Anatomy of the Biliary System & Liver Flashcards
What are the two divisions of the peritoneum?
The visceral and the parietal layers
Which layer of the peritoneum attaches to the organs?
The visceral layer
What is the peritoneal cavity and what is it filled with?
The cavity between the parietal and the visceral layers and it is filled with fluid
What is a pathology that is related to the peritoneal cavity?
Ascites, the accumulation of fluid in the peritoneal cavity
Which structures does the peritoneal cavity divide into?
Greater and lesser sacs
What are the structures that the greater sac contains?
The intestinal structures and the intestinal fluids
What is the lesser sac?
A peritoneal space that is located behind the stomach
What leads to the formation of the lesser sac?
The rotation of the stomach
What is the greater omentum made of?
Lesser and greater sacs
Are the greater and lesser sacs separated?
No, the greater and lesser sacs are not separated, they are a continuation of one another so that the fluid can move freely between them.
What is the epiploic foramen?
Communication or opening between two sacs
What are the borders of the Epiploic foramen?
Superiorly: Caudate lobe of the liver
Posteriorly: IVC
Inferiorly: First part of duodenum
Anteriorly: Free border of the lesser omentum
What are the structures inside the free edge of the lesser omentum?
Bile duct; anterior to the right
Hepatic artery; anterior to the left
Portal vein
What is the function of the lesser omentum?
To connect the lesser curvature of the stomach to the liver
What is the other name for Epiploic Foramen?
Foramen of Winslow
What are the different structures that the peritoneum has?
Spaces and Recesses
What are the examples of spaces in the peritoneum?
Right and left subphrenic spaces
Paracolic gutters
What are examples of the recesses found in the peritoneum?
Duodenal
Cecal
Intersigmoid
What is the direction of the fluid in the peritoneal cavity?
It will follow the path from the bottom towards the diaphragm, since it has to follow the lymphatic drainage
Where are the parabolic gutters located?
Aside from ascending and descending colons
How do peritonitis and ascites develop?
Alteration of movement of fluid, or accumulation
What are the common sites of pus collection? Why?
Subphrenic recesses, more frequent will be the right subphrenic space because of the ruptured appendix and duodenal ulcers
Which structures are continuous with the hepatorenal recess?
Both recesses and omental bursa (lesser sac)
What is an internal hernia?
A lobe of the small intestine gets stuck in a space such as a recess or omentum
What are omenta and what are their examples?
Omenta are two layered folds, they are called that when attached to the stomach:
Greater and lesser omenta
What does the greater omentum cover?
It will cover all of the intestinal lubes and run back and attach ti the transverse colon, mesocolon and posterior abdominal wall
What is the function of the mesenteries?
To give the structure they are attached to some mobility and freedom
What are the different examples of mesenteries in the body?
Mesentery of the small intestine
Mesentery of the transverse mesocolon, mesentery of the sigmoid mesocolon
Which parts of the colon do not have mesenteries? Why?
Ascending and descending colons they are retroperitoneal structures and thus there is no need for because of their close proximity to the abdominal wall
What are the ligaments of the peritoneum?
Falciform, coronary, spenicorenal, gatsrophrenic
What is the alternative name of the ligaments of the peritoneum?
Peritoneal reflections
What are the divisions of the lesser momentum?
Hepatoduodenal and hepatogastric
Which of the peritoneal ligaments are derived from the ventral mesentery?
The falciform and the coronary and they are related to the liver
What does the splenicorenal ligament connect?
The spleen to the kidneys
What does the gastrosplenic ligament connect?
The stomach to the spleen
Where are most of theligaments derived from?
The dorsal mesentery
What re intraperitoneal structures?
Any organ that has a mesentery or ligament attached to posterior or anterior wall
What are retroperitoneal structures?
Organs or structures that have no mesentery attached to them
What are the divisions of the retroperitoneal structures?
Primary and secondary
What is the difference between primary and secondary retroperitoneal structures?
During development, the structures that were initially intraperitoneal and later on moved towards the back are known as secondary retroperitoneal.
The ones that from the beginning did not have a mesentery are not as primary retroperitoneal
What are infraperitoneal structures?
