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Block 1 > Clinical Anatomy Of The Pancreas, Liver + Spleen > Flashcards

Clinical Anatomy Of The Pancreas, Liver + Spleen Flashcards

1
Q

What are the liver, pancreas and spleen embryological derivatives of?

A

Liver + pancreas = foregut derivatives

Spleen = mesodermal derivative of mesenchymal origin (but share foregut blood supply)

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2
Q

What does the ventral mesentery contain? What does it form in adults?

A

Liver
Gallbladder
Part of pancreas

Lesser omentum

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3
Q

What does the dorsal mesentery contain? What does it form in adults?

A

Spleen
Part of pancreas

Greater omentum

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4
Q

What does the falciform ligament contain in embryology? What does it become in adults?

A

Umbilical vein; the major vein that drains blood from placenta into developing embryo

Becomes a fibrous chord called the ligamentum teres in adults

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5
Q

What does the stomach do in embryology?

A
  1. Rotates right by 90o about a longitudinal axis + clockwise 90o about a sagittal axis
  2. Liver grows out of top of ventral mesentery
  3. Pancreas + duodenum become 2ndarily retroperitoneal
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6
Q

What structure joins the lesser and greater sac?

A

Epiploic foramen

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7
Q

What are the boundaries of the lesser sac?

A

Transverse mesocolon inferiorly

Splenorenal + gastrophrenic ligament to the right

Left coronary ligament superiorly

Bare area of liver to the left

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8
Q

What can paracolic gutters help you to do?

A

Track the movement of fluid

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9
Q

What compartments exist in the abdomen? Where are they?

A

Supracolic: sits above transverse colon mostly & in front of greater omentum

Infracolic: sits below transverse colon mostly + behind the greater omentum

Both in greater sac

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10
Q

Where does the liver sit?

A

Mainly in R hypochondrium + extends across epigastric + L hypochondrium

Follows upper limit of diaphragm (5th rib at MCL) so is associated with costodiaphragmatic recess

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11
Q

Where is the liver palpable?

A

Margin not normally palpable below costal margin although it can be near the midline below the sternum

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12
Q

How should you clinically examine the liver?

A

Percussion

Palpation at costal margin; moves inferiorly on inspiration

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13
Q

What do you need to tell the patient to do when taking a liver biopsy? Why?

A

To take a deep breath out because the lungs will drop down over the margin of the liver when a deep breath is taken in so could be punctured

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14
Q

What are the 4 anatomical lobes of the liver?

A

Anterior:
Right
Left

Posterior:
Caudate (superior)
Quadrate (inferior)

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15
Q

What splits the left and right lobe of the liver?

A

Falciform ligament

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16
Q

What major vein comes into the liver?

A

IVC -> hepatic vein

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17
Q

What is the porta hepatis?

A

Entry/exit point for portal vein, bile duct, hepatic artery + autonomic nerves

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18
Q

What is the liver separated into?

A

8 functionally independent segments where each segment is served by its own hepatobiliary division

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19
Q

What are the consequences of organ segmentation?

A

Surgically, a segment can be removed/dead + the rest of the organ functions fine

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20
Q

What is the livers point of reflection?

A

When peritoneum is reflecting/turning back on itself + is stuck to the diaphragm meaning the liver moves with breathing

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21
Q

What is the bare area of the liver?

A

The part of the liver not covered in peritoneum, in DIRECT contact with the diaphragm bordered by the coronary + triangular ligaments

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22
Q

What are the liver ligaments? What are their names?

A

When the peritoneum lifts off the liver + is stuck to the diaphragm

Coronary
Triangular

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23
Q

What is the blood supply to the liver?

A 
Portal vein (70%)
Hepatic artery (30%)
24
Q

Where does the hepatic artery come from and what does it run through?

A

Coeliac trunk

Runs in free edge of lesser omentum in hepatoduodenal ligament (contains common bile duct + portal vein too) so can be accessed via epiploic foramen

25
Q

What is the blood supply to the gallbladder?

A

Cystic artery from right hepatic artery (normally)

26
Q

What are the branches of the coeliac trunk?

A

Common hepatic -> gastroduodenal -> hepatic -> L + R hepatic & cystic

27
Q

What is the lesser omentum?

A

The peritoneum between the stomach + liver

28
Q

What is the pringle manoeuvre?

A

When you the pinch the free edge of lesser omentum through the epiploic foramen o cut off the blood supply to the liver as this contains the common bile duct, hepatic artery + portal vein

29
Q

Where is the portal vein formed and what forms it?

A

Formed posterior to pancreatic neck

Formed from the splenic vein, SMV + IMV (joins either at splenic or onto SMV)

30
Q

What organs does the portal vein drain? What consequences does this have?

A

Spleen + majority of GI tract drain to the liver so if there is pressure in the portal venous system, the spleen for e.g. can become enlarged

31
Q

What is the porto-systemic anastomoses? What consequence may this have?

