Accessory Organs of the Digestive System Flashcards
The largest visceral organ and the largest gland in the human body
Liver
Important roles of Liver
- production and secretion of bile (used in emulsification of fats)
- detoxification (by filtering the blood to remove bacteria and foreign particles that have gained entrance from the intestine)
- storage of carbohydrate as glycogen (to be broke later to glucose)
- production of storage of lipids as triglycerides
- plasma protein synthesis (albumin and globulin)
- production of blood coagulants (fibrinogen and prothrombin)
- anticoagulants (heparin), and bile pigments (bilirubin and biliverdin) from the breakdown of hemoglobin (when RBC are being degraded)
- reservoir for blood and platelets
- storage of certain vitamins, iron, and copper
What is liver important for in the fetus?
manufacture of red blood cells
Liver is surrounded by the peritoneum and is attached to the diaphragm by?
coronary and falciform ligaments
right and left triangular ligaments
What is the point of reference for anatomical lobes?
falciform ligament
What are in the right and left lobes of anatomical division of liver?
Left Lobe: II (Lateral superior lobe), III ( Lateral inferior lobe)
Right Lobe: IVa (Medial superior lobe), IVb (Medial inferior lobe), V (Anterior inferior lobe), VI (Posterior inferior lobe), VII (Posterior superior lobe), VIII (Anterior superior lobe)
What is the other term for medial superior lobe?
Caudate lobe
What is the other term for medial inferior lobe?
Quadrate lobe
Important for determining landmark for surgeries (e.g. hepatectomy-removal of liver, liver transplant)
Functional division of liver
What is the point of reference for the functional division of liver?
rex cantlie line (imaginary line drawn between gallbladder and IVC)
What are the right and left lobes in the Functional division of liver?
Left: II (lateral superior lobe), III (lateral inferior lobe), IV a (medial superior lobe), IV b (medial inferior lobe)
Right: V (anterior inferior lobe), VI (posterior inferior lobe), VII (posterior superior lobe), VIII (anterior superior lobe)
Depressions / landmarks where specific organs are lodged into the liver
Impressions
What are the impressions on the liver?
Gastric impression: stomach; Esophageal impression: esophagus; Suprarenal impression: renal adrenal gland; Renal impression: right kidney; Colic impression: colon
What does the liver have on the diaphragmatic surface, which is limited by layers of the coronary ligament but is devoid of peritoneum?
Bare area
Where does liver receive oxygenated blood and deoxygenated, nutrient-rich, sometimes toxic blood?
hepatic artery
portal vein
What drains the liver?
hepatic veins into the IVC
Liver contains the portal triad in the portal hepatis. What is its arrangement anterior to posterior?
○ Bile duct
○ Hepatic artery
○ Portal vein
How is liver divided based on hepatic drainage and blood supply?
right and left lobes by functional units or hepatic segments
What vein divides the liver via couinaud classification or functional division?
Middle hepatic vein
Divided into anterior and posterior segments, each of which is subdivided into superior and inferior areas or segments
Right Lobe
Divided into medial and lateral segments, each of which is subdivided into superior and inferior areas (segments)
Left Lobe
Includes the medial superior (caudate lobe), medial inferior (quadrate lobe), lateral superior, and lateral inferior segments.
Left Lobe
Where does quadrate lobe receive blood and drain bile?
receives blood from the left hepatic artery
drains bile into the left hepatic duct
Where does caudate lobe receive blood and drain bile?
receives blood from the right and left hepatic arteries
drains bile into both right and left hepatic ducts
Fissure located between the lateral portion of the left lobe and the quadrate lobe
round ligament (ligamentum teres hepatis / umbilical vein)
Fissure located between the caudate lobe and the lateral portion of the left lobe
ligamentum venosum
Fossa located between the quadrate lobe and the major part of the right lobe
Fossa for Gallbladder
Fissure located between the caudate lobe and the major part of the right lobe
Fissure for the IVC
This transverse fissure on the visceral surface of the liver between the quadrate and caudate lobes lodges the hepatic ducts, hepatic arteries, branches of the portal vein, hepatic nerves, and lymphatic vessels.
Porta hepatis
What does the coronary ligament form?
Right and left triangular ligament
The upper & lower layers of coronary ligament & right triangular ligament bound a large area on the post surface of the liver which has no peritoneal covering.
Bare area
Bile Passage way
- From the liver (production)
- To right hepatic duct, left hepatic duct, forming the common hepatic duct (which will join the cystic bile duct to form common bile duct) (some bile go to gallbladder)
- Empty to 2nd part of duodenum
Bile Passage way
- From the liver (production)
- To (a) right hepatic duct, (b) left hepatic duct, forming the (c ) common hepatic duct (which will join the cystic bile duct to form common bile duct) (some bile go to gallbladder)
- empty to 2nd part of duodenum
A condition where the liver cells are progressively destroyed and replaced by fatty and fibrous tissue that surrounds the intrahepatic blood vessels and biliary radicals, impeding the circulation of blood through the liver.
