Anatomy - Liver, Gallbladder, Gastric, Splenic Vasculature (+ Liver structure)

Question 1

Describe the portal triad

Answer 1

Portal vein
hepatic artery
common bile duct

nerves
lymphatics

Functions:

• Supplies blood to liver
• Takes away bile
• Innervates liver

Question 2

Describe the biliary tree

Answer 2

Bile produced (liver)
-->
Stored and concentrated (gallbladder)
-->
2nd part of the duodenum

Question 3

Describe the celiac trunk

Answer 3

first anterior branch of the descending aorta

Bifurcates at T12

Supplies the foregut

It is retroperitoneal

Question 4

Describe the branches of the celiac trunk

Answer 4

Trifurcates into:

• Splenic artery
• Common hepatic artery
• Left gastric artery

Question 5

Describe the branches of the common hepatic artery

and the branches of the gastroduodenal artery

Answer 5

Common hepatic bifurcates into:

• Right gastric artery
• Gastroduodenal artery

Gastroduodenal artery bifurcates into:

• Right gastro-omental artery
• Superior pancreaticoduodenal artery

Question 6

Describe the splenic artery

What does it branch from?
Where does it run?
What does it supply?
Does it branch?

Answer 6

a branch of the celiac trunk

Runs along the superior pancreatic border

Supplies the spleen

Gives rise to the left gastro-omental artery

Question 7

What region of the abdomen is the spleen in?

What ribs is it deep to?

Answer 7

left hypochondrium

deep to ribs 9-11
rib fracture here can lead to rupture

Question 8

Describe the anatomical relationship of the following to the spleen:

• diaphragm
• stomach
• splenic flexure
• left kidney

Answer 8

diaphragm = posterior

stomach = anterior

splenic flexure = inferior

left kidney = medial

Question 9

What is the hematological function of the spleen?

Answer 9

Break down RBCs

producing bilirubin

Question 10

Describe the blood supply to the stomach

Answer 10

Lesser curvature:
- Right gastric artery
- Left gastric artery
(these anastomose together)

Greater curvature:
- Right gastro-omental artery
- Left gastro-omental artery
(these anastomose together)

Question 11

Describe the blood supply to the liver

Answer 11

Arterial (25%):

• Right hepatic artery
• Left hepatic artery

Venous (75%)
- Hepatic portal vein

Question 12

Describe the anatomical relationship of the following to the liver:

• diaphragm
• stomach
• hepatic flexure
• right kidney
• gallbladder
• IVC and abdo aorta

Answer 12

diaphragm = superior, anterior, posterior

stomach = medial

hepatic flexure = inferior

right kidney = posterior

gallbladder = posterior, inferior

IVC and abdo aorta = posterior

Question 13

What ribs protect the liver?

Answer 13

7-11

on the right hand side

Question 14

Name the 4 anatomical segments of the liver

Answer 14

Right lobe

Left lobe

Caudate lobe (posterior)

Quadrate lobe (anterior, beside gallbladder)

Question 15

Describe the 8 functional segments of the liver

Answer 15

Each has its own:

• hepatic venous drainage
• hepatic artery supply
• portal vein supply
• bile drainage

Question 16

Define a hepatic segmentectomy

Answer 16

The removal of a functional segment of the liver

Question 17

Why does an increase in central venous pressure cause hepatomegaly?

Answer 17

There are no valves between the liver and right atrium

Question 18

Describe blood flow to and from the liver

Answer 18

Portal vein and hepatic artery
-->
liver
-->
hepatic veins
-->
IVC

Question 19

Describe the flow of blood through a hepatic lobule

Answer 19

interlobular portal trial
-->
hepatic sinusoids
-->
centrilobular vein

Question 20

Describe the flow of bile through a hepatic lobule

Answer 20

Hepatocytes
-->
bile canaliculi
-->
bile ducts (interlobular portal trial)
-->
common bile duct

Question 21

Describe the hepatorenal recess

Answer 21

Peritoneal cavity between the liver and diaphragm

one of the lowest parts of the peritoneal cavity when the patient is supine

Question 22

Describe the subphrenic recess

Answer 22

Peritoneal cavity between the liver and right kidney

Question 23

Which veins feed from the:

• foregut
• midgut
• hindgut

Answer 23

foregut = Splenic vein

midgut = Superior mesenteric

hindgut = Inferior mesenteric

Question 24

Describe the venous drainage to the liver

Answer 24

inferior mesenteric joins the splenic vein
–>
splenic joins the superior mesenteric vein
–>
Portal vein
–>
liver

Question 25

Describe the coronary ligament

Answer 25

superior liver

attaches to diaphragm

Question 26

Describe the falciform ligament

Answer 26

anterior liver

between right and left lobes

attaches to anterior abdo wall

Question 27

Describe the blood supply to the gallbladder

Answer 27

right hepatic artery
-->
cystic artery
-->
gallbladder

(this is only the case in 75% of people)

Question 28

What is the function of the liver?

Answer 28

to store and concentrate bile

mainly between meals

Question 29

Describe the location of the gallbladder

Answer 29

posteroinferiorly to the liver

anterior to the duodenum

Question 30

Describe the morphology of the gallbladder

Answer 30

Body
-->
Neck
-->
Cystic duct

Question 31

Describe the innervation of the gallbladder

Answer 31

Visceral afferents from T6-9

Question 32

Describe the location of pain from the gallbladder

Answer 32

Initially:
- epigastric region

Then:
- Right hypochondrium

Referred pain:

• gallbladder inflammation can irritate the anterior diaphragm
• this can cause referred pain in the shoulder

Question 33

Define a cholecystectomy

Answer 33

removal of the gallbladder