Gut Book 3: Biliary Tree, Celiac Artery and its Branches Flashcards
Biliary apparatus consists of
gallbladder & biliary tree
Gallbladder- contact with abdominal wall
Inferior most portion (fundus) contacts the anterior abdominal wall near the junction of the right semilunar line and the 9th costal cartilage
Gall bladder location
in the gall bladder fossa of the right lobe immediately to the right of the quadrate lobe
Gall bladder peritonealization
Usually covered with peritoneum on its posterior and inferior surface, however, it may be completely peritonealized and suspended by a mesentery
Gall bladder contact with intestines
Contacts the transverse colon superiorly and the first and second portion of the duodenum posteriorly
Gall bladder size & shape
pear shaped, 7-10 cm in length, 2.5 cm at its broadest point
gall bladder capacity
approx 35 cc
Gall bladder divisions
fundus
body
neck
gall bladder fundus
most anterior inferior portion
gall bladder body contacts…
the visceral surface of the liver, transverse colon and superior duodenum
gall bladder neck
tapered, S-shaped curve, continuous with the cystic duct
Spiral fold (Valve of Heister)
Folds of mucosa within the gallbladder neck and proximal cystic duct form the spiral fold, which is important in maintaining patency of the cystic duct.
Gallbladder function
concentrate and dehydrate bile
Common hepatic duct
Right and left hepatic ducts join to form the common hepatic duct.
It exits the porta ventrally and to the right to course inferiorly within the hepatoduodenal ligament.
common bile duct
After a course of 4 cm the common hepatic duct is joined by the cystic duct from the gall bladder, their union forming the common bile duct.
Cystohepatic triangle (Calot)
the area between the common hepatic duct, cystic duct and visceral surface of the liver
Common bile duct: location
descends behind the first portion of the duodenum, running to the right of and parallel to the gastroduodenal artery. It passes posterior to the head of the pancreas, often being embedded within it.
Hepatopancreatic ampulla
the common bile duct joins the major pancreatic duct and pierces the posterior medial wall of the second part of the duodenum, forming the hepatopancreatic ampulla.
greater duodenal papilla
the hepatopancreatic ampulla opens into the lumen of the duodenum at the greater duodenal papilla.
choledochal sphincter
circular smooth muscle located at the distal end of the common bile duct.
Contraction prevents discharge of bile into the hepatopancreatic ampulla and forces bile in a retrograde fashion into the cystic duct and gall bladder for storage and concentration.
Hepatopancreatic sphincter (Oddi)
encircles the hepatopancreatic ampulla, controls discharge of bile and pancreatic digestive enzymes into the duodenum.
pancreatic duct sphincter
controls release of pancreatic enzymes from the main pancreatic duct into the hepatopancreatic ampulla
Cholelithiasis
gallstones. Can be located anywhere along the hepato-biliary tract and can compromise the flow of bile from the liver as well as compromise the outflow of bile and pancreatic enzymes due to blockage of the duodenal papillae at the hepatopancreatic ampulla. Blockage of the main pancreatic duct leads to back-up of bile resulting in pancreatitis.
cholecystitis
inflammation of the gallbladder (can be caused by gallstones eroding the gallbladder wall due to their abrasive action)
cholesystectomy
gallbladder removal
chole-cystoenteric fistula
sometimes gallstones erode the gallbladder wall to enter the duodenum and become lodged, usually at the ileocecal junction, causing intestinal blockage (ileus)
Celiac (Trunk) Artery
First unpaired branch of the abdominal aorta just after it emerges from the aortic hiatus of the diaphragm; located approx opposite TV12-LV1
Celiac artery supplies
the distal esophagus to the middle of the 2nd portion of the duodenum and upper half of the pancreas (beginning of mid-gut).
= artery of the foregut
Celiac artery travel
The trunk is short (1 cm); its three major branches traveling in a retroperitoneal plane to their respective destinations.
Note- Branches of all subdivisions of the celiac trunk course to their respective destinations either in a retroperitoneal position or within peritoneal ligaments.
Left gastric branch of the celiac artery
smallest major celiac branch; arises from the trunk at the 2 o’clock position
courses superiorly and to the left deep to the posterior body wall peritoneum
reaches the posterior cardiac portion of the stomach where it gives off an esophageal branch
Note- here the left gastric a. may also provide an aberrant hepatic branch (18%) to the left lobe of the liver.
