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GastroIntestinal > Anatomy 13 > Flashcards

Anatomy 13 Flashcards

1
Q

Where is the liver located?

A

In the right upper quadrant and epigastrium of the abdomen

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2
Q

Which direction does the liver move during inspiration?

A

Inferiorly

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3
Q

Which part of the liver may be palpable?

A

Lowermost part below the right costal margin in inspiration

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4
Q

How are the products of digestion transported from the gut to the liver?

A

Via the hepatic portal vein

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5
Q

What is the function of bile?

A

Emulsifies lipids in the chyme entering the duodenum from the stomach

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6
Q

What produces bile?

A

Liver

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7
Q

Where is the bile from the liver transported to for storage?

A

Gallbladder

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8
Q

What are the two surfaces of the liver?

A

Diaphragmatic Surface
Visceral Surface

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9
Q

Where is the diaphragmatic surface of the liver located?

A

Lies anterosuperior and is related to the inferior surface of the diaphragm

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10
Q

Where is the visceral surface of the liver located?

A

Lies posteroinferior and is related to other organs

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11
Q

What regions of the liver are not covered by the visceral peritoneum?

A
  • bare area of the liver – a region on the posterior surface that lies in contact with the diaphragm
  • the region where the gallbladder lies in contact with the liver
  • region of the porta hepatis – where hepatic blood vessels and ducts of the biliary system enter and exit the liver (the equivalent of the hilum of the lung)
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12
Q

What are the two anatomical lobes that the liver is composed of?

A

Large right lobe
Small left lobe

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13
Q

What are the anatomical lobes of the liver separated by?

A

Falciform ligament, which connects the anterior surface of the liver to the internal aspect of the anterior abdominal wall

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14
Q

What are the two accessory lobes?

A

Caudate
Quadrate

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15
Q

Where are the two accessory lobes located?

A

Posteroinferior surface

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16
Q

What is the liver organised into?

A

8 functional segments.

Each segment is served by its own branch of the hepatic artery and portal vein, and by its own hepatic duct

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17
Q

What is the liver supplied by?

A

The liver is supplied by the right and left hepatic arteries.
These branches ultimately derive from the coeliac trunk

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18
Q

What does the coeliac trunk give rise to?

A

Gives rise to the left gastric, splenic, and common hepatic arteries

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19
Q

What does the common hepatic artery give rise to?

A

Gives rise to the gastroduodenal artery; after this point, the common hepatic artery is called the hepatic artery proper (HAP)

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20
Q

What does the hepatic artery proper bifurcate into?

A

Right and left hepatic arteries, which enter the liver at the porta hepatis

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21
Q

How does venous blood exit the liver?

A

Exits the liver via two or three large hepatic veins that lie within the liver

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22
Q

What do the hepatic veins unite with?

A

Unite with the inferior vena cava as it passes posterior to the liver

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23
Q

How is nutrient-rich venous blood transported from the gut to the liver?

A

Via the hepatic portal vein, which receives blood from the superior and inferior mesenteric veins and the splenic vein.

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24
Q

How does venous blood leave the liver?

A

Via the hepatic veins and enters the inferior vena cava

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25
Q

What is the liver served by?

A

Served by the hepatic plexus

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26
Q

What is the hepatic plexus formed of?

A

Formed of parasympathetic fibres from the vagus nerves and sympathetic fibres.

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27
Q

Why is pain arising from the liver referred to the epigastric region?

A

Because the liver is a foregut derivative

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28
Q

What is the liver connected to?

A
  • diaphragm by the coronary and triangular ligaments
  • anterior abdominal wall by the falciform ligament
  • stomach and duodenum by the lesser omentum
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29
Q

What forms the portal triad in the free edge of the lesser omentum?

A

Hepatic artery
Hepatic portal vein
The bile duct

30
Q

What forms the anterior boundary of the epiploic foramen?

A

The portal triad and the free edge of the lesser omentum

31
Q

What is the epiploic foramen?

A

The entrance into the lesser sac (which lies posterior to the stomach)

32
Q

What are the recesses related to the liver?

A

Hepatorenal recess
Left and Right Subphrenic recesses

33
Q

What is the hepatorenal recess?

A

The hepatorenal recess lies between the right kidney and the posterior (visceral) surface of the right side of the liver.

Fluid flows into this space in the supine position

34
Q

What are the the left and right subphrenic recesses?

A

Lie either side of the falciform ligament, between the anterosuperior surface of the liver and the diaphragm

35
Q

Where does the liver develop from?

A

Develops from the embryological foregut.

It grows from a tissue bud that develops in the ventral mesentery – a peritoneal fold in the upper abdomen that connects the stomach to the anterior abdominal wall.

As the liver grows and migrates to the right side of the abdomen, its peritoneal attachments are pulled with it.

The remains of the ventral mesentery form the lesser omentum and the falciform ligament.

The peritoneal attachments of the liver anchor it to surrounding structures, including the diaphragm superior to it.

36
Q

What does the free edge of the falciform ligament contain?

A

Contains the round ligament of the liver (the ligamentum teres)

37
Q

What is the ligamentum teres?

A

The remnant of the umbilical vein, which, in the foetus, carries oxygenated blood from the placenta to the foetus

38
Q

What is the ligamentum venosum?

A

Remains of the ductus venosus, which in foetal life diverts blood from the umbilical vein to the IVC, thus shunting oxygen-rich blood to the heart and bypassing the liver

39
Q

Where is the ligamentum venosum located?

