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Medicine Sem 4 > Case 3 Anatomy > Flashcards

Case 3 Anatomy Flashcards

1
Q

what is the fascial sheath that surrounds the parotid gland derived from?

A

the investing layer of fascia

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2
Q

what is the parasympathetic innervation to the parotid gland provided by?

A

glossopharyngeal nerve

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3
Q

where are the nerve cells bodies of postganglionic fibres that supply the sublingual gland located?

A

in the submandibular ganglion

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4
Q

where does the duct that drains the submandibular gland open into the oral cavity?

A

lateral to the lingual frenulum

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5
Q

which structures run through the parotid gland?

A
  • external carotid artery
  • facial nerve
  • maxillary vein
  • retromandibular vein
  • superficial temporal artery
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6
Q

describe the exocrine and endocrine components of the pancreas

A
  • The exocrine component forms the largest component of the gland – it’s composed of closely packed acini which secrete pancreatic juice into a series of ducts
  • The endocrine component consists of the islets of Langerhans which are scattered throughout the gland – they secrete a number of hormones directly into the blood
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7
Q

what are the components of pancreatic juice?

A
  • Amylase
  • Lipase
  • Trypsinogen (inactive precursor of trypsin, an endopeptidase that hydrolyses peptides of arginine or lysine – trypsinogen forms trypsin by cleavage by enterokinase)
  • Chymotrypsinogen (inactive precursor of chymotrypsin, a digestive enzyme which breaks down proteins into smaller peptides)
  • Ribonuclease
  • Elastase
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8
Q

what is secreted by the islets of Langerhans?

A
  • Glucagon
  • Somatostatin (delta cells – strong inhibitor of somatotropin, insulin and glucagon)
  • Insulin
  • Vasoactive intestinal polypeptide
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9
Q

is the pancreas lobulated?

A

yes

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10
Q

where does the pancreas lie?

A

retroperitoneally in both the right and left upper quadrants of the abdomen

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11
Q

in which plane does the pancreas lie?

A

transpyloric plane

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12
Q

what are the different parts of the pancreas?

A
  • head
  • uncinate process
  • neck
  • body
  • tail
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13
Q

what is the head of the pancreas?

A

expanded part of the gland which lies in the concavity of the duodenum

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14
Q

what is the uncinate process of the pancreas?

A

the part of the head which extends behind the superior mesenteric vessels

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15
Q

what is the neck of the pancreas? what is formed behind it?

A

the hepatic portal vein is formed posterior to this constricted part of the gland

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16
Q

where does the body of pancreas run and what does it cross?

A

runs upwards to the left, crossing the midline

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17
Q

what does the tail of the pancreas pass between and contact?

A

between the layers of the splenorenal ligament and contacts the hilum of the spleen

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18
Q

what are the anterior relations of the pancreas?

A
  • Stomach
  • Gastroduodenal artery
  • Lesser sac
  • Transverse colon
  • Transverse mesocolon (its two layers of peritoneum leave the posterior abdominal wall across the anterior surface of the head and body of the pancreas and pass outward to surround the transverse colon
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19
Q

what are the posterior relations of the pancreas?

A
  • Superior mesenteric artery
  • Aorta
  • Splenic vein
  • Portal vein
  • Inferior vena cava
  • Renal vessels
  • Bile duct
  • Hilum of spleen
  • Left kidney
  • Left suprarenal gland
  • Left psoas muscle
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20
Q

summarise the pancreatic ducts (what secretes stuff, where does it go)

A
  • The secretory acini cells secrete pancreatic juice into a series of ducts
  • The duct system empties into the second part of the duodenum via the main pancreatic and accessory pancreatic ducts
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21
Q

main pancreatic duct

  • where does it extend from and to
  • what does it receive
  • how does it change
  • what does it unite with to form what
  • where does it enter the duodenum
A
  • Extends from the tail to the head of the pancreas
  • Receives many tributaries and increases in diameter
  • Unites with the bile duct to form the hepatopancreatic ampulla
  • Enters the duodenum at the major duodenal papilla
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22
Q

accessory pancreatic duct

  • is it always present
  • what does it drain
  • does it communicate with the main pancreatic duct
  • where does it open into the duodenum
A
  • Is absent occasionally
  • Drains the upper part of the head of pancreas
  • May communicate with the main pancreatic duct
  • Opens into the duodenum at the minor duodenal papilla
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23
Q

what is the flow of bile and pancreatic juice into the duodenum controlled by?

