GI 4

Question 1

the liver is split into the left and right lobe by _____ which is a remnant of ______

Answer 1

the liver is split into the left and right lobe by falciform ligament which is a remnant of ventral mesentery

Question 2

how is a liver biopsy taken?

Answer 2

• patient asked to hold breath in full expiration to prevent damage to pleura/lung
• needle inserted through the 9th/10th right ICS in the midaxillary line

Question 3

describe the caudate vs quadrate lobe

Answer 3

• caudate lobe of the liver contains the IVC
• quadrate lobe of the liber contains the gall bladder and the porta hepatis

Question 4

describe the falciform lig. and ligamentus teres hepatis

Answer 4

• falciform: liver is attached to the anterior abdominal wall
• posterior free margin is the ligamentum teres which is the obliterated umbilical vein

Question 5

Answer 5

Question 6

describe the bare are

Answer 6

bare area: triangular are devoid of peritoneal covering, relating to the diaphragm

Question 7

Answer 7

Question 8

describe the biliary apparatus

Answer 8

• R and L hepatic ducts join to form the common hepatic duct; joined by the cystic duct to form the common bile duct

Question 9

Answer 9

Question 10

describe biliary colic

Answer 10

• usually caused by spasm of the smooth muscle of the gall bladder in an attempt to expel the gall stones

Question 11

describe acute cholecystitis

Answer 11

• initial pain in the right upper quadrant -> may eventually cause subdiaphragmatic parietal peritoneum, which is supplisd by the phrenic nerve (referred pain would be in the right shoulder)

Question 12

Answer 12

• A: left hepatic duct
• B: right hepatic duct
• C: common hepatic duct
• D: cystic duct
• E: common bile duct
• F: major pancreatic duct
• G: ampulla of Vater

Question 13

describe the triangle of Calot

Answer 13

the triangle of Calot contains the cystic artery

• Liver
• lateral: cystic duct
• medial: common hepatic duct

Question 14

describe the portal vein

Answer 14

• collects venous blood with products of digestion from the abdominal part of GIT
• passes through the lesser omentum, enters the liver through porta hepatis and divides into r. and l. segmental branches

Question 15

describe the gastric-esophageal porto-caval anastomoses

Answer 15

• esophageal tributaries of the left gastric vein and esophageal tributaries of azygos and hemiazygos veins
  
  • esophageal varices -> hemetemesis

Question 16

describe the anal canal port-caval anastomoses

Answer 16

• superior rectal vein (which drains into the inf. mesenteric vein) + inferior and middle rectal veins (-> internal iliac vein)
  
  • varicosity leads to hemorrhoids

Question 17

describe the umbilical porto-caval anastomoses

Answer 17

• veins along the ligamentum teres - para-umbilical veins; tributaries of the sup. and inf. epigastric veins
  
  • caput medussae - dilated tortuous veins radiating from the umbilicus