GB 15. Liver and Extrahepatic Biliary System

Question 1

How many lobes does the liver have? Name them.

Answer 1

[1] Right Lobe
[2] Left Lobe
[3] Quadrate Lobe
[4] Caudate Lobe

Question 2

Where is the Ligamentum Teres located? What is it a remnant of?

Answer 2

In the free edge of the Falciform ligament.

It is a remnant of the umbilical vein. (the umbilical vein was the conduit for blood returning from placenta to fetus)

Question 3

What is the bare area of the liver?

Answer 3

It is an area on the diaphragmatic surface (superior surface) of the liver that has no peritoneal covering - it is directly attached to the diaphragm

Question 4

Are the right and left subphrenic spaces connected?

Answer 4

No, they are separated by the Falciform ligament and so, any fluid that accumulates in the right subphrenic space cannot move into the left subphrenic space.

Question 5

Where is Morison’s Pouch (Hepatorenal Pouch) located?

Answer 5

It is located under the liver and above the right kidney.

Question 6

What 2 fissures is the Falciform ligament made up of?

Answer 6

[1] Ligamentum Teres
[2] Ligamentum Venosum

ask this

Question 7

What is the ligamentum venosum a remnant of?

Answer 7

Ductus Venosus

Question 8

What is the porta hepatis and what does it include?

Answer 8

the porta hepatis is the “door” into the liver and it includes 3 structures:
[1] Portal Vein
[2] Hepatic Artery
[3] Bile Duct

Question 9

What are the 3 parts of the gall bladder?

Answer 9

[1] Fundus
[2] Body
[3] Neck

Question 10

What is the cystic duct?

Answer 10

• it is the duct arising from the gall bladder that joins it to the Common Hepatic Duct
• it contains the spiral valves of Heister

Question 11

What does the cystic duct contain?

Answer 11

the spiral valves of Heister

Question 12

If you were to split the liver in half, what lobe of the liver would the quadrate and caudate lobe be in?

Answer 12

the left lobe of liver

Question 13

What are the hepatic segments?

Answer 13

The liver is divided into 8 parts and each segment has its own vein, artery and bile duct

Question 14

Where are the hepatic segments located on the liver?

Answer 14

1 - Quadrate Lobe
2,3 - Left Lobe
4 - Caudate Lobe
5, 6, 7, 8 - Right Lobe

*start at quadrate lobe and move clockwise

Question 15

What are some other ligaments present on the liver? [4]

Answer 15

[1] Anterior Coronary Ligament
[2] Posterior Coronary Ligament
[3] Right Triangular Ligament
[4] Left Triangular Ligament

Question 16

What is the Pouch of Douglas (Rectouterine Pouch)?

Answer 16

• only in females*

- the space between the rectum and the back wall of the uterus

Question 17

Explain how the Common Bile Duct is formed.

Answer 17

1. the Right and Left Hepatic Duct join to form the Common Hepatic Duct
2. the Common Hepatic Duct joins with the Cystic Duct (of the gall bladder) to form the Common Bile Duct
   [3. eventually the Main Pancreatic Duct joins up with the Common Hepatic Duct to open into the Major Duodenal Papilla]

Question 18

What is the surface anatomy of the gall bladder?

Answer 18

it is at the top of the 9th rib

aka it is at L1

Question 19

Where is Hartmann’s Pouch located? Why is it important?

Answer 19

• it is an out-pouching of the wall of the gallbladder, at the junction of the neck of the gallbladder and the cystic duct
• it is important because gall stones usually block the biliary system in this pouch
• if there is a blockage, this leads to build up of bile and bilirubin and jaundice (yellowing of skin and eyes)

Question 20

What is Ampulla of Vater a landmark of?

Answer 20

It splits the foregut and the midgut

Question 21

Where does the accessory pancreatic duct open up into?

Answer 21

Minor Duodenal Papilla

Question 22

What is the blood supply of the gall bladder?

Answer 22

Cystic Artery

• this is a branch of the right hepatic artery
• and the right hepatic artery is a branch of the common hepatic artery
• the common hepatic artery is one of the 3 main branches of the celiac trunk

Question 23

Where does the superior mesenteric vein joint the splenic vein to become the portal vein?

Answer 23

behind the neck of the pancreas

- the SMV and SV join up to become the PV

Question 24

What is Murphy’s Sign?

Answer 24

Remember that Murphy’s Point is the surface marking for where the gall bladder is located on the body.

Murphy’s Sign occurs when inspiring, the inflamed gall bladder will touch the diaphragm and the patient may stop breathing or feel pain
- this occurs because the gall bladder is touching the parietal peritoneum + abdominal wall

Question 25

What is Murphy’s Point?

Answer 25

• it is where the gall bladder is located

- around mid-clavicular line at the 9th costal cartilage (transpyloric plane)