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MRCEM Primary > Abdominal viscera anatomy > Flashcards

Abdominal viscera anatomy Flashcards

1
Q

What are the 2 surfaces of the liver?

A

Diaphragmatic and visceral

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2
Q

Which surface of the liver is the diaphragmatic surface?

A

Antero-superior surface

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3
Q

Which surface of the liver is the visceral surface?

A

Postero-inferior surface

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4
Q

Where does the diaphragmatic surface of the liver fit?

A

Beneath the curvature of the diaphragm

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5
Q

Which part of the diaphragmatic surface is not covered by visceral peritoneum?

A

Posterior aspect (also not in direct contact with the diaphragm)

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6
Q

Which parts of the visceral surface of the liver are not covered with peritoneum?

A

Fossa of the gall bladder
Porta hepatis

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7
Q

What is the visceral surface of the liver irregular and flat?

A

Because it is moulded by the shape of the surrounding organs.

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8
Q

Name the structures that the visceral surface of the liver is in contact with.

A

Right kidney
Right adrenal gland
Right colic flexure
Transverse colon
First part of duodenum
Gall bladder
Oesophagus
Stomach

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9
Q

Name the structures that the diaphragmatic surface of the liver is in contact with.

A

Diaphragm
Lungs
Pleura

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10
Q

How is the posterior surface of the liver secured to the IVC?

A

Hepatic veins
Fibrous tissue

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11
Q

Which ligament attaches there anterior surface of the liver to the anterior abdominal wall?

A

Falciform ligament

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12
Q

Which ligament attaches the superior surface of the liver to the diaphragm?

A

Coronary ligament (split into left and right triangular ligaments)

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13
Q

What is the liver covered by?

A

A fibrous layer (Glisson’s capsule)

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14
Q

What is the liver comprised of?

A

Right lobe
Left lobe (smaller)
Caudate lobe (middle inferior)
Quadrate lobe (middle superior)

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15
Q

What does the caudate lobe lie between?

A

IVC and a fossa produced by ligamentum venous.

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16
Q

What does the quadrate lobe lie between?

A

The gallbladder and a fossa produced by the ligamentum trees.

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17
Q

What separates the caudate and quadrate lobes?

A

A deep, transverse fissure (porta hepatis)

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18
Q

What does the porta hepatis transmit?

A

All the vessels, nerves and ducts entering and leaving the liver (but not the hepatic veins)

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19
Q

What are the hepatocytes of the liver arranges into?

A

Lobules.

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20
Q

What are the structural units of the liver?

A

Lobules.

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21
Q

What is each lobule drained by?

A

A central vein.

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22
Q

What is found at the periphery of the lobules?

A

Portal triad

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23
Q

What does each portal triad consist of?

A

Arteriole
Venule
Bile duct

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24
Q

Aside from the arteriole, vein and bile duct, which 2 other structures are also found within the portal triad?

A

Lymphatic vessels
Vagus nerve (parasympathetic fibres)

