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104: Theme 2 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Describe the structure of the intrahepatic Bile ducts.

A
  • The ductules (smaller bile ducts) have a thinner wall made of cuboidal epithelium
  • Larger bile ducts are made of a single layer of columnar epithelium with underlying flexible connective tissue
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2
Q

Describe the Biliary Tree

A
  • Segments of the left liver form the left hepatic duct
  • Sectoral ducts of the right liver join to form the right hepatic duct
  • Left and Right leave through the porta hepatis and join to for the Common hepatic duct
  • This is joined by this Cystic duct to form the Common bile duct
  • the Pancreatic duct joins it forming the ampulla of Vater

- This drains into the Duodenum through the Sphincter of Oddi

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3
Q

Describe the structure of the Extrahepatic duct

A
  • the wall has a dense fibrous connective tissue to contain a larger volume of bile
  • smooth muscle cells to propel bile along
  • lumen remains highly columnar epithelium
  • Lies within the lesser omentum close to the free edge
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4
Q

Descrube the blood supply of the extrahepatic bile duct

A
  • supplied by the cystic arteries (from the coeliac in the foregut)
  • drains into the Portal vein
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5
Q

Describe the anatomical placement of the Portal Triad ( Bile Duct, Portal Vein, Hepatic Artery).

A
  • The Bile Duct is right of the Hepatic Artery
  • The Hepatic Artery and Bile Duct are anterior to the Portal Vein
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6
Q

Describe the anatomical position of the Gall Bladder

A
  • found on the visceral surface of right liver lobe
  • it’s at the inferior border of the liver anteriorly and the duodenum posteriorly
  • It’s held by the same layer of visceral peritoneum as the liver
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7
Q

Describe the anatomy of the Gall bladder

A
  • Divided into the Fundus, Body and Neck
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8
Q

What is the function of the gall bladder?

A
  • store and concentrate bile salt
  • selectively absorb bile salts
  • to excrete cholesterol
  • to excrete mucous
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9
Q

Describe the mechanism of the Gall bladder emptying

A
  • if fatty foods are detected in the duodenum, ( Cholecystokinin) CCK is released
  • CCK release triggers the gallbladder to contract and bile flows down the biliary tree
  • Sphincter of Oddi relaxes and bile enters the duodenum
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10
Q

Describe the anatomy of the pancreas

A
  • 12-15 cm long, 3 cm wide
  • head, body, tail
  • exocrine secretions are collected into small ducts then form one main duct called Wirsung
  • the duct of Santorini which drains directly into the duodenum
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11
Q

Describe the anatomical position of the Pancrease.

A
  • found posteriorly to the stomach
  • Head and body located in the Epigastrium
  • the tail is in the left hypochondriac region closer to the spleen
  • the head of the pancreas is encircled by the duodenum
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12
Q

Descibe the function and histology of the Pancreas

A
  • acts as an exocrine and endocrine gland

Exocrine

  • Acini (cluster cells) make up 98-99% of total cell population: they excrete digestive enzymes
  • they are pyramidal cells

Endocrine

  • Centroacinar cells, islets of Langerhans; secretes hormones, insulin
  • they are cuboidal cells
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13
Q

Give the VAN of the Pancreas

A
  • Arteries: mostly the splenic artery from the Celiac trunk, also the gastroduodenal and pancreaticoduodenal (which anastomosis with the superior mesenteric artery)
  • Veins: Pancreatic veins, draining into the portal vein
  • Nerves: sympathetic via Coeliac ganglia and parasympathetic via Vagus nerve
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14
Q

What disease process occurs to the pancreas and what causes them?

A

Inflammation

  • gallstones
  • heavy alcohol intake
  • cystic fibrosis
  • high levels of calcium or blood fats

Pancreatic Cancer

  • obstructive jaundice (gallstones)
  • heavy alcohol intake
  • smoking
  • genetics
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15
Q

Describe the anatomical position of the spleen

A
  • located in the left hypochondria region
  • lyes under ribs 9, 10 and 11
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16
Q

Describe the anatomy of the Spleen

A
  • Surrounded by Connective tissue
  • inside contains parenchyma divided into two sections

Red pulp: blood-filled venous sinuses

White pulp: a greater proportion of lymphatic tissue

17
Q

What is the main role of the Spleen?