A

Lies on the posterior surface of the liver, in the groove between the caudate lobe and the left lobe of the liver

40
Q

What is the function of the gallbladder?

A

Stores and concentrates bile

41
Q

Where is the gallbladder located?

A

Lies on the posteroinferior (visceral) surface of the liver and lies close to the duodenum

42
Q

What are the 3 parts of the gallbladder?

A

Fundus
Body
Neck

43
Q

What is the body of the gallbladder?

A

The body forms the main part of the gallbladder which sits in the gallbladder fossa on the visceral surface of the liver

44
Q

What is the neck of the gallbladder?

A

The body tapers towards the neck, which communicates with the cystic duct

45
Q

What is the fundus of the gallbladder?

A

The rounded end of the gallbladder, which typically extends to the inferior border of the liver

46
Q

Where is the surface marking of the fundus of the gallbladder?

A

At the tip of the 9th costal cartilage, at the point where the right midclavicular line intersects the right costal margin

47
Q

What produces bile in the liver?

A

Hepatocytes

48
Q

Where is bile first excreted?

A

Small channels called bile canaliculi

49
Q

What do the bile canaliculi do?

A

Drain into bile ducts of increasing calibre, which ultimately converge to form right and left hepatic ducts that exit the liver at the porta hepatis

50
Q

What do the left and right hepatic ducts converge to form?

A

Common hepatic duct

51
Q

What does the common hepatic duct receive?

A

Receives the cystic duct from the gallbladder.
Distal to this point, the duct is called the bile duct (or common bile duct)

52
Q

Where does the common bile duct run?

A

In the free edge of the lesser omentum

53
Q

Where is the bile duct located?

A

It lies posterior to the superior part of the duodenum and posterior to the head of the pancreas

54
Q

What does the common bile duct enter?

A

Duodenum

55
Q

What happens to bile leaving the liver if it is not needed for digestion?

A

It enters the gallbladder via the cystic duct.
When needed, bile flows from the gallbladder, via the cystic duct, to the bile duct and duodenum.

56
Q

Where is the spiral fold (spiral valve) located?

A

Lies at the junction between the gallbladder neck and the cystic duct

57
Q

Where does the gallbladder get its blood supply from?

A

Cystic artery

58
Q

What does the cystic artery arise from?

A

Right hepatic artery

59
Q

What is the gallbladder drained by?

A

Cystic veins that pass directly into the liver or join the hepatic portal vein

60
Q

What is the gallbladder innervated by?

A

Innervated by parasympathetic and sympathetic fibres

61
Q

Which spinal cords does visceral pain from the gallbladder enter?

A

Levels T5-T9 and is therefore referred to/felt in the epigastrium

62
Q

Where may gallbladder pain also be referred to and why?

A

The right shoulder if gallbladder pathology (e.g. inflammation) irritates the diaphragm

The diaphragm is innervated by the phrenic nerve (C3-5)

Spinal cord segments C3-5 also receive somatic sensory information from the skin over the shoulder.

63
Q

What happens if gallbladder pathology irritates the parietal peritoneum?

A

Pain is well localised to the right hypochondrium

64
Q

What is hepatomegaly?

A

Hepatomegaly is enlargement of the liver.

Causes include hepatitis (inflammation of the liver from various causes), malignancy, and heart failure.

When the liver is enlarged, its inferior border becomes palpable inferior to the right costal margin.

65
Q

What is liver metastases?

A

Although primary cancer of the liver does occur, most cancers of the liver are metastases from cancer elsewhere in the body.

Because venous blood from the gut passes through the liver, bowel cancers often metastasize to the liver.

66
Q

What is cirrhosis of the liver?

A

Cirrhosis is sometimes referred to as ‘scarring’ of the liver.

It is caused by chronic excess alcohol consumption, chronic infection with hepatitis B or C, or a build-up of fat in the liver.

Hepatocytes are destroyed and replaced with fibrous tissue.
The liver becomes shrunken, hard, and nodular.

Loss of hepatocytes impairs the function of the liver and liver failure may ultimately result.

67
Q

What is portal hypertension?

A

High blood pressure in the portal venous system.
It results when blood flow through the liver and portal vein is obstructed (e.g. in cirrhosis of the liver)

68
Q

What are portosystemic anastomoses ?

A

Communications between veins draining to the systemic circulation and veins draining to the portal circulation.

For example, in the distal oesophagus, venous blood drains into both the systemic veins (via the azygos) and into the portal system (via the gastric veins).

If flow in the portal system is obstructed, pressure in the portal system increases and blood is diverted from the portal veins into the systemic veins.

The systemic veins become distended and varicose (in the oesophagus these are called oesophageal varices) and prone to rupture, which can result in catastrophic bleeding

69
Q

What are gallstones?

A

Gallstones are common in the UK population.
They are mostly composed of cholesterol.
They are often asymptomatic, but cause symptoms when they migrate into the biliary tree and lodge there

70
Q

What is biliary colic?

A

Severe pain felt when the gallbladder contracts and there is a gallstone lodged in the cystic duct

71
Q

What is cholecystitis?

A

When a gallstone becomes stuck in the cystic duct blocking the flow of bile into the cystic duct and gallbladder

72
Q

What is a cholecystectomy?

A

Removal of the gallbladder
Usually performed laparoscopically

GastroIntestinal (19 decks)

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