Accessory Organs of the Digestive System Flashcards
1
Q
The largest visceral organ and the largest gland in the human body
A
Liver
2
Q
Important roles of Liver
A
- 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
3
Q
What is liver important for in the fetus?
A
manufacture of red blood cells
4
Q
Liver is surrounded by the peritoneum and is attached to the diaphragm by?
A
coronary and falciform ligaments
right and left triangular ligaments
5
Q
What is the point of reference for anatomical lobes?
A
falciform ligament
6
Q
What are in the right and left lobes of anatomical division of liver?
A
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)
7
Q
What is the other term for medial superior lobe?
A
Caudate lobe
8
Q
What is the other term for medial inferior lobe?
A
Quadrate lobe
9
Q
Important for determining landmark for surgeries (e.g. hepatectomy-removal of liver, liver transplant)
A
Functional division of liver
10
Q
What is the point of reference for the functional division of liver?
A
rex cantlie line (imaginary line drawn between gallbladder and IVC)
11
Q
What are the right and left lobes in the Functional division of liver?
A
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)
12
Q
Depressions / landmarks where specific organs are lodged into the liver
A
Impressions
13
Q
What are the impressions on the liver?
A
Gastric impression: stomach; Esophageal impression: esophagus; Suprarenal impression: renal adrenal gland; Renal impression: right kidney; Colic impression: colon
14
Q
What does the liver have on the diaphragmatic surface, which is limited by layers of the coronary ligament but is devoid of peritoneum?
A
Bare area
15
Q
Where does liver receive oxygenated blood and deoxygenated, nutrient-rich, sometimes toxic blood?
A
hepatic artery
portal vein
16
Q
What drains the liver?
A
hepatic veins into the IVC
17
Q
Liver contains the portal triad in the portal hepatis. What is its arrangement anterior to posterior?
A
○ Bile duct
○ Hepatic artery
○ Portal vein
18
Q
How is liver divided based on hepatic drainage and blood supply?
A
right and left lobes by functional units or hepatic segments
19
Q
What vein divides the liver via couinaud classification or functional division?
A
Middle hepatic vein
20
Q
Divided into anterior and posterior segments, each of which is subdivided into superior and inferior areas or segments
A
Right Lobe
21
Q
Divided into medial and lateral segments, each of which is subdivided into superior and inferior areas (segments)
A
Left Lobe
22
Q
Includes the medial superior (caudate lobe), medial inferior (quadrate lobe), lateral superior, and lateral inferior segments.
A
Left Lobe
23
Q
Where does quadrate lobe receive blood and drain bile?
A
receives blood from the left hepatic artery
drains bile into the left hepatic duct
24
Q
Where does caudate lobe receive blood and drain bile?
A
receives blood from the right and left hepatic arteries
drains bile into both right and left hepatic ducts
25
Fissure located between the lateral portion of the left lobe and the quadrate lobe
round ligament (ligamentum teres hepatis / umbilical vein)
26
Fissure located between the caudate lobe and the lateral portion of the left lobe
ligamentum venosum
27
Fossa located between the quadrate lobe and the major part of the right lobe
Fossa for Gallbladder
28
Fissure located between the caudate lobe and the major part of the right lobe
Fissure for the IVC
29
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
30
What does the coronary ligament form?
Right and left triangular ligament
31
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
32
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
32
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
33
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
34
Accumulation of fluid in the peritoneal cavity
Ascites
35
Dilated veins around the umbilicus
Caput medusa
36
Periportal zone, affected by viral hepatitis
Zone 1
37
Intermediate zone, associated with yellow fever
Zone II
38
Pericentral vein (centrilobular zone), affected 1st by ischemia and the site of alcoholic hepatitis
Zone III
39
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
40
Is a pear-shaped sac lying on the inferior surface of the liver in a fossa between the right and quadrate lobes
Gallbladder
41
What is the capacity of gallbladder?
approximately 30 to 50 mL
42
Where is gallbladder in contact with?
duodenum and transverse colon
43
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)
44
Receives bile, concentrates it (by absorbing water and salts), stores it, and releases it during digestion.
Gallbladder
45
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
46
Where does gallbladder receive blood?
cystic artery, which arises from the right hepatic artery
47
What are the borders of the cystohepatic triangle (of Calot)?
superiorly - visceral surface of the liver
inferiorly - cystic duct
medially - common hepatic duct
48
What is the abnormal conical pouch in the neck of gallbladder which is also called the ampulla of the gallbladder?
Hartmann pouch
49
What does gallbladder excrete and secrete?
