Abdominal viscera II Flashcards
What is the function of the spleen
filter RBC and platelets from circulation
what are the general features of the spleen
ovoid shaped organ
located in LUQ
protected by lower 4 ribs
peritonealized
what lay beneath the spleen
diaphragm and the costodiaphragmatic recess, ribs 9-11
which way does the hilum of the spleen face
anteromedially
describe the differences between the superior.anterior borders of spleen to inferioposterior
superior/anterior- notched and sharp
inferoposterior- smooth
what attaches the stomach to the spleen
gastrosplenic
what attaches spleen to kidney and post wall
splenorenal lig
what does the spleen rest inferiorly on
phrenicocolic ligament
what a supplies the spleen
splenic from the celiac trunk
travles through splenorenal lig to hilum
what is the course of the splenic vein
usually receives inferior mesenteric vein then merges with superior mesenteric vein to form portal vein
describe lymph drainage of the spleen
pacreaticosplenic lymph nodes–>celiac lymph nodes
what causes splenomegaly
anemias and lymphomas
where are accessory spleens found
within the gastrosplenic ligament
what is dangerous about splenic needle insertion
careful not to damage pleural cavity via the costodiaphragmatic recess relationship with the spleen
What are the 2 generalized functions of the pancreas
endocrine and exocrine
describe the exocrine function of the pancreas
secretes pancreatic enzymes into duodenum for digestion
describe the endocrine function on pancreas
secretion of pancreatic hormones into bloodstream from specialized cell sin Islets of langerhans
what do the cells in islets of langerhans secrete
glucagon and insulin
is the pancreas peritonealized or retroperitoneal
retro
What are the external parts of the pancreas
head uncinate process neck body tail
where is the tail of the pancreas
in the splenorenal ligament
Where is the head of the pancreas
right and inferior is the duodenum
posterior is LV1LV2, IVC and renal vessels and bile duct
anterior is the pyloric region of stomach and SI
Where is the uncinate process of the pancreas
posterior to the superior mesenteric vessels
where is the neck of the pancreas
anterior is the transverse mesocolon and SI
posterior is the superior mesenteric a, and the formation of the hepatic portal vein
where is the body of the pancreas
anterior to it is the stomach
posterior is the aortam left suprarenal gland, left kidney, renal vessels
what is the relationship between spleen and pancreas
the tail of the pancreas contacts the hilum of the spleen
What is the path of the main pancreatic duct
beins in tail, travels through pancreas and merges with bile duct to form hepatopancreatic ampulla
empties into second portion of duodenum at major duodenal papilla
what sphincters control release of bile and pancreatic enzymes
sphincter of pancreatic duct
sphincter of bile duct
hepatopancreatic sphincter of Oddi
Where does the accessory pancreatic duct
travels through superior portion of head of pancreas and empties into the 2nd portion of duodenum at the minor duodenal papilla
What 2 main arteries supply pancreas
celiac and superior mesenteric
what are the branches of celiac that supply pancreas
splenic artery gives off dorsal pacncreatic pancreatica magna artery of the tail on pancreas aa gastroduodenal gives of anterior superior pancreaticoduodenal and posterior superior pancreaticoduodenal
what are the branches off superior mesenteric a that supply pancreas
anterior inferior pancreaticoduodenal
posterior inferior pancreaticoduodenal
where do vv drain from pancreas
hepatic portal vein
describe lymph drainage of pancreas
pancreaticosplenic nodes along splenic a
these then drain to celiac and superior mesenteric lymph nodes
what is a common cause on pancreatitis
reflux of bile through hepatopancreatic ampulaa into the main pancreatic duct
(gallstones cause this)
what can pancreatic cancer cause on bile duct
obstruction that leads to gallbladder enlargement, retention of bile, secondary jaundice
What is the function of the liver
metabolism of bile, lipids, carbohydrates, proteins
production of urea
detox
where does the left lobe of liver exten to
apex of heart
what ribs provide some protection to the liver
ribs 5-11
describe the surfaces of the liver
anterior and superior is smooth and convex for diaphragm
posterior and inferior is smooth and concave for the viscera
What is the porta hepatis
fissure on central portion of posterior inferior surface
entrance for hepatic aa, portal v, bile ducts lymph and nerves
what are located on the sides of the porta hepatis
sagittal fissures
What is contatined in the sagittal fissures of the liver
R fissure has gall bladder(anterior) and IVC (posterior)
L fissure has ligamentum teres hepatis (anterior) and ligamentum venosum (posterior)
What is anterior and posterior to the porta hepatis
anterior is the quadrate lobe
posterior is the caudate lobe
What ligaments are assoc with the liver
falciform, coronary and lesser omentum has 2
laterally the coronary ligaments fuse and form what
triangular ligaments
what ligaments assist lesser omentum
hepatogastric
hepatoduodenal
what is within the hepatoduodenal ligament and their relative position
proper hepatic a (anterior and left)
bile duct (anterior and right)
hepatic portal vein (posterior)
What are the 2 recesses of the liver
subphrenic and hepatorenal
what separates the subphrenic recess
falciform ligament
what makes the subphrenic recess
extension of greater sac between anterior surface of liver with diaphragm
what makes the hepatorenal recess
extension of greater sac between visceral surface of liver and kidney
the anterior layer of coronary ligament binds what recess
posteiror layer?
