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Gastrointestinal System > Anatomy of the Biliary System & Liver > Flashcards

Anatomy of the Biliary System & Liver Flashcards

1
Q

What are the two divisions of the peritoneum?

A

The visceral and the parietal layers

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2
Q

Which layer of the peritoneum attaches to the organs?

A

The visceral layer

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3
Q

What is the peritoneal cavity and what is it filled with?

A

The cavity between the parietal and the visceral layers and it is filled with fluid

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4
Q

What is a pathology that is related to the peritoneal cavity?

A

Ascites, the accumulation of fluid in the peritoneal cavity

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5
Q

Which structures does the peritoneal cavity divide into?

A

Greater and lesser sacs

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6
Q

What are the structures that the greater sac contains?

A

The intestinal structures and the intestinal fluids

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7
Q

What is the lesser sac?

A

A peritoneal space that is located behind the stomach

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8
Q

What leads to the formation of the lesser sac?

A

The rotation of the stomach

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9
Q

What is the greater omentum made of?

A

Lesser and greater sacs

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10
Q

Are the greater and lesser sacs separated?

A

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.

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11
Q

What is the epiploic foramen?

A

Communication or opening between two sacs

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12
Q

What are the borders of the Epiploic foramen?

A

Superiorly: Caudate lobe of the liver
Posteriorly: IVC
Inferiorly: First part of duodenum
Anteriorly: Free border of the lesser omentum

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13
Q

What are the structures inside the free edge of the lesser omentum?

A

Bile duct; anterior to the right
Hepatic artery; anterior to the left
Portal vein

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14
Q

What is the function of the lesser omentum?

A

To connect the lesser curvature of the stomach to the liver

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15
Q

What is the other name for Epiploic Foramen?

A

Foramen of Winslow

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16
Q

What are the different structures that the peritoneum has?

A

Spaces and Recesses

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17
Q

What are the examples of spaces in the peritoneum?

A

Right and left subphrenic spaces
Paracolic gutters

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18
Q

What are examples of the recesses found in the peritoneum?

A

Duodenal
Cecal
Intersigmoid

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19
Q

What is the direction of the fluid in the peritoneal cavity?

A

It will follow the path from the bottom towards the diaphragm, since it has to follow the lymphatic drainage

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20
Q

Where are the parabolic gutters located?

A

Aside from ascending and descending colons

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21
Q

How do peritonitis and ascites develop?

A

Alteration of movement of fluid, or accumulation

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22
Q

What are the common sites of pus collection? Why?

A

Subphrenic recesses, more frequent will be the right subphrenic space because of the ruptured appendix and duodenal ulcers

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23
Q

Which structures are continuous with the hepatorenal recess?

A

Both recesses and omental bursa (lesser sac)

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24
Q

What is an internal hernia?

A

A lobe of the small intestine gets stuck in a space such as a recess or omentum

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25
Q

What are omenta and what are their examples?

A

Omenta are two layered folds, they are called that when attached to the stomach:
Greater and lesser omenta

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26
Q

What does the greater omentum cover?

A

It will cover all of the intestinal lubes and run back and attach ti the transverse colon, mesocolon and posterior abdominal wall

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27
Q

What is the function of the mesenteries?

A

To give the structure they are attached to some mobility and freedom

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28
Q

What are the different examples of mesenteries in the body?

A

Mesentery of the small intestine
Mesentery of the transverse mesocolon, mesentery of the sigmoid mesocolon

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29
Q

Which parts of the colon do not have mesenteries? Why?

A

Ascending and descending colons they are retroperitoneal structures and thus there is no need for because of their close proximity to the abdominal wall

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30
Q

What are the ligaments of the peritoneum?

A

Falciform, coronary, spenicorenal, gatsrophrenic

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31
Q

What is the alternative name of the ligaments of the peritoneum?

A

Peritoneal reflections

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32
Q

What are the divisions of the lesser momentum?

A

Hepatoduodenal and hepatogastric

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33
Q

Which of the peritoneal ligaments are derived from the ventral mesentery?

A

The falciform and the coronary and they are related to the liver

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34
Q

What does the splenicorenal ligament connect?

A

The spleen to the kidneys

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35
Q

What does the gastrosplenic ligament connect?

A

The stomach to the spleen

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36
Q

Where are most of theligaments derived from?

A

The dorsal mesentery

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37
Q

What re intraperitoneal structures?

A

Any organ that has a mesentery or ligament attached to posterior or anterior wall

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38
Q

What are retroperitoneal structures?

A

Organs or structures that have no mesentery attached to them

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39
Q

What are the divisions of the retroperitoneal structures?

A

Primary and secondary

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40
Q

What is the difference between primary and secondary retroperitoneal structures?

A

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

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41
Q

What are infraperitoneal structures?

