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Phase 1 - Anatomy > Anatomy - The Liver and Gallbladder > Flashcards

Anatomy - The Liver and Gallbladder Flashcards

1
Q

Give 4 functions of the liver.

A
  1. Synthesis of bile. 2. Glycogen storage. 3. Clotting factor production. 4. Detoxification of blood.
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2
Q

What is the liver an embryological derivative of and in which mesentery does it develop?

A

Derivative of the foregut. Develops in the ventral mesentery.

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3
Q

What structure(s) lie anterior to the liver?

A

The rib cage and the anterior abdominal wall.

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4
Q

What structure(s) lie superior to the liver?

A

The diaphragm.

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5
Q

What structure(s) lie posterior to the liver?

A

Oesophagus, stomach, gall bladder, first part of duodenum. (All are foregut derived organs).

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6
Q

What aspects of the liver does the diaphragmatic surface refer to?

A

The anterior superior aspects. This surface is smooth and convex.

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7
Q

What aspects of the liver does the visceral surface refer to?

A

The posterior inferior aspects. It is moulded by the shape of surrounding organs and so is irregular.

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8
Q

Name the 5 liver ligaments.

A
  1. The falciform ligament. 2. The right and left coronary ligaments. 3. The right and left triangular ligaments.
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9
Q

What is the function of the falciform ligament?

A

To attach the liver to the anterior abdominal wall.

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10
Q

What is found in the free edge of this ligament?

A

The ligamentum teres (remnant of the umbilical vein).

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11
Q

What is the function of the coronary and triangular ligaments?

A

They attach the superior surface of the diaphragm to the liver.

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12
Q

Name the 4 lobes of the liver.

A
  1. Right. 2. Left. 3. Caudate. 4. Quadrate.
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13
Q

What structures bind the Caudate lobe and where is it located?

A

The IVC and a fossa produced by the ligamentum venosum. It is located on the upper aspect of the right lobe on the visceral surface.

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14
Q

What structures bind the Quadrate lobe and where is it located?

A

The gall bladder and a fossa produced by the ligamentum teres. It is located on the lower aspect of the right lobe on the visceral surface.

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15
Q

What divides the liver into the right and left lobes?

A

The falciform ligament.

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16
Q

What vein supplies the liver with dexoygenated blood?

A

The hepatic portal vein.

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17
Q

What vein supplies the liver with oxygenated blood?

A

The hepatic artery proper.

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18
Q

What is the function of the gall bladder?

A

A temporary storage for bile.

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19
Q

What is the storage capacity of the gall bladder?

A

30-50ml.

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20
Q

What are the 3 divisions of the gall bladder?

A

Fundus, body and neck. The neck is where the gall bladder tapers and becomes continuous with the cystic duct.

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21
Q

Briefly describe the biliary tree.

A

Left and right hepatic ducts = common hepatic duct. Common hepatic duct + cystic duct = common bile duct. Common bile duct + pancreatic duct = hepatopancreatic ampulla of Vater.

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22
Q

What is it called where the common bile duct and pancreatic duct meet?

A

The hepatopancreatic ampulla of Vater.

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23
Q

What is the orifice called where bile empties into the duodenum?

A

The major duodenal papilla.

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24
Q

What sphincter regulates the emptying of bile into the duodenum?

A

The sphincter of Oddi.

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25
Q

What artery supplies blood to the gall bladder?

A

The cystic artery.

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26
Q

Does parasympathetic or sympathetic innervation result in contraction of the gall bladder and the secretion of bile?

A

Parasympathetic.

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27
Q

What is the arrangement anterior to posterior of the ducts, artery and portal vein at the porta hepatis?

A

Anterior: Common bile duct, hepatic artery, hepatic portal vein. (DAV)

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28
Q

What is Calot’s triangle?

A

An anatomic space bounded by the liver superiorly, the cystic duct laterally and the common hepatic duct medially.

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29
Q

What is the cystic artery a branch of?

A

The right hepatic artery - hepatic artery proper - common hepatic artery - coeliac trunk.

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30
Q

Where is the bare area of the liver?

A

Under the tendinous part of the right hemi-diaphragm. This area has no peritoneal covering.

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31
Q

What is the surface marking for the gall bladder?

A

The tip of the 9th costal cartilage. Where the lateral rectus sheath joins the costal margin.

32
Q

Where do the hepatic veins drain?

A

Into the IVC.

33
Q

Where in the abdomen is the Liver located?

A

right hypochondria and epigastric areas, extends into the left hypochondria

34
Q

Describes the diaphragmatic surface of the liver?

A
  • anteriosuperior Surface of the liver
  • Smooth and can be vexed fitting underneath the curvature of the diaphragm
  • posterior aspect is not covered by visceral peritoneal, it is in direct contact with the diaphragm itself ( known as the bare area)
35
Q

Described the visceral surface of the liver?

