Anatomy of the Liver, Gall bladder, Pancreas & Spleen, + liver physiology

Question 1

Functions of the liver?

Answer 1

• Carb, fat, protein metabolism
• production/secretion of bile
• Storage
• Immune protection
• Interaction with hormones
• Detoxify and metabolize drugs

Question 2

4 lobes of the liver?

Answer 2

Right
Left
Caudate
Quadrate

Question 3

Blood supply to the liver?

Answer 3

Hepatic artery proper (80%)

which runs next to hepatic bile duct and HPV to form portal triad

Question 4

What do lobules do?

Answer 4

Clean the blood

Question 5

Process of blood cleaning?

Answer 5

• Blood filters from portal triad branch through functional unit and be collected in the ventral vein of lobule
• At the same time hepatocytes produce bile that moves in opposite direction out towards bile duct in PT
• which eventually flows into hepatic duct and GB

Question 6

The systemic circulation drains blood from all other organs and tissues into the SVC & IVC. True or False?

Answer 6

TRUE

Portal venous system drains from the HG, MG & FG through the liver

Question 7

Phase 1 of drug metabolism?

Answer 7

Oxidise, reduce and hydrolyse the drug

which makes the drug more polar which helps phase 2

Question 8

Phase 2 of drug metabolism?

Answer 8

Adds on another functional group to the polarized molecule. eg methyl, acetate, sulphate

This makes the drug inactive, less toxic and available to be excreted by kidney

Question 9

Role of gall bladder?

Answer 9

Stores and concentrates bile

Question 10

Anatomical relations of GB?

Answer 10

• posterior to surface of liver

- anterior to duodenum

Question 11

Parts of the GB?

Answer 11

Fundus, body, neck, cystic duct

Question 12

What is the cystic artery a branch of?

Answer 12

Right hepatic artery

Question 13

What is in Calot’s triangle?

Answer 13

Cystic artery

Question 14

What is bile composed of?

Answer 14

• Water
• Bile salts
• bilirubin
• Cholesterol

Question 15

What cells make bile?

Answer 15

Hepatocytes

Question 16

Bile journey?

Answer 16

• Moves from hepatocytes into R/L hepatic ducts
• Bile then goes to cystic duct into GB to be stored and conced
• 0 mins post meal, chyme neters duodenum
• I cells secrete CCK into blood
• CCK reached GB, causing contractions
• Bile released from GB into CBD
• Cholangiocytes in BD secrete HCO3 into biliary tree
• CCK also relaxes sphincter of Oddi

Question 17

Micelle?

Answer 17

Formation of globule with hydrophillic head facing solvent and hydrophobic tail facing inward

Question 18

Bilirubin excretion

LONG EXPLANATION

Answer 18

1) RBC are degraded by macrophages at the end of their 120 day life cycle into haem and globin
2) Globin is further degraded into amino acids and haem is broken down into iron and protoporphyrin
3) Protoporphyrin is converted into unconjugated bilirubin (UCB)
4) UCB is not water-soluble so must bind with albumin in order to be transported to the liver
5) Hepatocytes in the liver convert UCB into conjugated bilirubin (CB), making it water-soluble
6) CB can now be secreted into the bile
7) Once the bile has reached the intestines, CB is converted into urobilinogen
8) Some of the urobilinogen is reduced to stercobilin (gives faeces brown colour)
9) Some of the urobilinogen goes to the kidneys and is converted to urobilin (gives urine yellow colour)
10) Some of the urobilinogen is recycled through the blood into the liver where it is added to the bile again

Question 19

What is globin degraded into?

Answer 19

Amino acids

Question 20

What is haem degraded into?

Answer 20

Iron

Protoporphyrin

Question 21

What is protopopphyrin converted into?

Answer 21

Unconjugated bilirubin (not water soluble)

Question 22

What does UCB bind with?

Answer 22

Albumin

Question 23

What converts UCB into CB? (water soluble)

Answer 23

Hepatocytes

Question 24

What is CB converted into in the intetsines?

Answer 24

Urobilinogen

Question 25

3 uses of urobilinogen?

Answer 25

• reduced to stercoblin (faeces brown colour)
• Converted to urobilin (urine yellow colour)
• Recycled through blood into liver and added to bile again

Question 26

What is the spleen supplied by?

Answer 26

Splenic artery

Question 27

Where in the peritoneum is the spleen?

Answer 27

Intraperitoneal

Question 28

Anatomical relations of the spleen?

Answer 28

Stomach is anterior
Diaphragm posterior
left kidney medially
Protected by ribs 9-11

Question 29

What does the spleen do?

Answer 29

Breaks down RBC to produce Bilirubin

Question 30

Describe location of pancreas?

Answer 30

Retroperitoneal organ 
Duodenum sits in a C shape around it 
-Head lies anterior to SMA branches 
Body lies over aorta at vertebrae L2 
Tail lies anterior to left kidney pointing to spleen 
BOTH FOREGUT & MIDGUT

Question 31

What blood supply is the pancreas?

Answer 31

Superior and inferior pancreaticoduodenal artery anastamose and supply pancreas

Question 32

Nerve supply to pancreas?

Answer 32

• Parasympathetic comes from vagus nerve CN X

- Sympathetic comes from abdominopelvic splanchnic

Question 33

Why does pancreatic pain sometimes refer to the back?

Answer 33

It is retroperitoneal

• interacts with posterior abdominal wall
• convergence of several sensory afferent nerves at one ganglia

Question 34

Difference between exocrine and endocrine?

Answer 34

Exo- Products released via ducts

Endo- Products released into blood

Question 35

Endocrine function of pancreas involves..?

Answer 35

Islet of Langerhan release of insulin and glucagon

Question 36

Exocrine function of pancreas?

Answer 36

production of digestive juices and enzymes produced by acinar cells

Question 37

What do the main pancreatic duct and CBD join together to form?

Answer 37

Ampulla of Vater