Anatomy of Biliary Tract and Spleen

Question 1

Gut associated organs and biliary trew

Answer 1

Gut associated organs: gallbladder, pancreas and spleen

Biliary tree: where liver, gallbladder and pancreas secretions enter duodenum - small ducts continuously join together

Question 2

Bile production

Answer 2

Produced by hepatocytes
Secreted into canaliculi
Canaliculi join to enter bile ductules and ducts in the portal triad
o Ductules: cuboidal epithelium
o Ducts: columnar epithelium

Question 3

Hepatic, cystic and bile ducts, and extra hepatic bile duct

Answer 3

Left and right hepatic ducts leave via the porta hepatis - Join to form the common hepatic duct
Cystic ducts joins to form the common bile duct
Extrahepatic bile duct:
- Duct wall now contains fibrous connective tissue and smooth muscle
- Meets the pancreatic duct to form the (hepatopancreatic) ampulla of Vater
- Finally, the sphincter of Oddi moderates emptying into the duodenum

Question 4

Bile Duct and Portal Triad

Answer 4

Anatomical relations in this area are a crucial surgical consideration
Bile duct is anterior to the portal vein
Bile duct is to the right of the hepatic artery

Question 5

Gallbladder

Answer 5

Functions: Store and concentrate bile; Selectively absorb bile salts; Excrete cholesterol and mucous
Bile is an important digestive fluid that emulsifies fats
Anatomy: Located on inferior surface of the right lobe of the liver; Characteristically conical/pear-shaped; Divided into the fundus, body and neck

Question 6

Pancreas

Answer 6

Located posterior to the stomach
Exocrine and endocrine gland
o Exocrine: secrete digestive enzymes into the duodenum
o Endocrine: secretes hormones such as insulin
Anatomy: Divided into the head, body and tail
- Supplied by - Arteries: splenic, coeliac trunk, pancreaticduodenal; Veins: pancreatic (drain into the portal vein); Nerves: coeliac ganglia and Vagus

Question 7

Exocrine pathway of the pancreas

Answer 7

Pancreatic secretions collect in small ducts
These ducts join to form the Wirsung
The Wirsung meets the common bile duct to form the hepatopancreatic ampulla/ampulla of Vater
This then empties into the duodenum at the major duodenal papilla

Question 8

Pancreatic Diseases

Answer 8

Inflammation (pancreatitis) - causes: gallstones, high alcohol intake, CF, high levels of calcium or blood fats
Pancreatic cancer - causes: obstructive jaundice (gallstones), high alcohol intake, smoking, genetics

Question 9

Spleen

Answer 9

Lymphoid organ - associated with the lymphatic system, and has an immune role
Blood gland: Removes old blood cells; Stores platelets; Produces blood cells during foetal live
Delicate and friable
Anatomy: Surrounded by a connective tissue (CT) capsule, The inner portion is known as parenchyma
- This contains red and white pulp - Red pulp – blood filled sinuses; White pulp – lymphatic tissue (think white blood cells)

Question 10

Visceral Pain

Answer 10

Pain felt from the organs (viscera)
Poorly localised in comparison to somatic pain
Due to innervation of structures (somatic vs autonomic innervation)
Described as dull, aching, pressure
Cause of referred pain (where pain is felt in a different location to where organ or structure injured)