Clinical Anatomy - Liver, Gallbladder & Pancreas

Question 0

Functions of liver: (11 functions)

Answer 0

• 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

Question 1

Largest visceral organ. Largest gland in human body?

Answer 1

Liver - weight=1500g (2.5% adult body weight) - right hypochondrium, epigastrium, part of left hypochondrium

Question 2

Which lobe is considered a “third liver”?

Answer 2

CAUDATE LOBE - independent vascularization (vessels from both portal triad bundles) - drained by 1 or 2 small hepatic vv. (directly to IVC)

Question 3

Falciform ligament

Answer 3

Liver –> anterior abdominal wall - separates subphrenic recesses (R/L)

Question 4

Subhepatic space

Answer 4

Portion of subcolic compartment of peritoneal cavity immediately inferior to liver

Question 5

Hepatorenal recess (Morison pouch)

Answer 5

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

Question 6

Peritonitis

Answer 6

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

Question 7

Bare area of liver?

Answer 7

Posterior: reflection of diaphragm peritoneum as anterior (upper) & posterior (lower) layers of CORONARY LIGAMENT - ports hepata + fossa for gallbladder also = no peritoneum

Question 8

Areas of liver (impressions):

Answer 8

1. 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)

Question 9

Dual Blood Supply

Answer 9

Dominant venous supply + lesser arterial supply

Question 10

Portal vein

Answer 10

• Superior mesenteric v + splenic v. - ascends anterior to IVC

Question 11

Cirrhosis of liver

Answer 11

Liver cells progressively destroyed and replaced by fatty/ fibrous tissue - impedes liver circulation - chronic alcoholism, Hep B,C,D, poison ingestion - causes portal hypertension

Question 12

Portal-systemic anastomoses:

Answer 12

1. Submucosal esophageal vv./ azygos 2. Inferior & middle rectal vv. (hemorrhoids) 3. Paraumbilical vv./ small epigastric vv. (capital medusae) 4. Retroperitoneal viscera

Question 13

Liver Biopsy

Answer 13

1. 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

Question 14

Gallbladder

Answer 14

• stores + concentrates bile - releases it intermittently when fat enters the duodenum - bile emulsifies the fat = easy absorption

Question 15

which hormone (produced by the duodenal mucosa) causes contraction of gallbladder ?

Answer 15

cholecystokinin

Question 16

what is the abnormal conical pouch that may be present in the neck of the gallblader?

Answer 16

Hartmann’s pouch (also = ampulla of gallbladder)

Question 17

Where do gallstones commonly collect?

Answer 17

in the infundibulum

Question 18

What could occur that would allow gallstones to enter the duodenum?

Answer 18

If a peptic duodenal ulcer ruptures = false passage may form between GB infundibulum + superior part of duodenum “cholecystenteric fistula”

Question 19

“Cholelithiasis” Name 3 main types of gallstones:

Answer 19

1. 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)

Question 20

gallstone ileus

Answer 20

gallstone entering small intestine becomes trapped at ileocecal valve = bowel obstruction

Question 21

Functions of Pancreas:

Answer 21

- exocrine secretion: pancreatic juice (from acinar cells) enters duodenum

• endocrine secretions: insulin, glucagon, somatostatin, etc. (from inlets of Langerhans) enter the blood

Question 22

Common/acute pancreatitis:

Answer 22

bile fr. bile duct goes retrogradly into pancreas (bile duct possibly blocked by stone)

Question 23

Identify the structures

(inferior view)

Answer 23

Question 24

Pancreatic Cancer

Answer 24

• 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