Clinical Anatomy - Liver, Gallbladder & Pancreas Flashcards
Functions of liver: (11 functions)
- produce & secrete bile (emulsifies fat) - produces bile pigments (bilirubin&biliverdin) = breaks down hemoglobin - detox & blood filtration - stores carbs (glycogen ->glucose) - produce/store lipids (triglycerides) - plasma protein synthesis (albumin&globulin) - produce blood coagulates (coagulation factors I, II, V, VII, IX, X, XI) - produce anticoagulants (heparin, protein C, protein S, antithrombin) - reservoir for blood&platelets - stores calcium, vitamin B12, iron, copper - fetus = produce RBC
Largest visceral organ. Largest gland in human body?
Liver - weight=1500g (2.5% adult body weight) - right hypochondrium, epigastrium, part of left hypochondrium
Which lobe is considered a “third liver”?
CAUDATE LOBE - independent vascularization (vessels from both portal triad bundles) - drained by 1 or 2 small hepatic vv. (directly to IVC)
Falciform ligament
Liver –> anterior abdominal wall - separates subphrenic recesses (R/L)
Subhepatic space
Portion of subcolic compartment of peritoneal cavity immediately inferior to liver
Hepatorenal recess (Morison pouch)
Posteriosuperior extension of subhepatic space (b/t right kidney & right visceral surface of liver) - fluid draining from omental bursa drain here - communicates anteriorly with right subphrenic recess
Peritonitis
Inflammation of peritoneal cavity - subphrenic recess = common site for pus - RIGHT subphrenic abscesses more common - drained via incision @12th rib or inferior; or subcostal incision inferior/peerless to R. costal margin
Bare area of liver?
Posterior: reflection of diaphragm peritoneum as anterior (upper) & posterior (lower) layers of CORONARY LIGAMENT - ports hepata + fossa for gallbladder also = no peritoneum
Areas of liver (impressions):
- Gastric & pyloric (R side anterior aspect of stomach) 2. Duodenal (superior duodenum) 3. Fossa for gallbladder 4. Colic (R colic flexure + R transverse colon) 5. Renal & suprarenal (R kidney + suprarenal gland)
Dual Blood Supply
Dominant venous supply + lesser arterial supply
Portal vein
- Superior mesenteric v + splenic v. - ascends anterior to IVC
Cirrhosis of liver
Liver cells progressively destroyed and replaced by fatty/ fibrous tissue - impedes liver circulation - chronic alcoholism, Hep B,C,D, poison ingestion - causes portal hypertension
Portal-systemic anastomoses:
- Submucosal esophageal vv./ azygos 2. Inferior & middle rectal vv. (hemorrhoids) 3. Paraumbilical vv./ small epigastric vv. (capital medusae) 4. Retroperitoneal viscera
Liver Biopsy
- Percutaneously by needle; right 8th or 9th intercostal space in the right midaxillary line; ultra-sound or computed tomography (CT) scan guidance - patient holds breath in full expiration to reduce costodiaphragmatic recess (lessen chance of damaging lung) 2. Transjugular liver biopsy; catheter into the right internal jugular vein, guiding through the superior vena cava, IVC, and right hepatic vein. - biopsy needle is inserted through catheter
Gallbladder
- stores + concentrates bile - releases it intermittently when fat enters the duodenum - bile emulsifies the fat = easy absorption
which hormone (produced by the duodenal mucosa) causes contraction of gallbladder ?
cholecystokinin
what is the abnormal conical pouch that may be present in the neck of the gallblader?
Hartmann’s pouch (also = ampulla of gallbladder)
Where do gallstones commonly collect?
in the infundibulum
What could occur that would allow gallstones to enter the duodenum?
If a peptic duodenal ulcer ruptures = false passage may form between GB infundibulum + superior part of duodenum “cholecystenteric fistula”
“Cholelithiasis” Name 3 main types of gallstones:
- Cholesterol stones (crystalline cholesterol monohydrate) –yellow; in Western countries 2. Pigment stones (bilirubin calcium salts) – dark colored; other countries 3. Brown Stones – biliary infections (parasites or bacteria)
gallstone ileus
gallstone entering small intestine becomes trapped at ileocecal valve = bowel obstruction
Functions of Pancreas:
- exocrine secretion: pancreatic juice (from acinar cells) enters duodenum
- endocrine secretions: insulin, glucagon, somatostatin, etc. (from inlets of Langerhans) enter the blood
Common/acute pancreatitis:
bile fr. bile duct goes retrogradly into pancreas (bile duct possibly blocked by stone)
Identify the structures
(inferior view)
Pancreatic Cancer
- most cases of extrahepatic obstruction of biliary ducts = cancer of pancreatic head
- One of the 1st symptoms: jaundice (obstructive jaundice); obstruction = retention of bile pigments + enlargement of the gallbladder + jaundice
- 90% of people w. pancreatic cancer have ductular adenocarcinoma (glandular origin)
- Severe pain in the back = common
- Cancer of neck + body of pancreas may cause portal or IVC obstruction (pancreas overlies these)
- no clinical symptoms for long period of time (until tumor reaches particular size)
- Metastasizes to liver & other structures ==> cannot remove all cancerous cells so prognosis is often not good
