Accessory organs Flashcards
the largest visceral organ in the body ?
Liver
primarily the liver is located in what regions ?
located in right hypochondrium and epigastric abdominal regions
functions of the liver
Functions in metabolism, synthesis of bile and prothrombin, excretion, glycogen storage and protection via antibody formation
2 surfaces of the liver
diaphragmatic surface: anterior, superior, and posterior directions
visceral surface:
inferior direction
The bare area of the liver ?
The bare area of the liver is found on the posterosuperior surface of theright lobeof theliver. This lies close to thethoracic diaphragm. It is the only part of the liver that has noperitonealcovering.
Attached directly to the diaphragm.
No intervening peritoneum between the liver and the diaphragm.
Anterior boundary: Anterior coronary ligament.
Posterior boundary: Posterior coronary ligament.
the liver is associated with 2 recesses continuous with each other anteriorly.
subphrenic recess:
Separates the diaphragmatic surface of the liver from the diaphragm.
- Divided into right and left areas by the falciform ligament.
Hepatorenal recess:
between liver, right kidney and suprarenal gland.
the visceral surface of the liver?
is covered by the visceral peritoneum. except for gallbladder and porta hepatis.
structures related to visceral surface of liver
oesophagus -right colic flexure
the right anterior part of the stomach- right transverse colon
the superior part of the duodenum right kidney
lesser omentum- right suprarenal gland.
The liver is attached to various structures by what structure?
several peritoneal ligaments ( folds of peritoneum)
falciform ligament.
attaches liver to the anterior abdominal wall.
derived from the ventral mesenteric of the liver.
ligamentum teres (round ligament)
Obliterated remnant of left umbilical vein
Runs in inferior free border of falciform ligament
Continues into a fissure on visceral surface of liver
ligamentum venosum
remnant of ductus venous
lies in a fissure on visceral surface of liver.
the ligament that attaches the liver to stomach
hepatogastric ligament
Hepatoduodenal ligament
attaches the liver to duodenum
Hepatoduodenal ligament
attaches the liver to duodenum
anterior and posterior coronary ligament
attach liver to diaphragm.
come together laterally to form right and left triangular ligament.
liver is divided to right and left lobes by which ligament?
falciform ligament
fissure for ligamentum teres (visceral)
fissure for ligamentum venosum
the right lobe of the liver
largest lobe- 5/6 of the liver
give rise to quadrate and caudate lobes.
functionally distinct.
left lobe
flattened from the above downwards.
approximately 1/6 of the liver
porta hepatis is similar to which structure?
helium
the deep transverse fissure between quadrate and caudate
porta hepatis-
Point of entry: Hepatic artery proper and portal vein
Point of exit: Hepatic ducts
hepatic ducts lie ………to portal vein, usually ……….lie between ducts and vein
A. anterior to
B. hepatic artery.
attachment site for lesser omentum
lesser omentum surrounds structures f the porta hepatis.
Hepatic artery proper and portal vein
Hepatic artery proper and portal vein ascend in lesser
omentum to porta hepatis
Common hepatic duct and lymphatic vessels
descend in lesser omentum from porta hepatis
hepatic veins
drains the liver and leaves the liver on its posterior surface to drain into vena cava
Lymphatic drainage is via nodes
via caval, hepatic, paracardial and coeliac nodes
Some lymph from coronary ligaments drains into thoracic duct directly
how many lobes is the liver divided into
The liver divided into 8 (functional) segments based on the distribution of portal venous branches in parenchyma.
- Forms basis of the current understanding of functional
anatomy of liver.
the liver is divided into four portal sectors.
right anterior
right posterior
left medial
left lateral
divided by 4 main hepatic veins
three veins lie between these segments as intersectoral veins
Three main fissures
main, right, and left fissures
divide the sectors, running through the parenchyma and contain three main hepatic veins.
Three minor fissures
- Umbilical, venous, Rouvieres sulcus
- Appear as physical clefts on liver surface
caudate lobe
segment 1
segments labelled in clockwise fashion.