anterior- subphrenic
posterior- hepatorenal
What is the deepest part of the peritoneal cavity when a patient is supine
hepatorenal recess
What is a subphrenic abscess
accumulation of purulent exudate in the subphrenic recess (on the right is most common)
where do abscess and fluid drain to from subphrenic recess
into hepatorenal recess
where is an incision made to drain the subphrenic recess
just below the 12th rib
what separates the right and left lobe of the liver
falciform ligament
what is the quadrate lobe
subdivision of the right lobe, anterior to the porta hepatis
what is the caudate lobe
subdivision of the right lobe
posterior to the porta hepatis
caudate process extends posterior to gall bladder
What determines a functional lobe of the liver
receives a primary branch of hepatic a and portal v and is drained via hepatic duct
What are the funtional lobes of the liver
right lobe
left lobe
caudate lobe
How many hepatic segments are each functional lobe divided into
8
what is the smallest unit of the liver
liver lobule
what is the structure of a liver lobule
6 hepatocytes around one central vein
What lay at the periphery of the liver lobule
6 branches of portal triad
interlobular branch of hepatic portal vein
portal a
bile duct
how does bile flow out of hepatocytes
within bile canaliculi to periphery to an interlobular bile duct then into right and left hepatic ducts to the common hepatic duct
what forms the bile duct
when the common hepatic duct merges with the cystic duct
Where does the bile duct travel within
free edge of the hepatoduodenal ligament
what forms the hepatopancreatic ampulla
distal bild duct merging with main pancreatic duct
where does the hepatopancreatic ampulla drain to
the minor part of the duodenum
what is the distal sphincter of the bile duct called
choledochal
What is an accessory hepatic duct and its potential risk
normal segmental hepatic duct outside liver
danger of being damaged during hepatic surgeries
the bare area of the liver is in direct contact with what structure? irritation here has referred pain where?
direct contact with diaphragm and refers to the shoulder because of phrenic n
What 2 main vascular aa/vv supply the liver
proper hepatic a to 20%
hepatic portal vein 80% blood to liver
the left saggital fissure of the liver is hat two structures? and what are they derived from?
ligamentum teres- round ligament from umbilical vein
ligamentum venosum- from ductus venosus
the caudate lobe is between what 2 structures
IVC and the ligamentum venosum
caudate and quadrate lobes are apart of what functional lobe
the left
describe path of proper hepatic a
travels with portal triad and divides into left and right hepatic a at the porta hepatis
what vessesl supplies most of oxygen to the liver parenchym
hepatic portal vein
what vessels form the hepaticportal vein
fusion of splenic and superior mesenteric veins
what is the portal triad
branch if biliary duct, branch of hepatic porta vein, branch of hepatic a
at the porta hepatis what happens to the hepatic portal vein
divides into left and right branches
an aberrant (accessory) left hepatic a is derived from what
left gastric a
an aberrant(accesssory) right hepatic a comes from what
superior mesenteric a
what are the 2 locations that the right hepatic a sits in relation to portal vein? then in relation to hepatic duct?
91% anterior to portal vein
9% posterior to portal vein
64% posterior to common hepatic duct
24% anterior to common hepatic duct
describe the venous drainage of the liver
both portal vein and hepatic a feed to hepatic sinusoids–>central veins–>hepatic veins (3-4)–>IVC
describe the lymphatic plexuses of the liver
superficial is deep to the capsule and drains to hepatic lymph nodes along hepatic aa, some superior go to phrenic
deep parallels the portal triad and drain to hepatic lymph nodes to the celiac nodes, some will follow IVC and drain to posterior mediastinal nodes
What is the cystohepatic triangle of Callot? clinical relation?
right is cystic duct left is common hepatic duct
cystic a runs right through these structures
used in cholectomies
What are the 3 main causes of hepatomegaly
increased central venous pressure that engorges liver with blood
hepatitis
metastatic carcinomas
where are liver biosies taken
though 10th ICS at midaxillary line
what is the function of the gall bladder
STORAGE and concentration of bile
at what level is the fundus portion of the gall bladder
9th costal cartilage at MCL
is the gall bladder peritonealized or retro
pertitonealized
what is the only part of the gall bladder that makes contact with body wall? where is referred pain
the fundus so at the 9th ICS and MCL
what structure drains the gall bladder?
cystic duct
what does the cystic duct merge with to form
merges with common hepatic duct to form bile duct
most common site for gall stone obstruction
hepatopancreatic ampulla
describe vascular supply to gall bladder
cystic a from right hepatic a
cystic vein
where does the cystic vein drain to
into liver
into portal vein
describe lymph drainage of gall bladder
hepatic lymph to celiac
cystic lymph nodes to hepatic to celiac lymph
describe referred pain of gallbladder
epigastric region but shift to R T8-T9 dermatomes because inflammation of parietal peritoneum
also C3C4C5 from phrenic sometimes
what can obstruction form a gallstone at the hepaticopancreatic ampulla lead to
jaundice from blocking biliary system and pancreatitis from blocking release of pancreatic enzymes
Inflammation because of gall stones can lead to what
adhesion of gall bladder wall to surrounding structures
can lead to ulceration and cause a cholecytoenteric fistula allowing gallstones to pass into that fused structure and cause obstruction and ileocecal junction