Liver cirrhosis
Accumulation of fluid in the peritoneal cavity
Ascites
Dilated veins around the umbilicus
Caput medusa
Periportal zone, affected by viral hepatitis
Zone 1
Intermediate zone, associated with yellow fever
Zone II
Pericentral vein (centrilobular zone), affected 1st by ischemia and the site of alcoholic hepatitis
Zone III
Located at the junction of the right ninth costal cartilage and lateral border of the rectus abdominis, which is the site of maximum tenderness in acute inflammation of the gallbladder.
Gallbladder
Is a pear-shaped sac lying on the inferior surface of the liver in a fossa between the right and quadrate lobes
Gallbladder
What is the capacity of gallbladder?
approximately 30 to 50 mL
Where is gallbladder in contact with?
duodenum and transverse colon
Where is the fundus, body and neck of gallbladder?
fundus - rounded blind end located at the tip of the right ninth costal cartilage in the midclavicular line and contacts the transverse colon
body - major part and rests on the upper part of the duodenum and the transverse colon
neck - narrow part and gives rise to the cystic duct with spiral valves (Heister valves)
Receives bile, concentrates it (by absorbing water and salts), stores it, and releases it during digestion.
Gallbladder
Gallbladder contracts to expel bile as a result of stimulation by the hormone?
cholecystokinin (CCK) - which is produced by the duodenal mucosa or by parasympathetic stimulation when food arrives in the duodenum
Where does gallbladder receive blood?
cystic artery, which arises from the right hepatic artery
What are the borders of the cystohepatic triangle (of Calot)?
superiorly - visceral surface of the liver
inferiorly - cystic duct
medially - common hepatic duct
What is the abnormal conical pouch in the neck of gallbladder which is also called the ampulla of the gallbladder?
Hartmann pouch
What does gallbladder excrete and secrete?
Excretes cholesterol
Secretes mucus
What does the internal surface of gallbladder have?
folds, spiral folds and crypts of Luschka
It is formed by solidification of bile constituents and composed chiefly of cholesterol crystals, usually mixed with bile pigments and calcium.
Gallstones (choleliths or cholelithiasis)
Where are gallstones commonly present?
4F: fat, fertile, forty, female
It is an inflammation of the gallbladder, caused by obstruction of the cystic duct by gallstones.
Cholecystitis
It is a surgical removal of the gallbladder resulting from inflammation or presence of gallstones in the gallbladder.
Cholecystectomy
Lies largely in the floor of the lesser sac in the epigastric and left hypochondriac regions, where it forms a major portion of the stomach bed.
Pancreas
What part of pancreas is not retroperitoneal?
tail, which lies in the lienorenal (splenorenal) ligament
Part of the pancreas that lies within the C-shaped concavity of the duodenum.
Head
If tumors are present in the head, bile flow is obstructed, resulting in?
jaundice
A projection of the lower part of the head of the pancreas to the left behind the superior mesenteric vessels.
uncinate process
It is the constricted portion of pancreas and connects head to body. It lies in front of beginning of portal vein and superior mesenteric artery.
Neck
It runs upward and to the left across midline (part of pancreas)
Body
Passes in splenorenal ligament and projects toward the hilum of the spleen
Tail
Where does pancreas receive blood?
branches of the splenic artery and from the superior and inferior pancreaticoduodenal arteries
Pancreas is __ which produces digestive enzymes that help digest fats, proteins, and carbohydrates.
Exocrine gland
Pancreas is an __ which secretes the hormones insulin and glucagon, which help the body to use glucose for energy, and also secretes somatostatin.
Endocrine gland (islets of Langerhans)
It lowers blood sugar levels by stimulating glucose uptake and glycogen formation and storage
Insulin
It enhances blood sugar levels by promoting conversion of glycogen to glucose.
Glucagon
It suppresses insulin and glucagon secretion.
Somatostatin
Begins in the tail, runs to the right along the entire pancreas, and carries pancreatic juice containing enzymes.
Main Pancreatic Duct (Duct of Wirsung)
The Main Pancreatic Duct (Duct of Wirsung) joins the bile duct to form the __ before entering the second part of the duodenum at the greater papilla
hepatopancreatic ampulla (ampulla of Vater)
Begins in the lower portion of the head and drains a small portion of the head and body.
Accessory Pancreatic Duct (Santorini Duct)
Where does Accessory Pancreatic Duct (Santorini Duct) empty?
lesser duodenal papilla approximately 2 cm above the greater papilla
Where is lymph drainage of pancreas?
celiac & superior mesenteric lymph nodes
Painfulness in this point arises in children with the pathology of the pancreatic tail.
Mayo-Robson’s point
Where can Mayo-Robson’s point be palpated? (palpation of pancreas)
Epigastric to left hypochondriac region or LUQ
It is an inflammation of the pancreas and is caused by gallstones or alcohol abuse.
Pancreatitis
It frequently causes severe back pain, has the potential to invade into the adjacent organs, and is extremely difficult to treat.
Pancreatic cancer
It is characterized by hypergylcemia that is caused by an inadequate production of insulin or inadequate action on body tissues.
