Foregut (liver and gall bladder) Flashcards

1
Q

what are the 4 lobes of the liver

A

left
right
caudate
quadrate

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2
Q

what 2 lobes can be seen from the anterior view of the liver

A

right and left

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3
Q

the peritoneum of the abdominal wall reflects over the surface of the liver to create what

A

falciform ligament

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4
Q

the ligamentum teres is a fibrous remnant of what

A

umbilical vein

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5
Q

where does the caudate lobe sit

A

between the IVC and left lobe

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6
Q

where does the quadrate lobe sit

A

between the left lobe and the gall bladder

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7
Q

what is the bare area of the liver

A

area that is not covered in peritoneum

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8
Q

where is the bare area

A

superior surface of right lobe

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9
Q

what is the hilum of the liver called

A

porta hepatis

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10
Q

what attaches to the porta hepatis

A

lesser omentum free edge

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11
Q

what does the free edge of the lesser omentum carry

A

hepatic artery and hepatic portal vein to the liver

bile duct away from liver

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12
Q

what structures are present at the porta hepatis

A
right and left hepatic ducts 
hepatic arteries
hepatic portal vein
ANS fibres
lymph nodes
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13
Q

where are the hepatic veins found

A

drain directly into the IVC as it passes along posterior surface of liver - NOT found in porta hepatis

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14
Q

the hepatic arteries and bile duct lie _____ to the portal vein

A

anterior

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15
Q

what regions does the liver lie in

A

fills right hypochondrium and crosses through the epigastric region

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16
Q

anterior surface of the liver is covered by what

A

lower ribs on right side

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17
Q

superior surface of liver covered by what

A

diaphragm

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18
Q

the liver reaches up to what ribs

A

ribs 5-6

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19
Q

what is the surface marking of the gall bladder

A

right 9th costal cartilage at mid-clavicular line

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20
Q

what are the relations of the posterior surface of the liver

A
oesophagus 
stomach
duodenum
right colic flexure
right kidney
supra-renal gland
gall bladder
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21
Q

where does the falciform ligament lie

A

between right and left lobes

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22
Q

what does the right layer of the falciform ligament create

A

coronary ligament over the right lobe and then the right triangular ligament

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23
Q

what does the left layer of the falciform ligament create

A

left triangular ligament

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24
Q

the liver is covered in visceral peritoneum except for

A

bare area - area attached to diaphragm

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25
Q

where does the falciform ligament pass

A

to umbilicus

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26
Q

the falciform ligament passes to the umbilicus and contains the remnants of waht

A

umbilical vein (ligamentum teres)

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27
Q

what is the ligamentum venosum

A

remnant of fetal ductus venosus which shunted blood from the umbilical vein to the IVC - oxygenated blood to IVC

28
Q

what is the purpose of the falciform ligament

A

attaches liver to anterior abdominal wall

29
Q

describe the blood supply of the liver

A

30% blood from hepatic artery

70% from portal vein

30
Q

what supplies the liver with oxygenated blood

A

hepatic artery

31
Q

what supplies the liver with blood rich in nutrients

A

portal vein

32
Q

the hepatic artery is a branch of what

A

coeliac axis

33
Q

after processing by the hepatocytes, the blood passes into what

A

hepatic veins and is drained directly into the inferior vena cava

34
Q

arterial and venous blood is conducted to the central vein of each liver lobule by

A

sinusoids

35
Q

the central veins drain into where

A

left and right hepatic veins (4 in total) and directly into vena cava

36
Q

lymph from the liver drains where

A

local nodes at porta hepatis and then to nodes clustered at coeliac axis (pre-aortic T12)

37
Q

small amount of lymph can also pass where

A

into the thoracic lymphatic system via diaphragm

38
Q

pain from liver is referred where

A

mainly body wall within epigastric region

but if liver irritates diaphragm pain may be felt in right shoulder

39
Q

why can pain be felt in right shoulder if liver irritates diaphragm

A

phrenic nerve - C345 - same dermatomes as right shoulder

40
Q

Autonomic nerves to liver are from

A

hepatic plexus derived from coeliac plexus

sympathetic from celiac plexus
parasympathetic from vagus nerves

41
Q

bile made by the liver is needed to what

A

emulsify fats when fatty food is eaten

42
Q

bile is secreted by what

A

liver

43
Q

bile is stored where

A

gall bladder

44
Q

the bile duct is _cm long

A

8cm

45
Q

the bile duct ends where

A

pierces medial wall of 2nd part of duodenum

46
Q

the bile duct is joined by what and opens into where

A

bile duct joined by main pancreatic duct and opens into hepatopancreatic ampulla (of vater)

47
Q

hepatopancreatic ampulla opens into duodenum via what

A

major duodenal papilla (sphincter of Oddi)

48
Q

what branches join to form the bile duct

A

right and left hepatic ducts unite and then join to cystic duct to form bile duct

49
Q

what happens when fat is present in the duodenum

A

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

50
Q

what are the 3 divisions of the gall bladder

A

fundus
body
neck

51
Q

where is the fundus of the gall bladder found

A

hands below liver

52
Q

where is the body of the gall bladder found

A

contacts visceral surface of liver

53
Q

where is the neck of the gall bladder found

A

joints cystic duct

54
Q

describe the surfaces of the gall bladder

A

external surface is smooth due to visceral peritoneum

internal surface has many folds (rugae and microvilli)

55
Q

what is the purpose of the rugae and microvilli of gall bladder

A

increase surface area for absorption of water during bile concentration

56
Q

what causes the gall bladder to contract

A

fat in duodenum causes the release of cholecystokinin from small intestine mucosa

57
Q

when the gall bladder contracts what happens to the smooth muscle at the end of the bile duct and the ampulla

A

relax

58
Q

what is the arterial supply of the gall bladder

A

cystic artery from right hepatic artery

59
Q

the cystic vein drains where

A

into portal vein

60
Q

where does lymph from the gall bladder go

A

to cystic node then hepatic then coeliac

61
Q

nerves to gall bladder come from where

A

coeliac plexus

62
Q

pain from gall bladder referred where

A

epigastric region

63
Q

gallstones are formed from what

A

crystalline bodies made from pigment and cholesterol components of bile

64
Q

gall stones cause pain when

A

if they lodge into biliary tree

65
Q

if the gall stones are made from cholesterol what colour are they

A

green or yellow/white

66
Q

if the gall stones are made from pigment stones (bilirubin and calcium salts)

A

usually small and dark