Gross Anatomy of the Hepatobiliary System and the Pancreas

Question 1

What is the weight and location of the liver?

Answer 1

1500g (2.5% of body weight); located in the right hypochondrium, epigastrium, and left hypochondrium, deep to ribs 7-11.

Question 2

List 5 key functions of the liver.

Answer 2

Homeostasis (toxin removal).

Nutrition (glucose/lipid regulation, vitamin storage).

Immune defense (phagocytic macrophages).

Bile secretion and glycogen storage.

Foetal haemopoiesis.

Question 3

Name the two main surfaces of the liver and their features.

Answer 3

Diaphragmatic: Smooth, convex, related to the diaphragm.

Visceral: Flat/concave, bears fissures (e.g., gallbladder fossa) and impressions.

Question 3

What are the four lobes of the liver?

Answer 3

Right lobe, left lobe, quadrate lobe (anterior), caudate lobe (posterior).

Question 4

How is the liver divided functionally?

Answer 4

4 portal sectors (right/left medial/lateral) by portal vein branches; further divided into segments by hepatic veins.

Question 5

What structures pass through the porta hepatis?

Answer 5

Right/left hepatic ducts, hepatic arteries, portal vein (VAD), lymph nodes, and nerves.

Question 6

What are the sources and proportions of liver blood supply?

Answer 6

Portal vein (70-80%, nutrient-rich deoxygenated blood).

Hepatic artery (20-25%, oxygenated blood).

Question 7

Trace bile flow from intrahepatic ducts to the duodenum.

Answer 7

Canaliculi → interlobular ducts → hepatic ducts → common hepatic duct + cystic duct → bile duct → ampulla of Vater → duodenum.

Question 8

Describe the gallbladder’s structure and function.

Answer 8

Pear-shaped, 7-10 cm, stores/concentrates bile; parts: fundus, body, neck; drains via cystic duct.

Question 9

Where is the pancreas located, and what are its parts?

Answer 9

Retroperitoneal, in epigastric/L hypochondriac regions; parts: head, neck, body, tail.

Question 10

How does the pancreas connect to the duodenum?

Answer 10

Main pancreatic duct joins bile duct at the hepatopancreatic ampulla (ampulla of Vater), opening at the major duodenal papilla.

Question 11

Which arteries supply the pancreas?

Answer 11

Head: Superior/inferior pancreaticoduodenal arteries.

Neck/Body/Tail: Splenic artery branches.

Question 12

Why is the hepatorenal recess (Morrison’s pouch) clinically significant?

Answer 12

Common site for fluid accumulation (e.g., blood, pus) in abdominal trauma/infections.

Question 13

Name 4 ligaments attaching the liver to surrounding structures.

Answer 13

Falciform ligament (to anterior abdominal wall).

Ligamentum teres (remnant of fetal left umbilical vein).

Left/Right triangular ligaments (to diaphragm).

Coronary ligament (surrounds the “bare area”).

Question 14

hat is the “bare area,” and why is it unique?

Answer 14

A triangular posterior liver surface not covered by peritoneum, directly attached to the diaphragm by loose connective tissue.

Question 15

What are the 3 key peritoneal spaces around the liver, and where are they located?

Answer 15

Subphrenic recess: Anterior/superior to liver (divided by falciform ligament into R/L).

Subhepatic space: Inferior to liver.

Hepatorenal recess (Morrison’s pouch): Between liver and right kidney.

Question 16

How do hepatic veins differ functionally from portal veins?

Answer 16

Hepatic veins: Drain deoxygenated blood from liver → IVC.

Portal vein: Brings nutrient-rich, deoxygenated blood from GI tract to liver.

Question 17

Trace the lymphatic drainage pathway of the liver.

Answer 17

Liver → nodes at porta hepatis → coeliac nodes → cisterna chyli → thoracic duct.

Question 18

What nerves supply the liver parenchyma and capsule?

Answer 18

Parenchyma: Hepatic plexus (sympathetic + vagal parasympathetic fibers).

Capsule: Lower intercostal nerves (somatic pain fibers).

Question 19

Which artery supplies the gallbladder, and what is a potential surgical concern?

Answer 19

Cystic artery (branch of right hepatic artery); risk of bleeding if damaged during cholecystectomy.

Question 20

Where does the bile duct lie in relation to the pancreas and duodenum?

Answer 20

Runs in the free edge of lesser omentum → posterior to duodenum → grooves pancreatic head → joins pancreatic duct at ampulla of Vater.

Question 21

What is the function of the sphincter of Oddi?

Answer 21

Controls bile/pancreatic juice flow into the duodenum via the major papilla; dysfunction can cause cholangitis/pancreatitis.

Question 22

Name 3 structures anatomically related to the pancreatic head.

Answer 22

Duodenum (C-shaped around head).

Bile duct (posterior groove).

IVC (posterior).

Question 23

What is the clinical significance of a “pancreas divisum”?

Answer 23

Congenital variant where pancreatic ducts fail to fuse; may predispose to pancreatitis due to poor drainage.

Question 24

What does Courvoisier’s law state, and what pathology does it suggest?

Answer 24

Painless jaundice + palpable gallbladder suggests malignancy (e.g., pancreatic head tumor) obstructing the bile duct.

Question 25

Where is pain referred in acute cholecystitis, and why?

Answer 25

Right subscapular region (visceral pain referred via phrenic nerve, C3-C5 dermatomes).

Question 26

Why is the Couinaud classification important in liver surgery?

Answer 26

Divides liver into 8 functionally independent segments, each with its own vascular inflow/outflow, enabling safe resection.

Question 27

What is the ligamentum venosum a remnant of, and where is it located?

Answer 27

Fetal ductus venosus (shunted umbilical vein blood to IVC); lies in the left sagittal fissure.

Question 28

Why is the pancreatic tail surgically significant?

Answer 28

Lies near the splenic hilum; risk of bleeding during distal pancreatectomy/splenectomy.

Question 29

What are the primary components of bile, and how does the gallbladder modify it?

Answer 29

Water, bile salts, cholesterol, bilirubin; gallbladder concentrates it by absorbing water/electrolytes.