
- middle colic artery
What does the inferior pancreaticoduodenal artery supply?
- head of pancreas
- duodenum
What does the right colic artery supply?
Ascending colon
What does the middle colic artery supply?
Transverse colon
What do the ileal and jejunal arteries give rise to?
- arterial arcades
- anastamose with each other
- lie within the mesentery of the small intestine
Where does the superior mesenteric artery arise from?
L1
What does the inferior mesenteric artery branch into?
- left colic artey
- sigmoid artery
- superior rectal artery
Where does the inferior mesenteric artery arise from?
L3
What is the marginal artery?
- anastomosis of superior and inferior mesenteric artery
- blood supply for watershed area of transverse colon
Which branch of the abdominal artery is largest?
Superior mesenteric artery
What are the two venous drainage pathways for the abdominal organs?
Portal venous system and systemic venous system
What is the hepatic portal venous system?
- Drains blood from GIT and associated organs
- Drains into liver at porta hepatis and then into inferior vena cava
Which veins drain foregut, midgut and hindgut organs?
- foregut = splenic vein
- midgut = superior mesenteric vein
- hindgut = inferior mesenteric vein
What is the layout of the portal venous system?
- splenic vein and superior mesenteric vein join behind neck of pancreas to form hepatic portal vein
- inferior mesenteric vein drains into splenic vein behind neck of pancreas
What is the systemic venous system?
- Venous drainage for kidneys, adrenal glands and gonads
- Drains straight into inferior vena cava
Why does blood from the systemic venous system not need to be processed by the liver?
- kidney filters blood
- adrenal glands and gonads need the hormones they produce to enter systemic circulation in order to reach their target organs
What are portosystemic anastomoses?
- sites of communication between portal and systemic venous systems
- provide alternate route for venous drainage if there is a blockage in the portal venous system
- allows blood to still be returned to the heart via the IVC
What is the danger of portosystemic anastomoses?
- blood from the GIT needs to processed by the liver to remove harmful/waste substances
- anastomoses allow these substances to enter heart and systemic circulation
Label 1-4
- Left adrenal vein
- Left renal vein
- Left testicular vein
- Left common iliac vein
Which lymphatic nodes drain abdominal organs?
Pre-aortic lymph nodes
Label this diagram
- peritoneum
- stomach
- gastrospenic ligament
- spleen
- splenorenal ligament
- left kidney
Label this diagram
- left gastric artery
- coeliac trunk
- common hepatic artery
- splenic artery
Label this diagram
- superior mesenteric artery
- jejunal and ileal arteries
- middle colic artery
- right colic artery
- ileocolic artery
Label this diagram
- marginal artery
- left colic artery
- sigmoid artery
- middle colic artery
- right colic artery
- ileocolic artery
Label this diagram
- splenic vein
- inferior mesenteric vein
- portal vein
- superior mesenteric vein
All with tributaries
Label this diagram
- left adrenal vein
- left renal vein
- left testicular vein
- left common iliac vein
- hepatic veins
- inferior vena cava
- right renal vein
- right testicular vein
Label 1-10
- falciform ligament
- caudate lobe
- inferior vena cava
- suprarenal impression
- bare area
- anterior coronary ligament
- posterior coronary ligament
- right triangular ligament
- renal impression
- right lobe of liver
Label 11-21
- neck
- body
- fundus
- gallbladder
- colic impression
- quadrate lobe
- porta hepatis
- oesophageal impression
- left lobe
- gastric impression
- left triangular ligament
