Accessory Organs

Question 1

Liver

Answer 1

RUQ
Lobes - right, left, quadrate, caudate

Question 2

Portal triad

Answer 2

Forms cross bar of H
Vein = posterior
Artery = inferior
Bile duct = green

Question 3

Ligaments of liver

Answer 3

Falficiform splits into right and left lobes
Continuous with coronary and triangular ligaments superior
Ends as round ligament (ligamentum teres hepatis) inferiorly

Question 4

Ligamentum venosum

Answer 4

Right side of H in liver
Used to be ductus venous
Shunt umbilical vein to IVC

Question 5

Round ligament

Answer 5

Ligamentum teres hepatis
Used to be umbilical vein

Question 6

Liver segments

Answer 6

Each receives a branch of hepatic artery and vein
High capacity for regeneration

Question 7

Nutrition to liver

Answer 7

Almost 3/4 by portal vein
Almost 1/3 by hepatic artery
Lymph nodes - supradiaphragmatic

Question 8

Liver biopsy

Answer 8

Right 10th intercostal space in midaxillary line
Hold breath to reduce damage to lung

Question 9

Hepatomegaly

Answer 9

Rise in central venous pressure

Question 10

Liver metastasis

Answer 10

Common site of metastasis of GIT, breast cancers

Question 11

Gallbladder

Answer 11

Right of quadrate lobe
Stores liver

Question 12

Cholecystitis

Answer 12

Inflammation of gallbladder due to blockage
Starts in epigastric, right hypochondriac then to shoulder
Murphy’s sign = sharp pain in RUQ

Question 13

Cystohepatic trinagle

Answer 13

Liver, cystic duct, common hepatic duct = borders
Contains cystic artery

Question 14

Gallstones

Answer 14

Cholesterol deposits in cystic duct

Question 15

Gallbladder referred pain

Answer 15

Referred to right shoulder

Question 16

Cholecystectomy

Answer 16

Removal of gallbladder

Question 17

Path of bile

Answer 17

Made in liver - bile canaliculi, ductules, ducts
Goes to gallbladder - hepatic ducts, common hepatic ducts, gallbladder, cystic duct, common bile duct, major duodenal papilla, duodenum

Question 18

Jaundice

Answer 18

Blockage, bile can’t leave gallbladderP

Question 19

ancrease

Answer 19

Exocrine & endocrine
Head = in duodenum curve, right
Uncinate process - inferior to head
Neck = hepatic portal vein
Body = part of stomach bed
Tail = close to spleen, spenorenal ligament

Question 20

Pancreatic duct

Answer 20

Also empties in major papilla of duodenum with bile duct

Question 21

Inflammation of pancreas

Answer 21

Pancreatic enzymes invade adjacent tissue

Question 22

Pancreatic cancer

Answer 22

Head - obstruct bile duct - jaundice
Neck & body - portal hypertension

Question 23

Spleen

Answer 23

Lymphatic organ
Delicate and easily ruptured (thin capsule) but hard to repair

Question 24

Peritoneal ligaments of spleen

Answer 24

Gastrosplenic
Splenorenal
Splenocolic
Phrenosplenic
Splenic hilum

Question 25

Gastrosplenic ligament

Answer 25

Short gastric artery

Question 26

Splenorenal ligament

Answer 26

Contains tail of pancreas and splenic artery and vein

Question 27

Celiac trunk

Answer 27

T12-L1 L. gastric, splenic, common hepatic

Question 28

Left gastric artery

Answer 28

Courses along lesser curve Comes of celiac trunk

Question 29

Splenic artery

Answer 29

Torturous, towards spleen Branches to pancreas, short gastric, l gastroomental End artery, occlusion leans to necrosis

Question 30

Left gastroomental artery

Answer 30

Celiac - splenic Along greater curvature Anastomoses with r. gastroomental

Question 31

Common hepatic artery

Answer 31

Branches into proper hepatic artery and gastroduodenal

Question 32

Proper hepatic artery

Answer 32

Part of portal triad in hepatoduodenal ligament

Question 33

Right & left hepatic artery

Answer 33

Celiac - common hepatic Towards liver

Question 34

Right gastric artery

Answer 34

Celiac - common hepatic Along lesser curve of stomach

Question 35

Gastroduodenal artery

Answer 35

Celiac - common hepatic Along greater curve Anastomoses with gastroomental

Question 36

Superior gastroduodenal artery

Answer 36

Celiac - common hepatic Supplys duodenum and pancreas

Question 37

SMA

Answer 37

L1 level Branches to inferior pancreaticoduodenal, middle colic, right colic, ileocolic, jejunal and ileal branches

Question 38

SMA and IMA anastamose

Answer 38

Middle colic and left colic anastamoseIMA at left colic flexure

Question 39

IMA

Answer 39

L3 level Branches to left colic, sigmoid, superior rectal

Question 40

Veins of large intestine

Answer 40

SMV, splenic vein meet at hepatic portal vein IMV drains into splenic vein

Question 41

Portocaval anastamosis

Answer 41

Portal veins carry nutrient rich blood from GI tract

Question 42

Portal hypertension

Answer 42

Blood can be shunted to esophageal, retroperitoneal, rectal or paraumbilical veins Gut - esophageal varices Butt - anorectal varices Caput - medusa on abdomen

Question 43

Portal hypertension in gut

Answer 43

Left gastric vein - esophageal vein Esophageal varices

Question 44

Portal hypertension in butt

Answer 44

Superior rectal and middle/inferior rectal veins Intestinal or anorectal varices

Question 45

Portal hypertension in caput medusa

Answer 45

Paraumbilical and superficial/thoracic epigastric veins Dilation of paraumbilical veins along round ligament - medusa appearance of abdoment

Question 46

Liver cirrhosis

Answer 46

Hobnail appearance, splenomegaly, ascites

Question 47

Abdomen sympathetics

Answer 47

Thoracic splanchnic Greater T5-T9 celiac ganglia Lesser T10-T11 superior mesenteric ganglion Least T12 aorticorenal ganglion Lumbar splanchnic Inferior mesenteric L1-L2

Question 48

Abdomen parasympathetics

Answer 48

Vagus nerve until 2/3 transverse colon Pelvic splanchnic

Question 49

Referred pain

Answer 49

Visceral afferent and autonomics travel together

Question 50

Lymph nodes

Answer 50

Celiac, SM, IM