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25
Which vessels supply the liver?
Hepatic artery proper (25%) Hepatic portal vein (75%)
26
Which parts of the liver are supplied by the hepatic artery proper?
Non-parenchymal structures.
27
Where is the hepatic artery proper derived from?
Coeliac trunk.
28
Which parts of the liver are supplied by the hepatic portal vein?
Liver parenchyma
29
What does the hepatic portal vein carry in the blood to the liver parenchyma?
Nutrients from the small intestine (allows detoxification to occur)
30
What is venous drainage of the liver through?
Hepatic veins
31
Where do the hepatic veins open up into?
The IVC
32
What is the innervation to the parenchyma of the liver?
Hepatic plexus = coeliac plexus (sympathetic) + vagus nerve (parasympathetic)
33
Where do the hepatic plexus nerve fibres enter the liver?
Hepatic plexus
34
What is Glisson's capsule of the lover innervated by?
Branches of the lower intercostal nerves
35
Which nodes drain the anterior aspect of the liver?
Hepatic lymph nodes
36
Which nodes drain the posterior aspect of the liver?
Phrenic and posterior mediastinal lymph nodes
37
At which vertebral level does the upper border of the liver lie at?
T6
38
Where does the left lobe of the liver lie?
To the left of the midline
39
Where is the lower border of the liver normally found?
About 3cm below the diploid process
40
To where can the liver extend inferiorly to?
The right costal margin
41
What are sinusoids in liver lobules?
Enlarged capillaries
42
What is the function of sinusoids in the liver lobules?
Drain blood from the portal triad into the central vein
43
Which structures are transmitted by the aorta hepatis?
Hepatic portal vein Hepatic artery Common hepatic duct Sympathetic nerves Hepatic branch the vagus nerve Lymphatics
44
What are the 2 superior relations of the liver?
Thoracic cavity Diaphragm
45
What are the 4 anterior relations of the liver?
Thoracic cage Costal margins Pleura and lungs Anterior abdominal wall
46
What are the 5 posterior relations of the liver
Oesophagus Stomach Gallbladder 1st part of duodenum IVC
47
The hepatic portal vein is formed by the union of which 2 vessels?
Superior mesenteric vein Splenic vein
48
How many hepatic veins are there normally draining the liver?
3
49
The gallbladder is entirely surrounded by what?
Peritoneum
50
What are the anterior + superior relations of the gallbladder?
Inferior border of the liver Anterior abdominal wall
51
What are the posterior relations of the gallbladder?
Transverse colon Proximal duodenum
52
What are the inferior relations of the gallbladder?
Biliary tree Duodenum (not proximal)
53
What is the storage capacity of the gallbladder?
30-50ml
54
What structure is the gall bladder continuous with?
Cystic duct
55
The left and right hepatic ducts join to form what?
Common hepatic duct
56
The common hepatic duct and the cystic duct joint to form what?
Common bile duct
57
What joins the common bile duct to form the hepatopancreatic ampulla (ampulla of water)?
Pancreatic duct
58
Where does the ampulla of water empty into?
The duodenum via the major duodenal papilla.
59
What is the major duodenal papilla regular by?
Sphincter of oddi (muscular valve)
60
What is Hartmann's pouch?
A mucosal fold in the neck of the gallbladder.
61
Why is Hartmann's pouch of clinical importance?
Because this is a common location for gallstones to get lodged.
62
Where is parasympathetic supply of the gallbladder and biliary tree from?
Vagus nerve
63
Where is sympathetic supply of the gallbladder and biliary tree from?
Coeliac plexus
64
Where is sensory supply of the gallbladder and biliary tree from?
Phrenic nerve (C3-C5)
65
What is responsible for the referred pain from the gallbladder to the right shoulder tip?
Stimulation of the phrenic nerve
66
What are the main sites of portosystemic anastomoses?
Oesophageal veins Para-umbilical veins Retroperitoneal veins Rectal veins
67
Due to the portosystemic anastomoses, what clinical findings happens when there is a rise in portal venous pressure?
Oesophageal varices Caput medusae Haemorrhoids
68
What does the spleen do?
Regulates the filtration fo red blood cells and the immune response.
69
What is the spleen comprised of?
Red and white pulp
70
What is the white pulp of the spleen composed of?
Nodules called Malpighian corpuscles
71
What are Malpighian corpuscles in the spleen composed of?
Lymphoid follicles (rich in B lymphocytes) AND Periarteriolar lymphoid sheaths (rich in T lymphocytes)
72
Which type of lymphocyte is most abundant in the white pulp?
B-lymphocytes
73
What is the red pulp of the spleen comprised of?
Sinuses filled with RBCs, platelets, granulocytes and scenic cords (or reticular fibres)
74
Where does the spleen usually lie?
Between the 9th and 11th ribs on the right hand side.
75
What is the anterior relation of the spleen?
Fundus of the stomach.
76
What are the 4 posterior relations of the spleen?
Left lung 9th to 11th ribs Left diaphragm Costodiaphargmatic recess
77
What are the 2 medial relations of the spleen?
Tail of pancreas Left kidney
78
What is the inferior relation of the spleen?
Left colic flexure
79
How can you differentiate between palpating a spleen or a retroperitoneal mass?
Spleen is not ballotable Spleen enlarges diagonally towards RLQ (kidney enlarges inferiorly) Spleen has a notch on anterior border Spleen is dull to percussion Upper edge of the spleen is not palpable (kidney is)
80
What is the endocrine function of the pancreas?
Controls blood glucose levels via the secretion of insulin and glucagon
81
What is the exocrine function of the pancreas?
Secretes digestive enzymes into the duodenum.
82
Which lumbar vertebrae is the pancreas in line with?
L1-L2
83
What is the exocrine part of the pancreas composed of?
Acini (clustered cells)
84
What is the path of the pancreatic duct?
Starts at the tail of the pancreas. Runs to the head. Units with CBD to form ampulla of water.
85
What are the 5 parts of the pancreas?
Head Uncinate process Neck Body Tail
86
Where does the head of the pancreas lie?
Within the 'C' shaped curve of the duodenum
87
What is posterior to the head of the pancreas?
IVC Right renal artery Right renal vein Left renal vein
88
What lies in a groove on the posterior surface of the head of the pancreas?
Bile duct
89
What is the uncinate process?
A prolongation of the pancreatic head.
90
What vessel is anterior to the uncinate process?
Superior mesenteric vessels
91
In what plane does the neck of the pancreas lie?
Transpyloric plane.
92
What is the portal vein formed by?
Union of the superior mesenteric vein and splenic vein.
93
What structures are posterior to the body of the pancreas?
Aorta L2 Left adrenal gland Left kidney
94
The tail of the pancreas lies in close proximity to what?
The hilum of the spleen
95
Which is the only part of the pancreas that is intraperitoneal?
Tail
96
What are the 4 anterior relations of the pancreas?
Lesser sac Stomach 1st part of duodenum Transverse mesocolon
97
What are the 7 posterior relations of the pancreas?
Left crus of diaphragm IVC Aorta Right and left renal vein Left kidney Left adrenal SMA (+ vein)
98
What is the left lateral relation of the pancreas?
Hilum of spleen
99
What are the 2 right lateral relations of the pancreas?
2nd part of the duodenum Ampulla of vater
100
What is the arterial supply of the pancreas?
Splenic artery
101
Which arteries does the head of the pancreas receive receive additional blood supply from?
Superior and inferior pancreaticoduodenal arteries
102
What is the venous drainage of the spleen?
Splenic vein
103
Where does the splenic vein drain into?
Superior mesenteric vein
104
What does the superior mesenteric vein drain into?
Hepatic portal vein
105
Which lymph nodes drain the pancreas?
Pancraticosplenic nodes (majority) AND Pyloric lymph nodes
106
What is the parasympathetic nerve supply to the pancreas?
Vagus nerve
107
What is the sympathetic and sensory nerve supply to the pancreas?
Thoracic splanchnic nerves (T6-T10)
108
What is responsible for the referred pain from the pancreas to the back?
Due to sensory innervation by the thoracic splanchnic nerves (T6-T10)
109
The dual supply of blood to the liver means that what typeof event is very rare?
Liver infarction

MRCEM Primary (39 decks)

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