Structures that are found below the peritoneum
What are the examples of intraperitoneal structures? (13)
- Stomach
- Duodenum (the first part)
- jejunum
- Ileum
- Cecum
- Appendix
- Transverse colon
- Sigmoid colon
- Rectum (upper 1/3)
- Liver
- Spleen
- Pancreas (tail only)
- Ovaries
What are the primary retroperitoneal structures? (6)
- Adrenal glands
- kidneys
- Ureter (proximal)
- Aorta
- IVC
- Anal canal
What are the secondary retroperitoneal structures? (5)
- Duodenum (2, 3, and 4th parts)
- Ascending colon
- Descending colon
- Rectum (middle 1/3)
- Pancreas (all parts except of tail)
What are the examples of the infraperitoneal structures? (6)
- Rectum (lower 1/3)
- Ureter (distal end)
- Urinary bladder
- Uterus
- Fallopian tubes
- Prostate
What are the different functions of the liver?
Metabolic
Haematological
Digestive
What are the different metabolic functions of the liver?
Regulate circulating levels of nutrients
Stores fat-soluble vitamins
Removes metabolic wastes and toxins
How do the nutrients reach the liver?
They get transported through the portal vein in order to get metabolised in the liver
Which are the fat soluble vitamins?
Vitamin A, D, E and K
Vitamin B12
What are the haematological functions of the liver?
Blood reservoir
Phagocytosis of circulating debris
Synthesis of plasma proteins
During embryonic phase the liver is the source of blood formation
What is an example of circulating debris that the liver phagocytoses?
Old and damaged RBCs
What is the digestive function of the liver?
Synthesis and secretion of bile
What is the edge of the Falciform ligament known as?
The round ligament
Which is the largest internal organ?
The liver
What are the surfaces of the liver?
Anterior - superior (diaphragmatic)
Posterior-inferior (Visceral)
What are the structures that the posterior-inferior surface has?
Fissures and Porta hepatis
What are fissures?.
Borderlines between the lobes
What are the different fissures of the liver?
Right and left sagittal
What are the structures of the right sagittal?
IVC and Gallbladder
What are the structures of the left sagittal?
Ligamentum teres & Ligametum Venosum
Which structure does the ligamentum teres derive from?
Umbilical vein
Which structure does the ligament venosum serve from?
Ductus venosus
What is the function of the umbilical vein?
Brings blood from the placenta to the embryo, highly oxygenated
What happens to the umbilical vein after birth?
There is no need for it after birth as the lungs have developed so it will be closed and replaced by fibrous tissue –> ligamentum teres
What is the ductus venosus?
Bypass shunt during the embryonic phase
What happens to the ductus venosus after birth?
It also closes after birth and it is replaced by fibrous tissue –> ligamentum venosum
What are the lobes of the liver?
Right
Left
Caudate
Quadrate
Which lobe do the caudate and quadrate lobes belong to?
Left
What is contained in the porta hepatis?
Right and left hepatic ducts
Right and left hepatic arteries
Portal vein
Autonomic nerves
Hepatic lymph nodes
What are the structures derived from the ventral mesentery?
Lesser omentum
Liver capsule
Falciform ligament
Coronary ligament
What are the divisions of the lesser omentum?
Hepatogatsric and hepatoduodenal
What is the name of the liver’s capsule?
Glisson’s capsule
What are the derivatives of the coronary ligament?
Right triangular ligaments
Bare area
Left triangular ligaments
Is the whole of the liver covered by peritoneum?
No there are some structures of the liver that are not covered
Which are the structures of the liver that are not covered by the peritoneum?
Gallbladder fossa
Porta hepatis
Bare area
What is the blood supply of the liver like?
Dual blood supply:
Hepoatic proper artery
Portal vein
What kind of blood does the hepatic proper artery carry?
Oxygenated blood
What kind of blood does the portal vein carry?
Fully oxygenated blood full of nutrients (absorbed from the GIT)
What are the divisions of the hepatic proper artery?
Left and Right hepatic arteries
Which structures does the left hepatic artery supply?
Left lobe
Caudate lobe
Quadrate lobe
Which structures does the right hepatic artery supply?
Right lobe
What is portal hypertension?
Increased resistance to blood flow into the liver
Where does the lower part of the liver drain into?
Left gastric which flows into portal circulation
In the cases of liver cirrhosis and portal hypertension what happens to the blood supply?
It finds an alternative route
Which areas will blood shunt through if normal volume of blood cannot enter the liver?