A

Structures that are found below the peritoneum

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42
Q

What are the examples of intraperitoneal structures? (13)

A
  1. Stomach
  2. Duodenum (the first part)
  3. jejunum
  4. Ileum
  5. Cecum
  6. Appendix
  7. Transverse colon
  8. Sigmoid colon
  9. Rectum (upper 1/3)
  10. Liver
  11. Spleen
  12. Pancreas (tail only)
  13. Ovaries
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43
Q

What are the primary retroperitoneal structures? (6)

A
  1. Adrenal glands
  2. kidneys
  3. Ureter (proximal)
  4. Aorta
  5. IVC
  6. Anal canal
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44
Q

What are the secondary retroperitoneal structures? (5)

A
  1. Duodenum (2, 3, and 4th parts)
  2. Ascending colon
  3. Descending colon
  4. Rectum (middle 1/3)
  5. Pancreas (all parts except of tail)
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45
Q

What are the examples of the infraperitoneal structures? (6)

A
  1. Rectum (lower 1/3)
  2. Ureter (distal end)
  3. Urinary bladder
  4. Uterus
  5. Fallopian tubes
  6. Prostate
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46
Q

What are the different functions of the liver?

A

Metabolic
Haematological
Digestive

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47
Q

What are the different metabolic functions of the liver?

A

Regulate circulating levels of nutrients
Stores fat-soluble vitamins
Removes metabolic wastes and toxins

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48
Q

How do the nutrients reach the liver?

A

They get transported through the portal vein in order to get metabolised in the liver

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49
Q

Which are the fat soluble vitamins?

A

Vitamin A, D, E and K
Vitamin B12

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50
Q

What are the haematological functions of the liver?

A

Blood reservoir
Phagocytosis of circulating debris
Synthesis of plasma proteins
During embryonic phase the liver is the source of blood formation

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51
Q

What is an example of circulating debris that the liver phagocytoses?

A

Old and damaged RBCs

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52
Q

What is the digestive function of the liver?

A

Synthesis and secretion of bile

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53
Q

What is the edge of the Falciform ligament known as?

A

The round ligament

54
Q

Which is the largest internal organ?

A

The liver

55
Q

What are the surfaces of the liver?

A

Anterior - superior (diaphragmatic)
Posterior-inferior (Visceral)

56
Q

What are the structures that the posterior-inferior surface has?

A

Fissures and Porta hepatis

57
Q

What are fissures?.

A

Borderlines between the lobes

58
Q

What are the different fissures of the liver?

A

Right and left sagittal

59
Q

What are the structures of the right sagittal?

A

IVC and Gallbladder

60
Q

What are the structures of the left sagittal?

A

Ligamentum teres & Ligametum Venosum

61
Q

Which structure does the ligamentum teres derive from?

A

Umbilical vein

62
Q

Which structure does the ligament venosum serve from?

A

Ductus venosus

63
Q

What is the function of the umbilical vein?

A

Brings blood from the placenta to the embryo, highly oxygenated

64
Q

What happens to the umbilical vein after birth?

A

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

65
Q

What is the ductus venosus?

A

Bypass shunt during the embryonic phase

66
Q

What happens to the ductus venosus after birth?

A

It also closes after birth and it is replaced by fibrous tissue –> ligamentum venosum

67
Q

What are the lobes of the liver?

A

Right
Left
Caudate
Quadrate

68
Q

Which lobe do the caudate and quadrate lobes belong to?

A

Left

69
Q

What is contained in the porta hepatis?

A

Right and left hepatic ducts
Right and left hepatic arteries
Portal vein
Autonomic nerves
Hepatic lymph nodes

70
Q

What are the structures derived from the ventral mesentery?

A

Lesser omentum
Liver capsule
Falciform ligament
Coronary ligament

71
Q

What are the divisions of the lesser omentum?

A

Hepatogatsric and hepatoduodenal

72
Q

What is the name of the liver’s capsule?

A

Glisson’s capsule

73
Q

What are the derivatives of the coronary ligament?

A

Right triangular ligaments
Bare area
Left triangular ligaments

74
Q

Is the whole of the liver covered by peritoneum?

A

No there are some structures of the liver that are not covered

75
Q

Which are the structures of the liver that are not covered by the peritoneum?

A

Gallbladder fossa
Porta hepatis
Bare area

76
Q

What is the blood supply of the liver like?

A

Dual blood supply:
Hepoatic proper artery
Portal vein

77
Q

What kind of blood does the hepatic proper artery carry?

A

Oxygenated blood

78
Q

What kind of blood does the portal vein carry?

A

Fully oxygenated blood full of nutrients (absorbed from the GIT)

79
Q

What are the divisions of the hepatic proper artery?

A

Left and Right hepatic arteries

80
Q

Which structures does the left hepatic artery supply?

A

Left lobe
Caudate lobe
Quadrate lobe

81
Q

Which structures does the right hepatic artery supply?

A

Right lobe

82
Q

What is portal hypertension?

A

Increased resistance to blood flow into the liver

83
Q

Where does the lower part of the liver drain into?

A

Left gastric which flows into portal circulation

84
Q

In the cases of liver cirrhosis and portal hypertension what happens to the blood supply?