A

the hepatopancreatic sphincter

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24
Q

what does the hepatopancreatic sphincter also do?

A

prevents reflux of duodenal content back into the pancreatic and bile ducts

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25
Q

what is the arterial supply of the pancreas?

A
  • The head (including uncinate process) of the pancreas are supplied by the superior and inferior pancreaticoduodenal arteries
  • The remainder of the pancreas is supplied by the splenic artery
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26
Q

what is the superior pancreaticoduodenal artery a branch of?

A

the gastroduodenal artery

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27
Q

what does the gastroduodenal artery arise from?

A

the hepatic artery

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28
Q

what does the inferior pancreaticoduodenal artery arise from?

A

the superior mesenteric artery

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29
Q

what does the splenic artery arise from?

A

the coeliac trunk

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30
Q

what is the venous drainage of the pancreas?

A
  • The head of the pancreas is drained by the superior and inferior pancreaticoduodenal veins
  • The remainder of the pancreas is drained by the splenic vein
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31
Q

what does the superior pancreaticoduodenal vein drain into?

A

the gastroduodenal vein?

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32
Q

what does the inferior pancreaticoduodenal vein drain into?

A

the superior mesenteric vein

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33
Q

what is the hepatic portal vein formed by?

A

the union of the superior mesenteric and splenic veins

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34
Q

how much does the liver weigh and what percentage of total weight?

A

in the adult it weighs approx. 1.5 kg and accounts for 2.5% of the body weight

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35
Q

where does the liver lie under cover of?

A

the costal margins

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36
Q

where is the healthy liver located?

A

in the right hypochondriac, epigastrium, and left hypochondriac abdominal regions

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37
Q

what are the different surfaces of the liver?

A
  • The liver has two surfaces; diaphragmatic and visceral
  • The diaphragmatic surface is smooth as it is moulded by the under surface of the diaphragm
  • In contrast the visceral surface is irregular as it is in contact with the irregular shaped viscera
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38
Q

what are the anterior relations of the liver?

A
  • Anterior abdominal wall
  • Xiphoid process
  • Lungs
  • Right and left costal margins
  • Right and left pleura
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39
Q

what are the posterior relations of the liver?

A
  • Stomach
  • Gallbladder
  • Duodenum
  • Right kidney
  • Hepatic flexure
  • Oesophagus
  • Colon
  • Inferior vena cava
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40
Q

what are the ligaments of the liver?

A
  • falciform ligament
  • ligamentum teres
  • ligamentum venosum
  • coronary ligament
  • right triangular ligament
  • left triangular ligament
  • hepatogastric ligament
  • heptatoduodenal ligament
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41
Q

what is the falciform ligament?

A

a double fold of peritoneum that connects anterior & superior surfaces of the liver to the anterior abdominal wall

42
Q

what is the ligament teres?

A
  • round ligament
  • remnant of the umbilical vein
  • it runs in the free edge of the falciform ligament
43
Q

what is the ligamentum venosum?

A
  • remnant of the ductus venosus

- it is attached to the portal vein and the IVC

44
Q

what is the coronary ligament?

A

a reflection of visceral peritoneum that extends from the posterior surface of the liver onto the diaphragm

(coronary - towards the heart)

45
Q

what is the right triangular ligament?

A

the right extremity of the coronary ligament

46
Q

what is the left triangular ligament?

A

the left extremity of the coronary ligament

47
Q

what is the hepatogastric ligament?

A

the part of the lesser omentum which extends from liver to lesser curvature of stomach

48
Q

what is the hepatoduodenal ligament?

A

the free border of the lesser omentum, it contains the bile duct, portal vein and hepatic artery

49
Q

what is the lesser omentum? what does it include?

A

double layer of peritoneum that extends from the liver to the lesser curvature of the stomach (hepatogastric ligament) and the first part of the duodenum (hepatoduodenal ligament)

50
Q

what separates the left and right lobes of liver?

A

falciform ligament

51
Q

what can be seen on the visceral surface?

A
  • When viewed from the visceral surface two smaller accessory lobes can be seen – the caudate and quadrate lobe
  • Functionally, the caudate and quadrate lobes are part of the left lobe (part of right or left lobe so confused?)
52
Q

what does the liver appear to have imprinted on the visceral surface? what formed by?