A
  • Posterioinferior surface of the liver
  • except for the fossa of the gallbladder and porta hepatis, it is covered in peritoneum
  • Irregular shaped due to surrounding organs
  • lies in contact with the right kidney, right adrenal gland, right colic flexure, transverse colon, first part of the duodenum, gallbladder, oesophagus and the stomach
36
Q

What is the falciform ligament?

A
  • Attaches the anterior surface of the liver to the anterior abdominal wall
  • forms a natural anatomical division between the left and right lobes of the liver
  • the free edge contains the ligamentum teres, a remnant of the umbilical vein
37
Q

What is the Coronary ligament?

A
  • Attached is the superior surface of the liver to the inferior surface of the diaphragm
  • marks the bare area of the liver
  • divided into the anterior and posterior folds
  • folds unite to form a triangular ligament on the right/left lobe of the liver
38
Q

What is the triangular ligament?

A
  • Formed by the union of the anterior and posterior layers of the coronary ligament at the apex of the liver
  • attaches the left/left lobes of the liver to the diaphragm
39
Q

What relevance is the lesser omentum to the liver?

A
  • Attaches delivered to the lesser curvature of the stomach and the first part of the duodenum
  • consists of:
    • hepatoduodenal ligament ( extends from the duodenum to the liver), Surrounds the portal triad
    • hepatogastric ligament (Extends from the stomach to the liver)
40
Q

How is the posterior surface of the liver secured to the inferior vena cava?

A

by 4 large hepatic veins

41
Q

What is a hepatic recess?

A
  • anatomical space between the liver and surrounding structures
  • clinically important as infections may collect in these areas to form abscesses
42
Q

Where are the sub-phrenic spaces?

A
  • Between the diaphragm and the anterior and superior aspects of the liver
  • divided Into the right and left by the falciform ligament
43
Q

Where is the sub-hepatic space?

A
  • a subdivision of the supracolic compartment (above the transverse mesocolon)
  • peritoneal space located between the inferior surface of the liver and the transverse colon
44
Q

Where is Morison’s Pouch?

A
  • a potential space between the visceral surface of the liver and the right kidney
  • deepest part of the peritoneal cavity when lying supine
  • Pathological abdominal fluid is more likely to be collected in this region
45
Q

Name the fibrous layer that covers the liver? What divides it into left and right?

A
  • Glisson’s capsule
  • the falciform ligament
46
Q

Name and describe the 2 accessory lobes that arise from the right lobe on the visceral surface of the liver?

A
  • caudate lobe - On the upper aspect of the visceral surface, lies between the inferior Vena Cava and the Fossa produced by the ligamentum venosum (Remnants of the fetal ductus venosus)
  • quadrate lobe - located on the lower aspect of the visible surface, lies between the gallbladder and the fossa produced by the ligamentum teres
47
Q

Name the deep transverse fissure that separates these accessory lobes? What is its function?

A
  • porta hepatis
  • transmits all the vessels, nerves and ducts entering or leaving the liver with the exception of the hepatic veins
48
Q

How are hepatocytes arranged in the liver?

A
  • in lobules, hexagonal - shaped and drained by a central vein
  • at the periphery of the lobules are three structures collectively known as the portal triad
49
Q

What is contained within the portal triad at the periphery of the lobule?

A
  • arteriole - a branch of the hepatic artery entering the liver
  • venule - a branch of the hepatic portal vein entering the liver
  • bile - a branch of the bile duct leaving the liver
  • also contains lymphatic vessels and the vagus nerve (parasympathetic)
50
Q

Describe the unique dual blood supply to the liver?

A
  • hepatic artery proper (25%) - supplies the non-parenchymal structures of the liver with arterial blood, Derived from the coeliac trunk
  • hepatic portal vein (75%) - supplies the liver with partially deoxygenated blood, carrying nutrients absorbed from the small intestines
    • dominant blood supply to the liver parenchyma, allowing the liver to perform it’s gut-related functions such as detoxification
51
Q

How is blood drained from the liver?

A
  • through hepatic veins
  • the central vein of the hepatic lobule forms a collecting vein which combines to form multiple hepatic veins
  • These then open up into the inferior vena cava
52
Q

Describe the innervation of the liver?

A
  • The parenchyma is innervated by the hepatic plexus
  • contains sympathetic ( coeliac plexus) and the parasympathetic (vagus nerve)
  • enter the liver at the porta hepatis
  • Glisson’s capsule is innervated by the branches of the lower intercostal nerves,
    • sharp well-localised pain
53
Q

Describe the lymphatic drainage of the liver?

A
  • lymphatic vessels of the anterior aspect of the liver drain into the hepatic lymph nodes
    • lie along the hepatic vessels and ducts in the lesser omentum
    • Empty into the colic lymph nodes which in turn drain into the cisterna chyli
  • lymphatic vessels of the posterior aspect of the liver drain into the phrenic and posterior mediastinal nodes
    • join the lymphatics and the thoracic duct
54
Q

What are the three important structures are transported in the porta hepatis in and out of the liver?

A
  • hepatic artery proper
  • hepatic portal vein
  • common bile duct
  • ( also nerves and lymphatics)
55
Q

Why might the liver become enlarged?