A
  • immunity
  • removal of old blood cells by macrophages
  • storage of platelets
  • during the fetal stage: produces blood cells
18
Q

What are the main functions of the liver?

A
  • detoxification
  • protein synthesis
  • production of bile
  • glycogen storage
19
Q

Describe the location of the liver

A
  • below the diaphragm
  • right of the stomach
  • above the colon
  • overlies the gallbladder
  • mostly in the right hypochondrium and epigastrium, does extend into the left hypochondrium
20
Q

What can be seen on the posterior view of the liver?

A
21
Q

What are the peritoneal folds associated with the liver and what are their functions?

A
  • Falciform ligament: links diaphragm to the upper surface of the liver. ligamentum trees (round ligament) at eh lower end
  • Round ligament: obliterated left umbilical vein, extends to the umbilicus
  • Coronary ligament: links the diaphragm to the liver
  • Lesser omentum: links the liver to the stomach
22
Q

Where does the lesser omentum extend to and what does it enclose?

A
  • from the lesser curvature of the stomach to the porta hepatis

Encloses

  • hepatic artery
  • portal vein
  • bile duct
  • lymph vessels
  • encloses the fastic arteries and veins near the stoamach
23
Q

What is the blood supply to organs in the foregut, midgut and hindgut?

A
  • Foregut: Coeliac artery/ trunk
  • Midgut: superior mesenteric artery
  • Hindgut: inferior mesenteric artery
24
Q

What is the blood supply of the liver?

A
  • the hepatic artery originating from the coeliac artery (foregut organ)
  • the portal vein: formed by the joining of the sup mesenteric and splenic veins
25
Q

Where does the coeliac artery exit from the aorta, what are the main branches and the organs it supplies?

A
  • exits the aorta at T12/L1
  • Main branches: Left gastric, Splenic, Hepatic
  • also supplies: duodenum and the pancreas
26
Q

What are the function of hepatocytes?

A
  • Synthesis and release plasma proteins into blood, e.g. albumin clotting factors
  • Deaminates amino acids, creating ammonia (this is then converted into urea in order to be safe)
  • Converting bilirubin to bile pigment
  • Production of bile salts, to emulsify fats
27
Q

Describe the division of the liver into segments

A
  • Lobes divided into Couinauds, according to how the hepatic artery and portal vein subdivide them
  • branches of hepatic artery and portal vein carry blood into sinusoids
  • Each lobe of liver contains several lobules which are hexagon-shaped
  • these lobules contain hepatocytes which secrete bile
  • each lobule has a portal triad at each corner
28
Q

Describe the venous drainage of the liver

A
  • mixed portal and hepatic blood in sinusoids pass through the hepatocytes into the central vein
  • the central vein is at the centre of a hepatic lobule
  • several central veins then drain into the interlobular (sublobular) vein
  • sublobular veins drain into hepatic veins
  • hepatic veins drain into the inferior vena cava
29
Q

What is the Hepatic portal system?

A
  • blood draining from the GI tract towards the liver
  • anything that is absorbed from the GI has to pass through the liver before reaching the heart
30
Q

What is portal-systemic anastomosis?

A
  • the systemic anastomosis is having some branches between the portal and systemic systems
  • these are portocaval anastomosis: this allows blood to bypass the liver to get to the heart
  • prevents portal hypertension if the portal vein becomes blocked or passage via the liver meers resistance
31
Q

Give some examples of portal-systemic anastomosis

A
  • Abdominal part of oesophagus – left gastric tributaries with oesophageal branches azygos
  • Anal canal – superior rectal anastomoses with middle and inferior rectal
  • Umbilicus – paraumbilical veins with epigastric veins
  • Veins of colon, duodenum, pancreas, liver with renal, lumbar and phrenic

(underlined is portal system)

32
Q

What are the presenting signs of portal hypertension? And how can it be treated?

A
  • Varicoses
  • Caput medusa

Transjugular intrahepatic portosystemic shunting (TIPS)

33
Q

How would the liver experience trauma and whats the impact?

A
  • if ribs are fractured/ a penetrating wounds
  • the liver is highly vascularized leads to severe haemorrhage
  • portions can be removed due to the segmental nature of the liver: this can be done if there is metastatic spread, cirrhosis and in case of liver bipsies

104: Theme 2 (7 decks)

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