A pear-shaped sac lies on the visceral surface of the right liver lobe.
Gallbladder
where does it lie and its fuction
lie in the visceral surface of the right liver lobe
in the fossa between the right and quadrate lobes
receives, concentrate and stores bile.
the gallbladder is comprised of:
Fundus:
- Rounded end which may project from inferior
border of liver (in angle between rectus
abdominus and 9th costal cartilage)
Body:
- Major part in fossa
- May lie against transverse colon and superior part
of duodenum
- Continuous with neck at right end of porta hepatis
Neck: Narrow part with mucosal folds forming spiral fold (prevents obstruction of bile flow)
the duct system for passage of the bile
extends from liver
connects with gallbladder
empties to the descending part of duodenum
common hepatic ducts is form by ?
left and right hepatic ducts
Common hepatic duct travels with hepatic artery proper and portal vein in free margin of lesser omentum
bile duct is formed by
common hepatic ducts joining cystic ducts at an angle
cystic forms from the neck of the gallbladder.
bile duct runs to what / empties to which strutures
Runs supraduodenal, retroduodenal, infraduodenal
and then intraduodenal
Opens into major duodenal papilla
The neurovasculature of
Arterial supply
Gallbladder: Cystic artery (branch of right hepatic artery)
Bile duct: Posterior superior
pancreaticoduodenal artery
Venous Drainage
Cystic veins, portal veins, hepatic veins
Lymphatics
Cystic node, hepatic node, upper pancreaticosplenic node
Innervation
Cystic plexus of nerves, right phrenic nerves.
The pancreas
Lies mostly posterior to stomach
Extends across posterior abdominal wall from duodenum (right) to spleen (left)
Retroperitoneal except for small part of tail
Structurally, branched acinar gland wrapped in delicate connective tissue
Healthy pancreas is yellow, with a soft-to-firm consistency and lobulated surface
at which level does the spleen lie
level L1
the primary function of pancreas
Exocrine gland that secretes enzymes involved in digestion of lipids, proteins and carbohydrates
secondary function of the pancreas
endocrine gland that takes part in glucose homeostasis, and upper gastrointestinal tract motility
the pancreas is comprised of ?
Head: Lies within C-shaped concavity of duodenum
Uncinate process: Projects from lower part of head and passes posterior to superior mesenteric vessels
Neck: Lies anterior to superior mesenteric vessels
- Posterior to neck, superior mesenteric and splenic
veins join to form portal vein
Body: Elongated and extends from neck to tail
Tail: Passes between layers of splenorenal ligament
pancreatic duct
Begins in tail of pancreas
Passes through body and neck of pancreas
Enters head of pancreas and turns inferiorly
Lower part of head: Joins bile duct
joining of the bile duct and pancreatic duct forms ?
Hepatopancreatic ampulla.
which then enters the second part of the duodenum at the major duodenal papilla.
the hepatopancreatic ampulla is surrounded by structure?
collective smooth muscles (sphincter ampulla)
what structure empties to the minor duodenal papilla.
accessory pancreatic duct .
usually communicates with main pancreatic duct.
neurovascular of the pancreas
Gastroduodenal artery (branch of common hepatic artery)
- Anterior superior pancreaticoduodenal artery
- Posterior superior pancreaticoduodenal artery
Splenic artery (branch of celiac trunk)
- Dorsal and great pancreatic arteries
Inferior pancreaticoduodenal artery (branch of superior mesenteric artery)
- Anterior inferior pancreaticoduodenal artery
- Posterior inferior pancreaticoduodenal artery
venous drainage of pancreas
portal vein superior mesenteric and splenic vein
superior and inferior pancreaticoduodenal vein draining head and uncinate process.
veins draining the body and tail of the pancreas drains into splenic vein then to portal vein.