A

letter H

  • formed by two sagittal fissures joined together in the middle by the porta hepatis
53
Q

where does the gall bladder lie in terms of the H?

A

lies in the fossa that forms the anterior part of the right sagittal fissure

54
Q

where does the IVC lie in terms of the H?

A

lies in the groove that forms the posterior part of the right sagittal fissure

55
Q

where does the ligamentum teres lie in terms of the H?

A

lies in the groove that forms the anterior part of the left sagittal fissure

56
Q

where does the ligamentum venosum lie in terms of the H?

A

lies in the groove that forms the posterior part of the left sagittal fissure

57
Q

where do structures enter and leave the liver?

A

through porta hepatis

58
Q

what doesn’t enter or leave the liver at the porta hepatis?

A

hepatic veins

59
Q

what leaves and enters the porta hepatis?

A
  • hepatic arteries
  • hepatic duct
  • portal vein
  • lymphatics
  • autonomic fibres
60
Q

what is the visceral surface of the liver covered with?

A

peritoneum except at the porta hepatis and at the fossa of the gallbladder

61
Q

what is the diaphragmatic surface of the liver covered with?

A

peritoneum except in a small area posteriorly where it comes into direct contact with the diaphragm = bare area

62
Q

what is the liver composed of?

A
  • Liver is a solid organ composed of tightly packed epithelial cells (hepatocytes)
  • The classical description of the liver suggests that the basic structural unit of liver is the liver lobule
63
Q

describe each lobule

A
  • Each lobule is hexagonal in shape and consists of plates of hepatocytes radiating towards a central vein
  • Vascular channels, the liver sinusoids, are placed between the plates of hepatocytes
  • They convey blood from the periphery of the lobule to the central vein
  • A portal triad is located at each angle of the hexagonal lobule
  • Each portal triad contains a branch of the hepatic artery and of the portal vein (which deliver blood to the lobule) and a small bile duct
  • Bile is secreted by the hepatocytes into small bile canaliculi which are located between adjacent hepatocytes
  • The canaliculi drain into the small bile duct at the portal triad
  • This arrangement is designed so that blood and bile don’t mix
64
Q

what is the arterial supply of the liver?

A
  • The hepatic artery proper delivers 20-25% of blood to the liver
  • The portal vein (hepatic portal vein) delivers 75-80% of blood to the liver
65
Q

where does the hepatic artery proper arise from?

A

the common hepatic artery

66
Q

what does the hepatic artery proper bifurcate into? what happens next?

A

right and left hepatic arteries which enter the liver at the porta hepatis

67
Q

what does the portal vein transport?

A

blood poor in oxygen but rich in nutrients from the abdominal organs to the liver

68
Q

where is the portal vein formed?

A

posterior to the neck of the pancreas

69
Q

what forms the portal vein?

A

splenic and superior mesenteric veins

70
Q

describe the blood flow through the liver

A
  • Branches of hepatic artery and portal vein enter the portal triad
  • Blood is conveyed through the liver sinusoid
  • Blood drains into the central vein
  • Blood drains into the right or left hepatic vein (there’s also a middle hepatic vein)
  • These vessels drain into the inferior vena cava
71
Q

what allows communication between two vascular systems?

A

anastomoses between the hepatic portal system and the systemic circulation

72
Q

what happens if the portal circulation through the liver is obstructed?

A

blood can return to the heart via the systemic circulation

73
Q

why can blood flow in a retrograde direction through the portal veins and its tributaries to the IVC?

A

because they have no valves

74
Q

what are the sites of anastomoses?

A
  1. inferior oesophagus
  2. anal canal
  3. secondary retroperitoneal structures
  4. anterior abdominal wall
75
Q

describe the inferior oesophagus anastomosis

A
  • lower third drains via left gastric vein into portal vein - middle third drains into azygos vein
76
Q

describe the anal canal anastomosis

A
  • superior rectal veins drain into portal system

- middle and inferior rectal veins drain into internal iliac and internal pudendal veins

77
Q

describe the secondary retroperitoneal structures

A
  • superior mesenteric, inferior mesenteric and splenic vessels drain into portal system
  • renal, lumbar and phrenic veins drain into IVC
78
Q

describe the anterior abdominal wall

A
  • paraumbilical veins drain into portal system

- superficial veins of abdomen drain into axillary or femoral veins

79
Q

what is a portocaval anastomosis?

