APP 2 Flashcards
Contact surfaces of liver
Superiorly: It is in contact with the diaphragm.
Inferiorly: It is related to the stomach, duodenum, right kidney, and colon.
Anteriorly: It is adjacent to the anterior abdominal wall.
Posteriorly: It touches the inferior vena cava (IVC) and hepatic veins.
Lobes of liver
Right lobe (largest).
Left lobe.
Caudate lobe (posterior).
Quadrate lobe (anterior).
Divided into two lobes the right functional and left functional lobe
Segments of liver
Segments I-IV: Constitute the left liver.
I is the caudate lobe.
II, III, IV are parts of the left lobe.
Segments V-VIII: Constitute the right liver.
Peritoneal reflections of liver
Covered almost entirely by visceral peritoneum except in bare area where it’s in contact with diaphragm
Falciform ligament: Attaches the liver to the anterior abdominal wall and diaphragm.
Coronary ligaments: Surround the bare area and anchor the liver to the diaphragm.
Triangular ligaments: Formed by the folds of the coronary ligaments on the right and left sides.
Lesser omentum: Contains the hepatoduodenal ligament, which encloses the portal triad (portal vein, hepatic artery, bile duct).
Liver movement during respiration
During inspiration, the liver moves inferiorly due to diaphragmatic contraction.
During expiration, the liver moves superiorly as the diaphragm relaxes. This movement is crucial for palpation during physical examination.
Portal vein
Carries nutrient rich blood from gastrointestinal tract,spleen,pancreas and gallbladder
Formed by confluence of superior mesenteric vein,splenic vein
Supplies 75% of livers blood
Porto systemic anastomoses
Connections between the portal venous system and systemic venous system,become significant when there is portal hypertension
Esophageal varices: Between the left gastric vein (portal) and the azygos vein (systemic).
Rectal varices: Between the superior rectal vein (portal) and middle/inferior rectal veins (systemic).
Caput medusae: Between the paraumbilical veins (portal) and the superficial epigastric veins (systemic), seen as distended veins radiating from the umbilicus.
Retroperitoneal varices: In the retroperitoneum
Location of gallbladder
Right upper quadrant beneath liver
Gallbladder structure
Fundus: The rounded bottom that projects anteriorly beyond the inferior margin of the liver.
Body: The central part of the gallbladder, lying against the visceral surface of the liver.
Neck: The narrow, tapered part that connects to the cystic duct.
Function of gallbladder
The gallbladder stores and concentrates bile produced by the liver. Bile helps digest fats and is released into the small intestine during digestion.
Bile secretion: During digestion, the gallbladder contracts and releases bile into the biliary tree, which leads to the duodenum via the common bile duct.
Biliary tree
Intrahepatic bile ducts: Bile is produced in the liver and collected in small ducts inside the liver, which merge to form the right and left hepatic ducts.
Common hepatic duct: Formed by the union of the right and left hepatic ducts.
Cystic duct: Connects the gallbladder to the common hepatic duct.
Common bile duct: Formed by the union of the cystic duct and common hepatic duct. It passes posterior to the duodenum and through the head of the pancreas, eventually joining with the pancreatic duct to empty into the duodenum at the ampulla of Vater.
Arterial supply of gallbladder
The gallbladder is supplied by the cystic artery, a branch of the right hepatic artery.
The common hepatic duct, common bile duct, and cystic duct are also supplied by small branches from the right hepatic artery and the gastroduodenal artery.
Venous drainage of gallbladder
Cystic veins and portal vein
Lymphatic drainage of gallbladder
Lymph from the gallbladder drains into the cystic lymph nodes, which then drain into the hepatic lymph nodes and eventually the celiac lymph nodes.
Relations of gallbladder in abdomen
Superiorly: The liver.
Inferiorly: The duodenum and transverse colon.
Anteriorly: The anterior abdominal wall and the diaphragm.
Posteriorly: The inferior vena cava and the right kidney.
Position of pancreas
Retroperitoneal gland at the posterior abdominal wall
Sits at L1-L2
Anatomy of pancreas
Head: The broadest part, located in the C-shaped curve of the duodenum. It wraps around the inferior vena cava (IVC) and the common bile duct passes through or near it before joining the pancreatic duct.
Uncinate process: A projection from the head that extends posterior to the superior mesenteric vessels.
Neck: Lies anterior to the superior mesenteric vessels and forms the portal vein by joining with the splenic and superior mesenteric veins.
Body: Extends leftward and is related to the stomach anteriorly and left kidney posteriorly.
Tail: Narrow, extends to the hilum of the spleen, and is the only part that is intraperitoneal.
Pancreatic ducts
Main pancreatic duct-merges with common bile duct and drains into duodenum,controlled by sphincter of oddi
Accessory pancreatic-smaller duct that drains part of the head until duodenum
Relation of pancreas
Anteriorly: Related to the stomach and covered by the lesser sac.
Posteriorly: Lies against major vessels like the inferior vena cava, aorta, splenic vein, and left kidney.
Superiorly: The splenic artery runs along the upper border.
Inferiorly: Related to the duodenojejunal flexure and coils of the jejunum.
Laterally: The head of the pancreas is nestled within the duodenal curve, and the tail reaches the spleen.
Spleen position
Left hypochondrium between ribs 9-11
Intraperitoneal except at hilum
Has ridges
Arterial supply of spleen
Splenic artery which arises from celiac trunk
Venous drainage of spleen
Splenic vein drains blood from spleen to join superior mesenteric vein to form portal vein
Lymphatic drainage of spleen
Celiac lymph nodes
Splenic ligaments
Gastrosplenic,splenorenal,phrenicosplenic ligaments
Relations of spleen
Anteriorly: The stomach.
Posteriorly: The diaphragm, which separates it from the left pleura, left lung, and 9th to 11th ribs.
Inferiorly: The left colic flexure of the colon.
Medially: The left kidney and tail of the pancreas.
Superiorly: The diaphragm and left lung.
Main abdominal lymph nodes
Pre aortic nodes-drain from stomach,intestine,liver,pancreas,spleen
Para aortic-drain from kidneys,adrenals,gonads,ureters,posterior abdominal wall
Iliac-pelvic,lower limbs,lower portion as of abdominal wall
Mesenteric-small intestine,cecum,colon,rectum