A

Joining of portal + systemic venous systems in the inferior oesophagus, umbilicus + rectum so increased portal venous pressure can dilate these anastomoses causing oesophageal/anorectal varices and/or caput medusae

32
Q

Where can gallstones get stuck? What can they cause?

A

In the duct system

Pain (biliary colic), cholecystitis + jaundice

33
Q

What are the different parts of the gallbladder?

A

Fundus (9th cc/L1 tip ~ at transpyloric plane)
Body
Neck
Drains into cystic duct (CD)

R + L hepatic duct form the common hepatic duct (CHD)

CD + CHD = bile duct

34
Q

Where does the bile duct drain into?

A

2nd part of duodenum at major papilla (marks foregut/midgut divide) which is guarded by the hepato-pancreatic sphincter

35
Q

What are the functions of the gallbladder?

A

Concentrates bile

Stores bile (when sphincter Oddi is shut)

Selective absorption of salts

36
Q

What valve keeps the cystic duct open?

A

Spiral valve (raised spiral of mucosa)

37
Q

What type of imaging can be done to look for a gallstone in the duct system?

A

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) that passes an endoscopy through the major duodenal papilla

38
Q

How is the gallbladder examined?

A

Dr puts pressure under right costal margin at 9th cc level + asks the patient to inhale - inspiration causes gallbladder to descend onto fingers producing pain if it is inflamed in cholecystitis (this pain = Murphy’s sign)

39
Q

What peritoneal recesses exist? Why is this important clinically?

A

Subphrenic space
Hepato-renal space (Morrison’s pouch)

Recesses gravity dependent so can be an area that accumulates fluid, for infection spread or abscess formation from the abdomen when patient is supine

40
Q

Where can gallbladder pain refer to? Why?

A

Epigastrium: gallbladder is a foregut structure

R hypochondrium: irritation to local tissues

R shoulder: gallbladder sits under diaphragm + irritates it (C3-5)

41
Q

Where does the pancreas sit?

A

Epigastric region extending to the L hypochondrium sitting posterior to stomach in ‘C’ of duodenum

Neck sits on transpyloric plane (L1) whilst tail sits near splenic hilum

42
Q

What is the pancreas?

A

Retroperitoneal foregut derivative with 4 (or 5) anatomical parts + exocrine & endocrine functions

43
Q

What can be a consequence of pancreatitis?

A

Pain (back/epigastric region)

Fluid accumulation in lesser sac

44
Q

How does the pancreas develop in embryology?

A

From 2 different embryological tissue buds: ventral & dorsal

Ventral bud forms the bile duct whilst the dorsal bud is the long shape of the pancreas so they must rotate around duodenum to form characteristic structure

45
Q

What is an annular pancreas?

A

When the embryological ventral pancreas bud does not swing round the duodenum, but splits + circles the duodenum obstructing it causing vomiting + failure to thrive in newborns

46
Q

What are the drainage points of the pancreas?

A

Minor duodenal papilla: receives accessory pancreatic duct

Major duodenal papilla: drains pancreatic + hepatic secretions

47
Q

How can the major duodenal papilla become blocked? What is the consequence of this?

A

Stones or tumours of pancreatic head

Pancreatic/bile duct drainage is blocked which can cause jaundice as bile is accumulating

48
Q

Where does the pancreas and duodenums arterial supply come from? Where is the venous supply?

A

Coeliac trunk (gastroduodenal, superior pancreaticoduodenal & splenic artery)

SMA (inferior pancreaticoduodenal artery)

Venous drainage into portal system tracks with arterial supply

49
Q

What is the lymph drainage of the pancreas and duodenum?

A

Coeliac nodes (follows arterial supply) -> thoracic duct -> supraclavicular nodes

50
Q

Why does the pancreas need a rich blood supply?

A

Because it has many roles i.e. endocrine AND exocrine

51
Q

Where does the spleen sit?

A

Left posterolateral abdominal wall intraperitoneally in L hypochondrium under costal margin

Related to ribs 9-11 or 10-12

52
Q

What injuries may damage the spleen?

A

Rib fracture in ~ ribs 9-12

Blood forced trauma - tissue bleeds profusely if injured & repair is difficult due to delicacy (alike liver)

53
Q

What is the costodiaphragmatic recess?

A

An area of the thoracic cavity that the lungs can extend into during normal tidal inspiration

54
Q

What other structures is the spleen in contact with?

A

The diaphragm at ribs 9–12 in the area of the costodiaphragmatic recess

Touches the stomach, tail of pancreas (sometimes), L kidneys + colon (splenic flexure)

55
Q

What is the spleens blood supply? What is its venous drainage? What is its lymph drainage?

A

Coeliac trunk -> splenic artery (torturous course) -> divides into segmental branches (no anastomoses between branches so damage to any part is irreparable)

Drains into portal venous system

Lymph drains into coeliac nodes (follows arterial supply)

56
Q

Can people live without a spleen?

A

Yes but need medical intervention

Block 1 (54 decks)

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