Diabetes mellitus
Common cause of dialysis to patients with end-stage kidney disease
Diabetes
Formed by union of intrahepatic ductules from each lobe of the liver and drain bile from the corresponding halves of the liver
- Right and Left Hepatic Ducts
- Formed by union of right and left hepatic ducts
* Accompanied by the proper hepatic artery and portal vein
Common Hepatic Duct
- Has spiral folds (valves) to keep it constantly open, and thus bile can pass upward into the gallbladder when the common bile duct is closed
- Runs alongside the hepatic duct before joining the common hepatic duct
Cystic Duct
Common site of impaction of gallstones
Cystic Duct
- Formed by union of the common hepatic duct and the cystic duct
- Located lateral to the proper hepatic artery and anterior to the portal vein in the right free margin of the lesser omentum
- Descends behind the first part of the duodenum and runs through the head of the pancreas
Common Bile Duct (Ductus Choledochus)
Common bile duct joins the main pancreatic duct to form __ which enters the second part of the duodenum at the greater papilla.
hepatopancreatic duct (hepatopancreatic ampulla)
Common bile duct contains the __ which is a circular muscle layer around the lower end of the duct.
sphincter of Boyden
This represents the junction of the embryonic foregut and midgut which is formed by the union of the common bile duct and the main pancreatic duct and enters the second part of duodenum at the greater papilla.
Hepatopancreatic Duct or Ampulla (Ampulla of Vater)
Contained in the hepatopancreatic duct, it is a circular muscle layer around it in the greater duodenal papilla which is contracted to prevent backflow of bile or intestinal contents to biliary tract; relaxes during digestion to release bile and pancreatic juice.
sphincter of Oddi
Common bile duct can be divided based on its location in relation to 1st part of duodenum. • \_\_- upper portion • \_\_- beneath 1st part of duodenum • \_\_- in the pancreas • \_\_- in the duodenum
Supraduodenal segment
Retroduodenal segment
Pancreatic segment
Intraduodenal segment
A large vascular lymphatic organ lying against the diaphragm and ribs 9 to 11 (T9-T11) in the left hypochondriac region, and supported by the lienogastric (splenogastric) and lienorenal (splenorenal) ligaments.
Spleen
What part of spleen is retroperitoneal?
Hilum
What supplies and drains the spleen?
splenic artery
splenic vein
Composition of spleen which consists of primarily lymphatic tissue around the central arteries and is the primary site of immune and phagocytic action
white pulp
Composition of spleen which consists of venous and sinusoids and splenic cords and is the primary site of filtration
red pulp
Functions of spleen
- Filters blood (removes damaged and worn-out erythrocytes and platelets by macrophages)
- Acts as a blood reservoir, storing blood and platelets in the red pulp;
- Provides the immune response (protection against infection);
- Produces mature lymphocytes, macrophages, and antibodies chiefly in the white pulp
It is hematopoietic in early life and later destroys aged (i.e., worn-out) red blood cells in the red pulp and sets free the hemoglobin
Spleen
What is hemoglobin, a respiratory protein of erythrocytes, degraded into?
(a) the globin (protein part), which is hydrolyzed to amino acid and reused in protein synthesis
(b) the iron released from the heme, which is transported to the bone marrow and reused in erythropoiesis
(c ) the iron-free heme, which is metabolized to bilirubin in the liver
and excreted in the bile
Developed as a thickening of the mesenchyme in the dorsal mesogastrium
Spleen
Part of the reticuloendothelial system (immuno regulatory, degrade blood products)
Spleen
A double layer of peritoneum that connects the fundus of stomach to hilum of spleen. It consists of short gastric and left gastroepiploic vessels
Gastrosplenic / Lienogastric / Splenogastric ligament
It extends between the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreas.
Splenorenal / Lienorenal ligament
Provides support to anterior end of spleen without attaching to it and prevents its downward placement
Phrenicosplenic ligament
Anterior, Posterior, Inferior, and Medial relations of Spleen
Anterior: Stomach, tail of pancreas, left colic flexure, and left kidney
Posterior: Diaphragm, left lung, ribs 9-11 / T9-T11
Inferior: Left colic flexure/ splenic flexure
Medial: Left kidney
It is caused by venous congestion resulting from thrombosis of the splenic vein or portal hypertension, which causes sequestering of blood cells, leading to thrombocytopenia (a low platelet count) and easy bruising.
Splenomegaly
It occurs frequently by fractured ribs or severe blows to the left hypochondrium and causes profuse bleeding
Rupture of the spleen
It is a malignancy characterized by painless, progressive enlargement of the lymph nodes, spleen, and other lymphoid tissue, accompanied by night sweats, fever (Pel-Ebstein fever), and weight loss.
Hodgkin’s Lymphoma
Anterior and Posterior relations of Gallbladder
Anterior: Anterior abdominal wall, Inferior surface of liver
Posterior: Transverse colon, 1st and 2nd part of duodenum
Anterior and Posterior relations of Pancreas
Anterior: Transverse colon, Transverse mesocolon, lesser sac, stomach
Posterior: Bile duct, portal and splenic veins, IVC, aorta, left psoas muscle, left suprarenal gland, left kidney, and hilum of the spleen.
