Accessory Organs I Flashcards
Identiy the regions of the abdomen and the contents within
The liver is found in which regions?
What are the functions of the liver?
- regions
- right hypochondrium
- epigastrium
- a little bit in the left hypochondrium
- functions
- bile adn a number of hormones
- serum proteins and lipids
- toxins and drugs
How does the position fo the liver change with respiratory states?
With full expiration, it can rache the 4th intercostal space/left nipple
With full inspiration, it can reach below the tip of the ribs
What structure is found within the hepatoduodenal ligament?
Portal triad
common bile duct (right), proper hepatic artery (left),
portal vein (posterior)
What are the attachment points of the falcicform ligament?
The falciform ligament is continuous with which 2 other structures?
What structure is enclosed within the falciform ligament?
- attachment
- umbilicus and liver
- continuous
- coronary ligament
- lesser omentum at the porta hepatis
- enclosed
- ligamentum teres hepatis (round ligament of liver)
What ligament attahes the liver to the diaphragm?
What ligament separates the two lobes of the liver?
- liver to diaphragm
- coronary ligament
- separates the two lobes
- falciform ligament
What is different about the bare area of the liver as compared to the rest of it?
It is encircled by what ligament?
it does not have any peritoneal covering
encircled by the anterior and posterior coronary ligaments, that together form the right and left triangular ligaments
Identify the ligaments outlined in green, yellow and red in the provided image
Green: falciform ligament
red: left triangular ligament
yellow: lesser omentum
Idenfity the features indicated in the photo
Why is the hepatorenal pouch of clinical concern?
if someone has just had surgery or anything with a fluid build up, and laying supine all of the fluid will accumulate in the hepatorenal space
Name the recesses that match the following descriptions
- anteior part of liver and the diapragm
- liver anteriorly and the kidney and suprarenal gands posteriorly (right side)
- between the left lobe of the liver and the diaphragm
- Subphrenic
- Hepatorenal
- Superior recess of omental bursa
Identify the featrues of the visceral surface of the liver
The main portal fissue is the estimated plane for what structure?
This line defines what boundary?
middle haptic vein
functional lobes
What defines the diaphragmatic surface of the liver?
the portion of the liver in contact with the diaphragm
What structures are found directly superiorly to the liver?
directly anteriorly?
directly posteriorly?
- superior
- base of right lung
- pericardium and heart
- base of left lung
- anteriorly
- costal margin
- xiphoid process
- abdominal
- posteriorly
- bare acrea
- inferior vena cava
- right suprarenal gland
- right kidney
What are the 4 anatomical lobes of the liver?
which one is associated with the galbladder?
which one sometimes has an additional process?
- Right
- Left
- Quadrate
- associated with Galbladder
- Caudate
- caudate adn papillary process
What defines the functional lobes?
Why is this knowledge important?
Are they the same as the anatomical lobes?
the branching of the portal tiads
if a lobe needs to be transected, the other lobes will be okay because they are receiving differnet supply from the hepatic triad
there may be not be any overlap between the anatomical and functional lobes
How many hepatic functional segments are there?
8
What are the difference between the two blood supplies to the liver? Which is the major supplier?
- ~25% oxygen-rich via hepatic artery
- ~75% nutrient-right vial portal vein
- directly from the intestine up to the liver
Why is the portal vein important
Where is it found?
What is is made from?
- important
- provides 75% blood to the liver
- location
- posterior to neck of pancreas
- related to first part of duodenum
- free edge of lesser omentum (hepatoduodenal ligament)
- anterior to epiploic foramen
- posterior to common bile duct
- posterior to proper hepatic artery
- made from
- splenic vein will unite iwth superior mesenteric vein to produce portal vein
Describe the branching patterns of artery supply to the liver
- CT: celiac trunk
- CHA: common hepatic artery
- PHA: proper hepatic artery
- LHA: left hepatic artery (left of common hepatic duct)
- RHA: right hepatic artery (posterior to common hepatic duct)
- PHA: proper hepatic artery
- CHA: common hepatic artery
The 3 major hepatic veins drain to what structure?
inferior vena cava
Which aspects of the liver drain lympatics into the phrenic nodes? Hepatic nodes?
- phrenic
- superior
- posterior
- hepatic
- all others
Origination of preganglionic sympathetic innervation to the liver?
Sympathetic ganglion?
How do they reach the liver?
Origination of parasympathetic innervation? Route?
Which nerve provides afferent fibers related to diaphragmatic parietal peritoneum?
- sympathetic
- Greater spanchnic (T5-T9)
- celiac ganglion (next to celiac trunk)
- postganglionic follow arteries to the liver
- parasympathetic
- vagus, hitch-hikes iwth sympathetic to the organ
- synapse in ganglia within or near the organ wall
- Afferent Fibers
- Right phrenic nerve
What is the main function of the galbladder?
Intraperitoneal or retroperitoneal?
- store and concentrates bile
- 30-50 ml
- intraperitoneal
Where is the galbladder located with relation to the galbladder?
Location with relation to abdominal quadrants?
The gall baldder is the physically touching which structures?
- in the gall bladder fossa on the visceral surface of the liver between the anatomical right and quadrate lobes
- intersection of the midclavidular line and the transpyloric plane
- at the level of the 9th rib
- toughing
- visceral surface of liver
- transverse colon
- superior part of duodenum
Identify the parts of the gall bladder.
Where do gallstones often get lodged?
Hartmann’s pouch
Neurovasculature and lymphatics
Artery?
Vein?
Lymph nodes?
Innervation?
- cystic artery
- commonly arises from right hepatic artery
- cystic veins
- drains directly or indirectly to the liver
- cystic lymph nodes
- hepatic to celiac
- Celiac plexus
Cystohepatic/Calot’s triangle is formed from what structures?
Why is it important?
What is contained within it?
- inferior
- cystic duct
- superiorly
- liver
- mediall
- common hepatic duct
- it is an important surgical landmark
- contains
- right hepatic artery
- cystic artery
What are the 4Fs increasing susceptibility to gallstones?
fertile (previously given birth), female, forty, fat
What is portal hypertension?
What are possivle causes for this?
When there is a build up of pressure in the portal vein, because the liver tissue is stiff
this can be due to a number of problems with the liver
What are teh 4 portal-caval anastomosis that are most affected from portal hypertension?
- esophageal veins and left gastric veins
- esophageal varices
- superior rectal and middle and inferior rectal veins
- ano-rectal varices
- hemmrhoids
- paraumbilical veins and epigastric veins or anterior abdominal wall
- caput medusae
- retrocolic
