Accessory Organs Flashcards
Liver
RUQ
Lobes - right, left, quadrate, caudate
Portal triad
Forms cross bar of H
Vein = posterior
Artery = inferior
Bile duct = green
Ligaments of liver
Falficiform splits into right and left lobes
Continuous with coronary and triangular ligaments superior
Ends as round ligament (ligamentum teres hepatis) inferiorly
Ligamentum venosum
Right side of H in liver
Used to be ductus venous
Shunt umbilical vein to IVC
Round ligament
Ligamentum teres hepatis
Used to be umbilical vein
Liver segments
Each receives a branch of hepatic artery and vein
High capacity for regeneration
Nutrition to liver
Almost 3/4 by portal vein
Almost 1/3 by hepatic artery
Lymph nodes - supradiaphragmatic
Liver biopsy
Right 10th intercostal space in midaxillary line
Hold breath to reduce damage to lung
Hepatomegaly
Rise in central venous pressure
Liver metastasis
Common site of metastasis of GIT, breast cancers
Gallbladder
Right of quadrate lobe
Stores liver
Cholecystitis
Inflammation of gallbladder due to blockage
Starts in epigastric, right hypochondriac then to shoulder
Murphy’s sign = sharp pain in RUQ
Cystohepatic trinagle
Liver, cystic duct, common hepatic duct = borders
Contains cystic artery
Gallstones
Cholesterol deposits in cystic duct
Gallbladder referred pain
Referred to right shoulder
Cholecystectomy
Removal of gallbladder
Path of bile
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
Jaundice
Blockage, bile can’t leave gallbladderP
ancrease
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
Pancreatic duct
Also empties in major papilla of duodenum with bile duct
Inflammation of pancreas
Pancreatic enzymes invade adjacent tissue
Pancreatic cancer
Head - obstruct bile duct - jaundice
Neck & body - portal hypertension
Spleen
Lymphatic organ
Delicate and easily ruptured (thin capsule) but hard to repair
Peritoneal ligaments of spleen
Gastrosplenic
Splenorenal
Splenocolic
Phrenosplenic
Splenic hilum
Gastrosplenic ligament
Short gastric artery
Splenorenal ligament
Contains tail of pancreas and splenic artery and vein
Celiac trunk
T12-L1
L. gastric, splenic, common hepatic
Left gastric artery
Courses along lesser curve
Comes of celiac trunk
Splenic artery
Torturous, towards spleen
Branches to pancreas, short gastric, l gastroomental
End artery, occlusion leans to necrosis
Left gastroomental artery
Celiac - splenic
Along greater curvature
Anastomoses with r. gastroomental
Common hepatic artery
Branches into proper hepatic artery and gastroduodenal
Proper hepatic artery
Part of portal triad in hepatoduodenal ligament
Right & left hepatic artery
Celiac - common hepatic
Towards liver
Right gastric artery
Celiac - common hepatic
Along lesser curve of stomach
Gastroduodenal artery
Celiac - common hepatic
Along greater curve
Anastomoses with gastroomental
Superior gastroduodenal artery
Celiac - common hepatic
Supplys duodenum and pancreas
SMA
L1 level
Branches to inferior pancreaticoduodenal, middle colic, right colic, ileocolic, jejunal and ileal branches
SMA and IMA anastamose
Middle colic and left colic anastamoseIMA at left colic flexure
IMA
L3 level
Branches to left colic, sigmoid, superior rectal
Veins of large intestine
SMV, splenic vein meet at hepatic portal vein
IMV drains into splenic vein
Portocaval anastamosis
Portal veins carry nutrient rich blood from GI tract
Portal hypertension
Blood can be shunted to esophageal, retroperitoneal, rectal or paraumbilical veins
Gut - esophageal varices
Butt - anorectal varices
Caput - medusa on abdomen
Portal hypertension in gut
Left gastric vein - esophageal vein
Esophageal varices
Portal hypertension in butt
Superior rectal and middle/inferior rectal veins
Intestinal or anorectal varices
Portal hypertension in caput medusa
Paraumbilical and superficial/thoracic epigastric veins
Dilation of paraumbilical veins along round ligament - medusa appearance of abdoment
Liver cirrhosis
Hobnail appearance, splenomegaly, ascites
Abdomen sympathetics
Thoracic splanchnic
Greater T5-T9 celiac ganglia
Lesser T10-T11 superior mesenteric ganglion
Least T12 aorticorenal ganglion
Lumbar splanchnic
Inferior mesenteric L1-L2
Abdomen parasympathetics
Vagus nerve until 2/3 transverse colon
Pelvic splanchnic
Referred pain
Visceral afferent and autonomics travel together
Lymph nodes
Celiac, SM, IM