Areas of anastomosis; areas in which the blood can flow from the portal system into the systemic system
What will be the result of the blood passing through the areas of anastomosis?
The additional volume of blood will cause the local vessels to become enlarged –> varicose
Inferior rectal veins?
Inferior vein is systemic so it will drain into the internal ileac artery –> systemic venous system
Middle and superior rectal veins?
They will join the portal system through the superior mesenteric vein
What are the liver lobules made of?
Hepatocytes
Liver sinusoids
Central vein
Portal area
Where is the central vein located?
In the centre of the lobule
Where is the portal area located?
In the periphery of the lobules
What is the portal area made out of?
Portal triad: hepatic artery, portal vein, bile duct
What kind of tissue divides the liver into lobules?
Connective tissue septa
What is the shape format of a lobule?
Hexagonal, with 6 portal areas
What is the structure arrangement of the hepatocytes called?
Laminae
What are laminae bound by on either side?
Endothelial lined spaces, hepatic sinusoids
What blood vessels drain into the central vein?
Hepatic artery and portal vein
Where does the central vein drain into?
Hepatic vein and then into the IVC
Where is bile produced and what is the direction it flows in?
Produced in the hepatocytes and it flows in the opposite direction of blood; from the central to portal triad
Why does bile flow towards the portal triad?
There is a branch of the bile duct
What is the oxygen environment like in the central vein?
Not as much oxygen so cells mainly use anaerobic functions
What do all central veins join to form?
Connect to form the hepatic vein
The blood flow from hepatic portal vein…
Blood from the hepatic portal vein and hepatic proper artery flow through the hepatic sinusoids towards the central vein
What are the functions of the hepatocytes?
Produce & secrete bile into bile canliculi
Secretion of bilirubin
Protein synthesis & Carbohydrate storage
What is the route of bile?
Produced and secreted from the hepatocytes –> into bile canaliculi –> bile ductules –> bile ducts in the portal area
What do bile ducts merge to form?
Right and left hepatic ducts
What are some characteristics of the liver lobules?
They are rich in organelles: they have centrally-located nuclei, RER for production of proteins, SER for detox effects and mitochondria which cause it to be an eosinophilic cell
What are the different structures inside the liver lobule?
Space of Disse
Kupffer cells
Fat-storing checks
What is the function of space of Disse?
Separates hepatocytes from endothelial cells, allowing proteins and other plasma components from the sinusoids to be absorbed by the hepatocytes
What are Kupffer cells? Where do they come from?
Phagocytic cells, they are derived from the mesoderm
Where are hepatocytes derived from?
From the endoderm
What are the different parts of the gallbladder?
The fundus
The body and
The neck
What is the neck of the gallbladder connected to?
Communicated with the bile ducts
Where do the bile ducts empty?
Into the second part of the duodenum
What are the functions of the gallbladder?
Concentrates bile
Stores bile
Excretes cholesterol
Secretes mucus
The extrahepatic ducts:
Left hepatic duct + Right hepatic duct –> Common hepatic duct
Common hepatic duct + Cystic duct -> Common bile duct
Common bile duct –> Major duodenal papilla
What does the left hepatic duct drain?
Left lobe
What does the right hepatic duct drain?
Right lobe
What are the structures of the major duodenal papilla?
Hepatopancreatic ampulla
Sphincter of Odds
Where do the main pancreatic duct and the accessory pancreatic duct drain?
Minor duodenal papilla
What controls the regulation of excretion of bile and pancreatic juice into the small intestine?
The sphincter of Oddi
Which hormone affects the function of the sphincter of Oddi?
CCK
Where does the major duodenal papilla open into?
Opens in the medial side of the duodenum
What is the blood supply of the gallbladder?
Right hepatic artery
Left hepatic artery
Cystic artery
Hepatic artery
What is the gallbladder wall made? (Layers)
Mucosa (lamina propria)
Smooth muscle
Perimuscular connective tissue
Serosa
What is the epithelium of the mucosa of the gallbladder?
Simple columnar epithelium
What is the function of CCK in regards to smooth muscle of gallbladder?
Stimulate contraction of smooth muscle
What is perimuscular connective tissue?
A mix of smooth and connective tissue
Which part is not covered by the serosa of the liver?
The area that is adherent to the liver