A
  • if blood flow through the hepatic portal vein is impeded
  • conditions such as congestive heart failure, cirrhosis, tumours or viral Infections like hepatitis
56
Q

What is the clinical relevance of hepatic Endocepalopathy?

A
  • If the liver is diseased, blood will bypass it through the portosystemic shunt
  • causing the patient to develop a neurological disease
  • or if the short-chain proteins are broken down by the liver they can act as neurotransmitters
59
Q

What region of the abdomen would you find the gallbladder?

A

right hypochondrial region

60
Q

What is the primary function of the gallbladder?

A

to concentrate and store bile which is produced in the liver

61
Q

When is stored bile released from the gallbladder?

A
  • as part of the gustatory response, in response to cholecystokinin
  • also, a small amount released by the Parasympathetic stimulation causing a contraction of the gallbladder, and secretion of bile into the cystic duct due to the relaxation of the sphincter of Oddi
62
Q

Describe what is on the anterior, superior, posterior and inferior borders of the gallbladder?

A
  • entirely surrounded by peritoneum
  • direct relation to the visible surface of the liver
  • anteriorly and superiorly - inferior border of the liver and the anterior abdominal wall
  • posteriorly - transverse colon and the proximal duodenum
  • inferiorly - biliary tree and the remaining part of the duodenum
63
Q

What is a storage capacity of the gallbladder?

64
Q

Describe the three parts that the gallbladder is typically divided into?

A
  • fundus - the rounded distal portion of the gallbladder, projects into the inferior surface of the liver in the mid-clavicular line
  • Body - largest part, lies adjacent to the posteroinferior aspect of the liver, transverse colon and superior part of the duodenum
  • Neck - tapers to become continuous with the cystic duct, Leading to the biliary tree
    • contains mucosal folds known as Hartmann’s pouch
      • common location for gallstones to become lodged causing cholestasis
65
Q

What is the biliary tree? Describe its function?

A

A series of gastrointestinal ducks allowing newly synthesised bile from the liver to be concentrated and stored in the gallbladder

66
Q

Describe where bile is initially produced and its journey to the gallbladder?

A
  • initially secreted from hepatocytes
  • drain from both lobes of the liver into the left and right hepatic ducts
  • Ducts combine to form the common hepatic duct ( runs alongside the hepatic vein)
  • the cystic duct joins the hepatic duct, allowing bile to flow in and out of the gallbladder for storage and release
    • Becomes the common bile duct
67
Q

Describe the journey of bile through the common bile duct?

A
  • Common bile duct ascends and passes posteriorly to the first part of the duodenum and the head of the pancreas
  • joins the main pancreatic duct, forming the hepatopancreatic ampulla (ampulla of Vater)
  • empties into the duodenum via the major duodenal papilla
    • regulated by a muscular valve called the sphincter of Oddi
68
Q

Describe the arterial supply of the gallbladder?

A
  • via the cystic artery
    • Usually a branch of the right hepatic artery ( derived from the common hepatic artery one of the major branches of the coeliac trunk)
      • Can be a branch of the left hepatic or the hepatic artery
69
Q

Describe the venous drainage of the neck of the gallbladder? How does this differ from venous drainage of the fundus and body of the gallbladder?

A
  • Neck - via the cystic veins, which drain directly into the hepatic portal vein
  • body and fundus - Flows into the hepatic sinusoid
70
Q

Describe the innervation of the gallbladder?

A
  • sympathetic and sensory - coeliac plexus T5,6,7,8 and 9
  • parasympathetic - vagus nerve
71
Q

Describe lymph drainage from the gallbladder?

A
  • drains into the cystic lymph nodes, in the gallbladder’s neck
  • cystic lymph node then drain into hepatic lymph nodes and ultimately the coeliac lymph nodes
72
Q

What are gallstones formed of?

A

bile components mainly cholesterol, bile salts and bilirubin

73
Q

What is the clinical relevance of gallstones?

A
  • often asymptomatic
  • biliary colic pain is when they obstruct Cystic duct outflow Or the common bile duct
    • cramping like pain
74
Q

What is the clinical relevance of cholecystitis?

A
  • infection caused by obstruction of the outflow
  • the gallbladder becomes infected
  • Can lead to complications like pancreatitis and jaundice
  • pain is felt in three places:
    • via the greater splanchnic nerve (foregut), dull vague pain in the epigastric region)
    • via the parietal peritoneum, pain fell accurately over the area of contact as a sharp well-localised pain
    • via the phrenic nerve, if the gallbladder comes in contact with the diaphragmatic layer of the parietal peritoneum (C345), pain is felt on the right shoulder
75
Q

What is the spiral valve?

A
  • honeycomb appearance of the mucosa of the gallbladder
  • spiral folds of the mucosa running down the cystic duct
76
Q

What is the surface marking of the fundus of the gallbladder?

A
  • Tip of the 9th costal cartilage, on the mid-clavicular line (also transplyoric line)
  • or the most lateral attachment of the rectus-abdominis

Phase 1 - Anatomy (29 decks)

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