A

area of the body that is drained by veins that will end of in the hepatic portal vein and veins that drain to the IVC

80
Q

what might occur if the volume of blood returned via the systemic circulation is excessive?

A
  • varices

- could be potentially fatal

81
Q

how much lymph does the liver produce?

A

up to half the lymph that is made in the body

82
Q

what does most of the lymph from the liver drain into?

A

the hepatic nodes which are located at the porta hepatis

83
Q

what is the route of lymph from hepatic nodes to cistern chyli?

A
  • The coeliac nodes receive lymph from the hepatic nodes
  • The intestinal trunk drains lymph from the coeliac nodes
  • The intestinal trunk drains into the cisterna chyli (dilated sac at lower end of thoracic duct – lymph from the intestinal trunk and two lumbar lymphatic trunks drains into)
84
Q

what is the innervation of the liver?

A
  • The greater splanchnic nerve provides sympathetic innervation to the liver (foregut structure)
  • Postganglionic sympathetic fibres for the liver arise in the coeliac ganglion (the one associated with the greater splanchnic nerve)
  • The vagus nerve transmits parasympathetic fibres to the liver (and in general the gut I think)
85
Q

what do the nerves to the liver provide?

A

vasomotor control to the liver but it is unclear what other effects these nerves may have

86
Q

what is the function of the gallbladder?

A

vasomotor control to the liver but it is unclear what other effects these nerves may have

87
Q

where does the gallbladder lie?

A

in the fossa of the gallbladder

88
Q

what does the gallbladder consist of?

A
  • fundus
  • body
  • neck
89
Q

what is the fundus of the gallbladder? where is it located?

A
  • rounded portion of the gall bladder that projects from the lower border of the liver - located at the tip of the 9th costal cartilage in the midclavicular line
90
Q

what is the body of the gallbladder? where is it located?

A
  • main part of the gall bladder

- located posterior to the liver, superior part of the duodenum and the transverse colon

91
Q

what is the neck of the gallbladder? where is it located?

A
  • part of the gall bladder which is continuous with the cystic duct
  • it lies superior to the duodenum
92
Q

what is the arterial supply of the gall bladder?

A

the cystic artery

93
Q

where does the cystic artery usually arise from?

A

the right hepatic artery

94
Q

where is the cystic artery usually located?

A

in the triangle between the inferior border of the liver, cystic duct and common hepatic duct = cystohepatic triangle

95
Q

what is the cystohepatic triangle?

A

triangle between the inferior border of the liver, cystic duct and common hepatic duct

96
Q

what is the venous drainage of the gallbladder?

A
  • Fundus and body = directly through visceral surface of liver into hepatic sinusoids
  • Neck and cystic duct = cystic veins which drain into liver directly or via portal vein
97
Q

what is the lymphatic drainage route of the gallbladder?

A
  • Cystic nodes
  • Hepatic nodes
  • Coeliac nodes
  • Intestinal trunk
  • Cisterna chyli
  • Thoracic duct
  • Left subclavian vein
98
Q

what is the innervation of the gallbladder?

A
  • The greater splanchnic nerve provides sympathetic innervation
  • Postganglionic sympathetic fibres arise from coeliac ganglion
  • The vagus nerve transmits parasympathetic fibres
99
Q

describe the biliary tree

A
  • Liver
  • Right hepatic duct
  • Left hepatic duct
  • Common hepatic duct
  • Gallbladder
  • Cystic duct
  • Bile duct
  • Pancreatic duct
  • Hepatopancreatic ampulla
  • Duodenum
100
Q

describe flow of bile

  • what happens when what is or isn’t present
  • what secretes what
A
  • Bile is continuously secreted by the liver
  • It passes down the right and left hepatic ducts into the common hepatic duct and then through the bile duct to the duodenum
  • If fat is present in the duodenum the sphincter of Oddi (hepatopancreatic sphincter) will be open and bile will be able to enter
  • In the absence of fat, the sphincter will be closed and the bile will track back up the bile duct, into the cystic duct and into the gall bladder
  • When fat is present the enteroendocrine cells within the duodenum release a hormone, called cholecystokinin
  • Cholecystokinin causes the sphincter of Oddi to open and the walls of the gall bladder to contract so that bile is released

Medicine Sem 4 (23 decks)

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