Anatomy of Gallbladder, Liver, Pancreas, Spleen

Question 1

Describe the duct system for the passage of bile from the liver to the duodenum and for storage in the gallbladder

Answer 1

Liver produces the bile.

> Right and left hepatic ducts form the common hepatic duct

>Common hepatic duct joins the cystic duct to form the common bile duct. (At the cystic duct, bile can pass up into the gallbladder if the common bile duct is closed)

> Joins the main pancreatic duct and forms the hepatopancreatic duct/ampulla of Vater

>Hepatopancreatic duct enters the second part of the duodenum at the greater papilla.

Question 2

Blood supply to the gallbladder

Answer 2

Cystic artery, which arises from the right hepatic artery within the triangle of calot

Question 3

Venous drainage of the gallbladder

Answer 3

Cystic veins, which drain into the portal vein

Question 4

Lymphatic drainage of the gallbladder

Answer 4

Cystic lymph nodes in the gallbladder neck

Question 5

The liver has a dual blood supply

Answer 5

Portal vein (75%): nutrient-rich, but deoxygenated blood; much higher volume

Hepatic artery: higher pO2

Question 6

Venous drainage of the liver

Answer 6

Hepatic veins drain into the IVC

Question 7

Where is the gallbladder? What organs is it contact with?

Answer 7

On the inferior surface of the liver a fossa between the right and quadrate lobes; is also in contact with duodenum and transverse colon

Question 8

Lymphatic drainage of the liver

Answer 8

Most drain through portal lymphatic vessels to celiac nodes?

Question 9

Position, functional anatomy, and vasculature of the gallbladder and the biliary tree?

Question 10

How does gallstone ileus form?

Answer 10

Stones that get lodged in teh fundus can ulcerate through the wall into the transverse colon or into the duodenum.

If they enter the duodenum, they produce an intestinal obstruction- the gallstone ileus

Question 11

3 common sites where gallstones are impacted and the effects on bile flow

Answer 11

(1) Cystic duct - blocks gallbladder drainage, but bile can still flow from the liver
(2) Ampulla of vater - bile regurgitates back to pancreas

(3) Common bile duct - bile flows back into the blood, causing jaundice; choledocholithiasis

Question 12

Triangle of Calot

Answer 12

Question 13

Location of the pancreas.

What happens if you have a tumor in the head?

Answer 13

Mostly retroperitoneal - head that lies in the duodenum

Tumors in the head will obstruct bile flow –> jaundice

Question 14

Function of gallbladder

Answer 14

Receive bile, concentrate it, store it, and release it during digestion in response to cholecystokinin

Question 15

Cholecystitis- what is it and where would pain refer?

Answer 15

Inflammation of the gallbaldder caused by obstruction of the cystic duct by gall stones

–> trapped bile can cause bacterial infection and perforation.

Pain may radiate to the back or right shoulder region.

Question 16

Portal triad

Answer 16

Hepatic artery bringing in oxygen and nutrients to liver

Hepatic veins bringing nutrient-rich and oxygen-poor blood to lvier

Hepatic ducts carrying bile out to emulsify fat in the digestive system

Question 17

Blood supply of pancreas

Answer 17

Pancreatic branches of the splenic artery

Superior pancreaticoduodenal artery from gastroduodenal artery

Inferior pancreaticoduodenal artery from superior mesenteric arteries

Question 18

Lymphatic drainage of pancreas

Answer 18

Head of pancreas drains into pancreaticoduodenal lymph nodes, lymph nodes in the hepatoduodenal ligament, pre-&postpyloric lymph nodes.

Question 19

Venous drainage of the pancreas

Answer 19

Head: Superior mesenteric branches of the portal vein

Rest of pancreas: Splenic vein

Question 20

Autonomic innervation of organs in the upper abdomen associated with the foregut.

Answer 20

Parasympathetic:

Preganglionic: Vagus nerve (CNX)

Postganglionic: Terminal gg @target organ

Sympathetic:

Pre-ganglionic: IML T5-T9, Greater splanchnic nerve

Post-ganglionic: Celiac ganglion

Question 21

Referred pain among foregut organ goes where?

Answer 21

Epigastrium

Question 22

Spleen- position, blood supply, attachments

Answer 22

Lies against the diaphragm against ribs 9, 10, and 11 in the left hypochondriac region.

Attachments: Supported by lienogastric/splenogastric and lienorenal/splenorenal ligaments

Supply: splenic artery

Venous drainage: splenic vein

Question 23

Significance of the spleen in trauma and hematopoietic disorders?

Answer 23

Ruptured spleen: profuse bleeding cna cause death

Spleen is hematopoietic in early life and later destroys old RBCs to set the hemoglobin free

Question 24

Collateral blood flow to the spleen

Question 25

Lymphatic drainage of the foregut organs

Question 26

Left hemiliver is composed of what segments?

Answer 26

Segments I - IV

I: caudate lobe

II-III: left lateral segment

IVa/IVb: left medial segment

Question 27

Right hemiliver

Answer 27

Segments V - VIII

V/VIII: right anterior

VI/VII: right posterior

Question 28

What duct is at the head of the pancreas?

Answer 28

Common bile duct