Biliary system Flashcards
How is the liver divided?
- Into the left and right lobes
- Inferiorly by fissure for ligamentum teres
- Posteriorly by fissure for ligamentum venosum
How is the liver functionally divided?
- Cantlie’s line
- Through the fossa of gallbladder and fossa of IVC
What are the relations of the caudate and quadrate lobes?
- Quadrate lobe is inferior
- Caudate lobe is superior
- Quadrate lobe is bound by fissure for ligamentum teres and gallbladder
- Caudate lobe is bound by fissure for ligamentum venosum and IVC
- The 2 lobes are separated by the porta hepatis
What are the ligaments of the liver?
- Falciform ligament: Anterior diaphragm, anterior abdominal wall
- Triangular ligaments (right and left): Left/right lobe → Posterior diaphragm
- Coronary ligaments (anterior and posterior, continuous with ): Right lobe → Posterior diaphragm
- Ligamentum teres: Inferior free edge of falciform ligament → Umbilicus
What are the boundaries of the bare area of the liver?
- Anterior/posterior coronary ligaments
- Right triangular ligament
What is the blood supply to the liver?
- ~70% provided by portal vein
- ~30% provided by hepatic artery
- All blood from the liver drains into the hepatic veins that drain into the IVC.
- The liver receives ~1.25L blood per minute.
What are the relations of the liver?
Right lobe (anterior):
- Hepatic flexure
- Right kidney
Left lobe (anterior):
- Oesophagus
- Stomach
Caudate lobe:
- Lesser sac
What are the surfaces of the liver?
- Diaphragmatic surface
- Visceral surface
What are the spaces related to the liver?
- Right and left subphrenic spaces lie between the liver and the inferior aspects of the diaphragm
- Right subhepatic space (hepatorenal pouch of Morrison) lies directly inferior to the liver
- Left subhepatic space lies within the lesser sac
What are the surface markings of the liver?
- The whole liver does not extend beyond the costal margin on expiraton
- The right lobe extends as high as 4th costal cartilage
What is the structure of the gallbladder?
- Divided into 3 segments:
1. Fundus
2. Body
3. Neck - The neck is connected to the cystic duct which joins the common hepatic duct to become the common bile duct
What is the fundus of the gallbladder related to?
9th costal cartilage
What is the blood supply of the gallbladder?
Cystic artery (branch of right hepatic artery)
What is the structure of the sphincter of Oddi?
3 parts:
- Controls common bile duct
- Controls main pancreatic duct
- Ampulla of Vater
What are the sites of portosystemic anastomoses?
- Lower oesophagus: Left gastric → Azygos vein
- Lower rectum/anal canal: Superior rectal → Middle/inferior rectal
- Umbilicus (caput medusae): Veins in ligamentum teres → Superior/inferior epigastric
- Left colon: Colic → Veins of abdominal wall
- Bare area of liver: Portal (branches) → Inferior phrenic vein
- Ductus venosus: Portal → IVC
