Goal 14 (a-f): Structure Of Pancreas, Hepatobiliary And Portal System

Question 1

What is the pancreas’ exocrine and endocrine function?

Answer 1

• exocrine: pancreatic juice

- endocrine: glucagon and insulin

Question 2

Where is the pancreas located? What is in front of it? To the right? To the left? And anterior to it?

Answer 2

• retroperitoneal, transversely across posterior abdominal wall
• front: stomach
• right: duodenum
• left: spleen
• anterior: transverse mesocolon

Question 3

What area do bedridden patients get fluid collection if they abscesses in the subphrenic recess, appendicitis, or ruptured duodenal ulcers? What is the landmark to create an incision to drain this area?

Answer 3

• Hepatorenal or Morrison’s pouch

- incise at the 12th rib to drain

Question 4

What is the fetal derivative of the Ligamentum venosum?

Answer 4

Ductus venosus

Question 5

What is the adult derivative of the umbilical vein?

Answer 5

Round ligament

Question 6

Where is the landmark for liver biopsies? What do you ask the patient to do right before puncturing and why?

Answer 6

• right 10th intercostal space

- tell them to hold their breath in full expiration to protect lung and pleural cavity

Question 7

What organ is the most common site of metastatic carcinoma? Why?

Answer 7

• liver

- secondary cancers spread from organs that are drained by the portal system, which is a direct system into the liver

Question 8

What ducts join to make the common hepatic duct?

Answer 8

Left and right hepatic ducts

Question 9

What ducts join to make the common bile duct?

Answer 9

Cystic duct (off the gallbladder) and the common hepatic duct

Question 10

What ligament do you find the common bile duct?

Answer 10

Hepatoduodenal ligament

Question 11

What is joined to form the hepatopancreatic ampulla (ampulla of Vater)?

Answer 11

Bile duct joins the pancreatic duct

Question 12

Where does the Ampulla of Vater open up to?

Answer 12

Second part of the duodenum, major duodenal papilla

Question 13

How much bile can the gallbladder hold? What’s it’s function?

Answer 13

• 30-50ml of bile

- concentrate and store bile

Question 14

What are the liver’s venous and arterial supply?

Answer 14

• vein: portal vein

- artery: hepatic artery

Question 15

What is the gallbladder’s venous and arterial supply?

Answer 15

• vein: cystic vein

- artery: cystic artery

Question 16

What is superolateral, inferolateral, and medial to Carlot’s Triangle? What does it contain? Why is it important to know this?

Answer 16

• sup: liver
• infr: cystic duct
• medial: common hepatic duct
• contains the CYSTIC ARTERY
• in case of need to ligate the cystic artery for surgery

Question 17

With gallstones, why is there referred pain from the epigastrium to the shoulder?

Answer 17

Phrenic nerve supplies both areas

Question 18

What is the most narrow part of the hepatobilary system? What commonly happens here because it is so narrow?

Answer 18

• hepatopancreatic ampulla

- gallstones are frequently here

Question 19

What are cholelithiasis made up of?

Answer 19

• Aka Gallstones

- made up of cholesterol

Question 20

What can happen to the duodenum if gallstones are inflamed and dilated enough?

Answer 20

• the swollen gallbladder gets big enough to touch the duodenum, creating connections called adhesions to it
• if gallstones remain inflamed, they will break down or ulcerate the organ attached to it to make a connection (fistula) = Cholecystoenteric fistula

Question 21

What two veins make up the Portal Vein

Answer 21

• superior mesenteric vein

- splenic vein

Question 22

What portal system vein and systemic vein cause esophageal varicies if dilated?

Answer 22

• portal: left gastric

- systemic: esophageal

Question 23

What is the significance of having anastomoses between the hepatic portal system and the system venous system?

Answer 23

-the connection provides collateral circulation in case an obstruction happens in the portal vein