Ach: Liver, Gallbladder, Pancreas, Spleen Flashcards
Where is the liver located?
Undercover of ribs 5-10 and the diaphragm
What is the largest gland in the body?
Liver
What does the liver do?
- Regulates chemical levels in the body
- Processes nutrients and drugs
- Store house for glycogen
- Secretes bile
Bile is important for…
fat digestion
Where is bile concentrated and stored?
gall bladder
passes via heaptic ducts> cystic ducts> gall bladder
What is the diaphragmatic surface of the liver?
Smooth and dome-shaped, conforms to cavity of the diaphragm. Most of the surface is covered w/ peritoneum except for the “bare area”.
What is the visceral surface of hte liver?
It is in contact posterioinferiorly w/ abdominal viscera and is covered w/ peritoneum.
What is the porta hepatis?
entry/exit for blood vessels and bile ducts
What are the four lobes of the liver?
The FALCIFORM LIGAMENT divides the liver into the right and left anatomical lobes while the cuadate and quadrate are ANATOMICALLY part of the right lobe.
The cuadate and quadrate are FUNCTIONALLY part of what lobe?
Left lobe
The left portal vein drains into what areas according to functional division?
Left cuadate and quadrate lobes
Where does the right portal vein drain into?
right lobe
Why is it important that the left and right part of the liver are supplied by different hepatic arteries and bile ducts?
If part of the liver is malignant or cirrhotic and needs to be resected, you can isolate the part based on blood supply and reduce blood loss.
What is the only organ in the body that can regenerate itself?
liver
What is the H shaped group of fissrues?
It divides the liver into 4 lobes
right saggital limb
sulcus for the IVC and the fossa for the gallbladder
left sagital limb
fissure for the ligamentum venosum and the fissure for the ligamentum teres hepatis
portal limb
door to the liver
separates the caudate and quadrate lobes
What is the portal triad?
bile duct
hepatic artery
portal vein
What is the hepatic pedicle?
Hepatic artery, portal vein, bile duct, enclosed in the free edge of the hepatoduodenal ligament….enters the porta hepatis
How do you minimize blood loss following traumatic injury to the liver or during hepatic surgery? What is the likely source if bleeding persists?
clamp the pedicle
Hepatic veints or retrohepatic IVC
hepatic artery
celiac trunk> common hepatic> hepatic artery
Delivers 30% of blood to the liver and supplies the liver w/ oxygenated blood
portal vein
Union of SMV, IMV and SV forms the portal vein. It delivers 80% of blood to the liver and collects blood from the entire GI tract.
What supplies most of the blood to the liver?
portal vein
How does bile get to the hepatopancreatic ampulla?
Bile is secreted hepatocytes in the liver then travels down the right and left hepatic ducts, which come together to form the common hepatic duct. The cystic duct and the common hepatic duct then merge to form the common bile duct which eventually merges with the pancreatic duct to form the hepatopancreatic ampulla. The hepatopancreatic ampulla opens into the 2nd part of hte duodenum at the major duodenal papilla.
What controls the flow of bile and pancreatic juices into the duodenum?
the sphincter of the hepatopancreatic ampulla
What controls the flow of bile in the common bile duct to the hepatopancreatic ampulla?
the choledochal sphincter
Where do gall stones commonly lodge?
The terminus of the hepatopancreatic ampulla (the narrowest part of the biliary passage) is the most common space for gallstones to lodge. Blockage of the bile duct causes severe pain known as biliary colic. Jaundice can occur if the blockage is persistent.
What forms the hepatic veins?
The union of the central veins of the lobules of the liver.
What do the hepatic veins open into?
the IVC just inferior to the diaphragm
What causes portal hypertension?
Obstruction of the portal vein (liver cirrhosis or a tumor) can cause reversed flow of blood into the systemic veins and enlargement of the anasomoses.
What are the portal systemic anastamoses?
Provide an alternative route for venous return
What are the collateral routes that blood can take from the GI tract to the right atrium?
- Between the left gastric vein and azygos system of veins in the gastroesophageal region
- Paraumbilical veins in the falciform ligament anastomose with subcutaneous veins in the anterior abdominal wall
- Superior rectal vein anastomoses w/ the middle and inferior rectal veins
Esophageal varices
Left gastric vein and the azygos system of veins
caput medusae
epigastric veins and parumbilical veins
Rectal hemorrhoids
inferior rectal vein and superior rectal vein
What does the gallbladder do and where is it located.
The gallbladder, lies along the right edge of the quadrate lobe of the liver in a shallow fossa on its visceral service. It’s covered in peritoneum on the exposed side only and it concentrates bile and stores it in intervals between active digestion.
What are the different parts of the gall bladder?
- fundus (at the tip of the 9th costal cartilage in the midclavicular line)
- Body
- Neck
- Cystic duct
Why does the gall bladder contain a spiral fold of smooth muscle?
The smooth muscle acts to keep the duct constantly open so that bile can pass into the gallbaldder if the common bile duct is closed by the choledochal sphincter or it can pass out into the duodenum when the gallbladder contracts and the sphincter is open.
What is a cholecystectomy?
gall bladder removal
What often happens after a gall bladder is removed?
bile duct and hepatic ducts dilate to store bile
What procedure is used to visualize the gallbladder?
ultrasonography
What is the blood supply to the gallbladder?
The cystic artery which arises from the right hepatic artery in the angle between the common hepatic and the cystic ducts in the triangle of calot
Where is biliary colic felt?
Spasmodic pain that accompanies gallstones that is often felt in the upper epigastric region or the R upper quadrant.
What type of gland is the pancreas?
Both exocrine (pancreatic juices) and endocrine (insulin and glucagon)
Where is the pancreas located?
along the posterior abdominal wall, posterior to the stomach, from the duodenum to the spleen
Is the pancreas retroperitoneal?
Yes, all of it is except for the tail that lies w/in the hilus of the spleen
What are the different parts of the pancreas?
Head, neck, body, tail
Describe the path of the main pancreatic duct.
The main pancreatic duct begins at hte tail of the pancreass, runs along the gland and joins the common bile duct to form the hepatopancreatic duct. It then opens into the duodenum at the major duodenal papilla.
What is the accessory pancreatic duct?
Drains the head of the pancreas and opens independently in hte duodenum at the summit of hte minor duodenal papilla.
What is one cause of pancreatitis?
bile reflux–when bile backs up into the pancreatic duct d/t a gallstone lodged in the bile duct
Cancer of the pancreas usually affects what part?
pancreatic head
What is the blood supply to the pancreas?
- Splenic artery branches
- Gastroduodenal artery
- Superior mesenteric branches
Where is the spleen located?
large vascular lymphatic organ in the LUQ against ribs 9-11
The spleen is surrounded by peritoneum except at…
the hilus
What are the functions of the spleen?
Produces Abs from B lymphocytes
Filter blood and dispose of defective blood cells
store and concentrate blood cells and platelets
What is the hilus?
medial aspect where hte splenic artery enters and the splenic vein leaves the spleen
What is the gastrolineal ligament?
passes form the hilus to the greater curvature of the stomach–carries the left gastro-omental and short gastric arteries
What is the splenorenal ligament?
Passes to the left kidney from the hilus and contains the splenic vessels and tail of the pancreas
What is the most frequently injured organ in the body?
spleen
Is a splenectomy compatible w/ life?
yes b/c other organs assume it’s functions
What part of the pancreas is related to the hilus?
tail of the pancreas
Why does injury to the spleen cause perfuse bleeding?
it’s a bag of blood