A

It finds an alternative route

85
Q

Which areas will blood shunt through if normal volume of blood cannot enter the liver?

A

Areas of anastomosis; areas in which the blood can flow from the portal system into the systemic system

86
Q

What will be the result of the blood passing through the areas of anastomosis?

A

The additional volume of blood will cause the local vessels to become enlarged –> varicose

87
Q

Inferior rectal veins?

A

Inferior vein is systemic so it will drain into the internal ileac artery –> systemic venous system

88
Q

Middle and superior rectal veins?

A

They will join the portal system through the superior mesenteric vein

89
Q

What are the liver lobules made of?

A

Hepatocytes
Liver sinusoids
Central vein
Portal area

90
Q

Where is the central vein located?

A

In the centre of the lobule

91
Q

Where is the portal area located?

A

In the periphery of the lobules

92
Q

What is the portal area made out of?

A

Portal triad: hepatic artery, portal vein, bile duct

93
Q

What kind of tissue divides the liver into lobules?

A

Connective tissue septa

94
Q

What is the shape format of a lobule?

A

Hexagonal, with 6 portal areas

95
Q

What is the structure arrangement of the hepatocytes called?

A

Laminae

96
Q

What are laminae bound by on either side?

A

Endothelial lined spaces, hepatic sinusoids

97
Q

What blood vessels drain into the central vein?

A

Hepatic artery and portal vein

98
Q

Where does the central vein drain into?

A

Hepatic vein and then into the IVC

99
Q

Where is bile produced and what is the direction it flows in?

A

Produced in the hepatocytes and it flows in the opposite direction of blood; from the central to portal triad

100
Q

Why does bile flow towards the portal triad?

A

There is a branch of the bile duct

101
Q

What is the oxygen environment like in the central vein?

A

Not as much oxygen so cells mainly use anaerobic functions

102
Q

What do all central veins join to form?

A

Connect to form the hepatic vein

103
Q

The blood flow from hepatic portal vein…

A

Blood from the hepatic portal vein and hepatic proper artery flow through the hepatic sinusoids towards the central vein

104
Q

What are the functions of the hepatocytes?

A

Produce & secrete bile into bile canliculi
Secretion of bilirubin
Protein synthesis & Carbohydrate storage

105
Q

What is the route of bile?

A

Produced and secreted from the hepatocytes –> into bile canaliculi –> bile ductules –> bile ducts in the portal area

106
Q

What do bile ducts merge to form?

A

Right and left hepatic ducts

107
Q

What are some characteristics of the liver lobules?

A

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

108
Q

What are the different structures inside the liver lobule?

A

Space of Disse
Kupffer cells
Fat-storing checks

109
Q

What is the function of space of Disse?

A

Separates hepatocytes from endothelial cells, allowing proteins and other plasma components from the sinusoids to be absorbed by the hepatocytes

110
Q

What are Kupffer cells? Where do they come from?

A

Phagocytic cells, they are derived from the mesoderm

111
Q

Where are hepatocytes derived from?

A

From the endoderm

112
Q

What are the different parts of the gallbladder?

A

The fundus
The body and
The neck

113
Q

What is the neck of the gallbladder connected to?

A

Communicated with the bile ducts

114
Q

Where do the bile ducts empty?

A

Into the second part of the duodenum

115
Q

What are the functions of the gallbladder?

A

Concentrates bile
Stores bile
Excretes cholesterol
Secretes mucus

116
Q

The extrahepatic ducts:

A

Left hepatic duct + Right hepatic duct –> Common hepatic duct

Common hepatic duct + Cystic duct -> Common bile duct

Common bile duct –> Major duodenal papilla

117
Q

What does the left hepatic duct drain?

A

Left lobe

118
Q

What does the right hepatic duct drain?

A

Right lobe

119
Q

What are the structures of the major duodenal papilla?

A

Hepatopancreatic ampulla
Sphincter of Odds

120
Q

Where do the main pancreatic duct and the accessory pancreatic duct drain?

A

Minor duodenal papilla

121
Q

What controls the regulation of excretion of bile and pancreatic juice into the small intestine?

A

The sphincter of Oddi

122
Q

Which hormone affects the function of the sphincter of Oddi?

A

CCK

123
Q

Where does the major duodenal papilla open into?

A

Opens in the medial side of the duodenum

124
Q

What is the blood supply of the gallbladder?

A

Right hepatic artery
Left hepatic artery
Cystic artery
Hepatic artery

125
Q

What is the gallbladder wall made? (Layers)

A

Mucosa (lamina propria)
Smooth muscle
Perimuscular connective tissue
Serosa

126
Q

What is the epithelium of the mucosa of the gallbladder?

A

Simple columnar epithelium

127
Q

What is the function of CCK in regards to smooth muscle of gallbladder?

A

Stimulate contraction of smooth muscle

128
Q

What is perimuscular connective tissue?

A

A mix of smooth and connective tissue

129
Q

Which part is not covered by the serosa of the liver?

A

The area that is adherent to the liver

130
Q
A

Gastrointestinal System (28 decks)

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