Excretes cholesterol
| Secretes mucus
50
What does the internal surface of gallbladder have?
folds, spiral folds and crypts of Luschka
51
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)
52
Where are gallstones commonly present?
4F: fat, fertile, forty, female
53
It is an inflammation of the gallbladder, caused by obstruction of the cystic duct by gallstones.
Cholecystitis
54
It is a surgical removal of the gallbladder resulting from inflammation or presence of gallstones in the gallbladder.
Cholecystectomy
55
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
56
What part of pancreas is not retroperitoneal?
tail, which lies in the lienorenal (splenorenal) ligament
57
Part of the pancreas that lies within the C-shaped concavity of the duodenum.
Head
58
If tumors are present in the head, bile flow is obstructed, resulting in?
jaundice
59
A projection of the lower part of the head of the pancreas to the left behind the superior mesenteric vessels.
uncinate process
60
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
61
It runs upward and to the left across midline (part of pancreas)
Body
62
Passes in splenorenal ligament and projects toward the hilum of the spleen
Tail
63
Where does pancreas receive blood?
branches of the splenic artery and from the superior and inferior pancreaticoduodenal arteries
64
Pancreas is __ which produces digestive enzymes that help digest fats, proteins, and carbohydrates.
Exocrine gland
65
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)
66
It lowers blood sugar levels by stimulating glucose uptake and glycogen formation and storage
Insulin
67
It enhances blood sugar levels by promoting conversion of glycogen to glucose.
Glucagon
68
It suppresses insulin and glucagon secretion.
Somatostatin
69
Begins in the tail, runs to the right along the entire pancreas, and carries pancreatic juice containing enzymes.
Main Pancreatic Duct (Duct of Wirsung)
70
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)
71
Begins in the lower portion of the head and drains a small portion of the head and body.
Accessory Pancreatic Duct (Santorini Duct)
72
Where does Accessory Pancreatic Duct (Santorini Duct) empty?
lesser duodenal papilla approximately 2 cm above the greater papilla
73
Where is lymph drainage of pancreas?
celiac & superior mesenteric lymph nodes
74
Painfulness in this point arises in children with the pathology of the pancreatic tail.
Mayo-Robson's point
75
Where can Mayo-Robson's point be palpated? (palpation of pancreas)
Epigastric to left hypochondriac region or LUQ
76
It is an inflammation of the pancreas and is caused by gallstones or alcohol abuse.
Pancreatitis
77
It frequently causes severe back pain, has the potential to invade into the adjacent organs, and is extremely difficult to treat.
Pancreatic cancer
78
It is characterized by hypergylcemia that is caused by an inadequate production of insulin or inadequate action on body tissues.
Diabetes mellitus
79
Common cause of dialysis to patients with end-stage kidney disease
Diabetes
80
Formed by union of intrahepatic ductules from each lobe of the liver and drain bile from the corresponding halves of the liver
1. Right and Left Hepatic Ducts
81
* Formed by union of right and left hepatic ducts
| * Accompanied by the proper hepatic artery and portal vein
Common Hepatic Duct
82
* 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
83
Common site of impaction of gallstones
Cystic Duct
84
* 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)
85
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)
86
Common bile duct contains the __ which is a circular muscle layer around the lower end of the duct.
sphincter of Boyden
87
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)
88
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
89
```
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
90
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
91
What part of spleen is retroperitoneal?
Hilum
92
What supplies and drains the spleen?
splenic artery
| splenic vein
93
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
94
Composition of spleen which consists of venous and sinusoids and splenic cords and is the primary site of filtration
red pulp
95
Functions of spleen
1. Filters blood (removes damaged and worn-out erythrocytes and platelets by macrophages)
2. Acts as a blood reservoir, storing blood and platelets in the red pulp;
3. Provides the immune response (protection against infection);
4. Produces mature lymphocytes, macrophages, and antibodies chiefly in the white pulp
96
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
97
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
98
Developed as a thickening of the mesenchyme in the dorsal mesogastrium
Spleen
99
Part of the reticuloendothelial system (immuno regulatory, degrade blood products)
Spleen
100
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
101
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
102
Provides support to anterior end of spleen without attaching to it and prevents its downward placement
Phrenicosplenic ligament
103
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
104
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
105
It occurs frequently by fractured ribs or severe blows to the left hypochondrium and causes profuse bleeding
Rupture of the spleen
106
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
107
Anterior and Posterior relations of Gallbladder
Anterior: Anterior abdominal wall, Inferior surface of liver
Posterior: Transverse colon, 1st and 2nd part of duodenum
108
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.