Lymphatic Drainage
Starts at interlobular septa within gland
Then larger lymphatic vessels follow paths of arteries
Tail and body lymph drains into nodes along splenic artery
Head and neck lymph eventually drains into pre-aortic nodes
structure that develops as part of vascular system in dorsal mesentery
spleen.
where does the spleen lie
lie against the diaphragm
at rib 9-10
in the left hypochondrium of abdomen
function of the spleen
Functions in phagocytosis, hematopoiesis, immune response and in storage of red blood cells
the is pleen is connected to the stomach by ligament?
gastrosplenic ligament
Contains short gastric and gastro-omental vessels
the spleen is connected to left kidney.
via splenorenal ligament.
contains splenic vessels.
the ligament of the greater-omentum
splenorenal ligament
gastrosplenic ligament
Surrounded by visceral peritoneum
- Except area of hilum on medial surface
Splenic hilum
- Entry/exit point for splenic vessels
- Occasionally, tail of pancreas reaches this area
The borders and visceral surface of the spleen.
superior border - notched on anterior end - splenic notch.
inferior border- Rounded
the visceral surface has an impression: of gastric, renal, colic, and pancreatic.
vasculature of the spleen
Arterial supply
Splenic artery
Venous drainage
Splenic vein
Lymphatic drainage
Pancreaticosplenic nodes
Innervation
Coeliac plexus and vagus nerves
Accessory Organs Innervation of liver
Parenchyma of liver is supplied by hepatic plexus which has sympathetic (coeliac plexus) and parasympathetic (vagus nerve) fibres
where is the referred pain of the liver lies on
on the epigastric region
right shoulder for diaphragm surface and localized ‘somatic’ pain for fibrous capsule
Accessory Organs Innervation fo r gallbladder
Receives sympathetic and sensory fibres from coeliac plexus, parasympathetic fibres from vagus nerve (stimulates contraction)
referred pain of the gallbladder
Referred pain is to right hypochondriac and epigastric regions (can radiate to back, inferior to right scapula)
Accessory Organs Innervation of pancreas
Receives nerve supply from extra-pancreatic and intra-pancreatic plexuses
Vagal efferents reach pancreas via hepatic, gastric and coeliac branches of vagus nerve
Referred pain is localized to lower thoracic spine
Accessory Organs Innervation of spleen
Receives nerve supply from coeliac plexus
Sympathetic supply is dominant
Parasympathetic supply comes from vagus nerve
referred of spleen
on the epigastric regiom
Final common pathway for transport of venous blood from:
- Spleen, pancreas, and gallbladder
portal vein
portal vein is formed by union…….. and at what level
Formed by union of splenic and superior mesenteric veins
- Posterior to neck of pancreas at L2 vertebral level
Ascends toward liver
- Passes posterior to superior part of duodenum
- Enters right margin of lesser omentum (anterior to
omental foramen and posterior to bile duct and hepatic
artery proper)
when the left and right portal vein enters the livers parenchyma blood enters/through ?
hepatic sinusoids
- Then through progressively larger veins
- Until it enters hepatic veins
- Which return venous blood to inferior vena cava (just
inferior to diaphragm)
Tributaries
Right and left gastric veins
Cystic veins
Para-umbilical veins
splenic vein
Forms from numerous smaller vessels leaving hilum of spleen
Passes to the right, through splenorenal ligament with splenic artery and tail of pancreas
In contact with body of pancreas as it crosses posterior abdominal wall
Joins superior mesenteric vein to form portal vein
Tributaries of the splenic
left gastro-omental vein.
short gastric vein.
pancreatic veins.
inferior mesenteric vein.
Superior Mesenteric Vein
Drains blood from small intestine, cecum, ascending colon, and transverse colon
Begins in right iliac fossa
Veins draining terminal ileum, cecum, and appendix join and ascend in mesentery to right of superior mesenteric artery
Joins splenic vein to form portal vein
Tributaries
Jejunal, ileal, ileocolic, right colic, and middle colic veins
Right gastro-omental vein
Anterior and posterior inferior pancreaticoduodenal veins
