Foregut (liver and gall bladder) Flashcards
what are the 4 lobes of the liver
left
right
caudate
quadrate
what 2 lobes can be seen from the anterior view of the liver
right and left
the peritoneum of the abdominal wall reflects over the surface of the liver to create what
falciform ligament
the ligamentum teres is a fibrous remnant of what
umbilical vein
where does the caudate lobe sit
between the IVC and left lobe
where does the quadrate lobe sit
between the left lobe and the gall bladder
what is the bare area of the liver
area that is not covered in peritoneum
where is the bare area
superior surface of right lobe
what is the hilum of the liver called
porta hepatis
what attaches to the porta hepatis
lesser omentum free edge
what does the free edge of the lesser omentum carry
hepatic artery and hepatic portal vein to the liver
bile duct away from liver
what structures are present at the porta hepatis
right and left hepatic ducts
hepatic arteries
hepatic portal vein
ANS fibres
lymph nodes
where are the hepatic veins found
drain directly into the IVC as it passes along posterior surface of liver - NOT found in porta hepatis
the hepatic arteries and bile duct lie _____ to the portal vein
anterior
what regions does the liver lie in
fills right hypochondrium and crosses through the epigastric region
anterior surface of the liver is covered by what
lower ribs on right side
superior surface of liver covered by what
diaphragm
the liver reaches up to what ribs
ribs 5-6
what is the surface marking of the gall bladder
right 9th costal cartilage at mid-clavicular line
what are the relations of the posterior surface of the liver
oesophagus
stomach
duodenum
right colic flexure
right kidney
supra-renal gland
gall bladder
where does the falciform ligament lie
between right and left lobes
what does the right layer of the falciform ligament create
coronary ligament over the right lobe and then the right triangular ligament
what does the left layer of the falciform ligament create
left triangular ligament
the liver is covered in visceral peritoneum except for
bare area - area attached to diaphragm
where does the falciform ligament pass
to umbilicus
the falciform ligament passes to the umbilicus and contains the remnants of waht
umbilical vein (ligamentum teres)
what is the ligamentum venosum
remnant of fetal ductus venosus which shunted blood from the umbilical vein to the IVC - oxygenated blood to IVC
what is the purpose of the falciform ligament
attaches liver to anterior abdominal wall
describe the blood supply of the liver
30% blood from hepatic artery
70% from portal vein
what supplies the liver with oxygenated blood
hepatic artery
what supplies the liver with blood rich in nutrients
portal vein
the hepatic artery is a branch of what
coeliac axis
after processing by the hepatocytes, the blood passes into what
hepatic veins and is drained directly into the inferior vena cava
arterial and venous blood is conducted to the central vein of each liver lobule by
sinusoids
the central veins drain into where
left and right hepatic veins (4 in total) and directly into vena cava
lymph from the liver drains where
local nodes at porta hepatis and then to nodes clustered at coeliac axis (pre-aortic T12)
small amount of lymph can also pass where
into the thoracic lymphatic system via diaphragm
pain from liver is referred where
mainly body wall within epigastric region
but if liver irritates diaphragm pain may be felt in right shoulder
why can pain be felt in right shoulder if liver irritates diaphragm
phrenic nerve - C345 - same dermatomes as right shoulder
Autonomic nerves to liver are from
hepatic plexus derived from coeliac plexus
sympathetic from celiac plexus
parasympathetic from vagus nerves
bile made by the liver is needed to what
emulsify fats when fatty food is eaten
bile is secreted by what
liver
bile is stored where
gall bladder
the bile duct is _cm long
8cm
the bile duct ends where
pierces medial wall of 2nd part of duodenum
the bile duct is joined by what and opens into where
bile duct joined by main pancreatic duct and opens into hepatopancreatic ampulla (of vater)
hepatopancreatic ampulla opens into duodenum via what
major duodenal papilla (sphincter of Oddi)
what branches join to form the bile duct
right and left hepatic ducts unite and then join to cystic duct to form bile duct
what happens when fat is present in the duodenum
the sphincer of Oddi opens and gall bladder contracts causing the bile that has been stored and concentrated in the gall bladder to be released into the 2nd part of duodenum
what are the 3 divisions of the gall bladder
fundus
body
neck
where is the fundus of the gall bladder found
hands below liver
where is the body of the gall bladder found
contacts visceral surface of liver
where is the neck of the gall bladder found
joints cystic duct
describe the surfaces of the gall bladder
external surface is smooth due to visceral peritoneum
internal surface has many folds (rugae and microvilli)
what is the purpose of the rugae and microvilli of gall bladder
increase surface area for absorption of water during bile concentration
what causes the gall bladder to contract
fat in duodenum causes the release of cholecystokinin from small intestine mucosa
when the gall bladder contracts what happens to the smooth muscle at the end of the bile duct and the ampulla
relax
what is the arterial supply of the gall bladder
cystic artery from right hepatic artery
the cystic vein drains where
into portal vein
where does lymph from the gall bladder go
to cystic node then hepatic then coeliac
nerves to gall bladder come from where
coeliac plexus
pain from gall bladder referred where
epigastric region
gallstones are formed from what
crystalline bodies made from pigment and cholesterol components of bile
gall stones cause pain when
if they lodge into biliary tree
if the gall stones are made from cholesterol what colour are they
green or yellow/white
if the gall stones are made from pigment stones (bilirubin and calcium salts)
usually small and dark