Remainder of left gastric artery courses along the lesser curvature between layers of lesser omentum providing gastric branches to the anterior and posterior surfaces of the stomach.
Ends by anastomosing with the right gastric artery.
esophageal branch of left gastric branch of celiac artery
which supplies the distal portion of the esophagus through the esophageal hiatus of the diaphragm.
Common hepatic branch of celiac artery
Arises from the trunk at the 9 o’clock position.
courses in a retroperitoneal position along the superior border of the pancreas
reaching the superior border of the 1st portion of the duodenum, it divides into the gastroduodenal and proper hepatic aa.
Gastroduodenal a.
a division of the common hepatic artery.
Descends posterior to the 1st portion of the duodenum.
provides supra and retroduodenal branches to those respective regions of the upper duodenum
Provides the posterior superior pancreaticoduodenal a.
Divides at inferior border of the 1st portion of the dudoenum into right gastro-omental and anterior superior pancreaticoduodenal aa.
pancreaticoduodenal a.
branch of gastroduodenal a.
courses to the left following the curvature of the 3rd portion of the duodenum, providing pancreatic and duodenal branches; will anastomose with the posterior inferior pancreaticoduodenal a. (from sup. mesenteric a.)
Right gastro-omental a.
division of gastroduodenal a.
travels within the gastrocolic ligament along the inferior border of the greater curvature
provides gastric branches to the anterior and posterior surfaces of the stomach as well as epiploic branches to the greater omentum
anastomoses with the left gastroepiploic artery
Anterior superior pancreaticoduodenal a.
courses anterior to the head of the pancreas at the junction of the 3rd portion of the duodenum providing pancreatic and duodenal branches; will anastomose with the anterior inferior pancreatico-duodenala. (from sup. mesenteric a.)
Proper hepatic a.
Branches from the common hepatic passing superiorly to enter the hepatoduodenal ligament.
Ascends parallel to the common bile duct and anterior to the portal v. to provide the right gastric a. and terminates as the left and right hepatic aa.
Right gastric a.
Branches from the proximal portion of the proper hepatic artery.
Descends to course along the lesser curvature (from the pyloric end) between layers of lesser omentum providing gastric branches to the anterior and posterior surfaces of the stomach.
Anastomoses with the left gastric artery
Right hepatic artery
One of the terminal branches of the proper hepatic a. (NOTE: 14% of the time this artery originates from the superior mesenteric a.)
Courses to the right behind the common hepatic duct (64%) and anterior to the portal v. (91%) where it breaks up into smaller branches which enter the right side of the hilum of the liver.
Provides the cystic a. to the cystic duct as it passes between the common hepatic and cystic ducts (cystohepatic angle)
Left hepatic artery
one of the terminal branches of the proper hepatic a.
branches from the proper hepatic a. to enter the left side of the hilum of the liver.
May provide a middle hepatic a. (40% occurrence) to the middle segment of the liver
accessory or aberrant hepatic artery
present in 42% of individuals. An accessory arter is defined as an additional arterial supply from any origin that DOES NOT replace an existing artery. An aberrant artery is defined as an artery that originates from any source which REPLACES an artery of traditional distribution.
Splenic artery
largest branch of celiac trunk
arises from the left side of the celiac trunk inferior to the left gastric artery
follows a highly tortuous course posterior to the omental bursa partially embedded within the superior portion of the pancreas.
Passes within the lienorenal ligament over the superior pole of the left kidney
Before entering the hilum of the spleen divides into 4 or 5 branches which enter the spleen as end arteries.
Branches of the splenic artery include…
Pancreatic branches: Dorsal pancreatic, Greater pancreatic (pancreatica magna), arteries of the tail (caudal pancreatic branches)
Left gastro-omental
Short gastric aa.
dorsal pancreatic branch of splenic artery
variable in origin, but most often arises from the proximal inferior portion of the splenic artery; descends through the neck of the pancreas
NOTE: the dorsal pancreatic a. provides a branch at the level of the uncinate process that crosses the head of the pancreas to anastomose with the ant. inf. pan. duo. a., thereby forming the pre-pancreatic arcade.
Greater pancreatic a. branch of splenic artery
arises from the inferior surface of the splenic artery along its mid-course, descends into the substance of the pancreas where its branches parallel the main pancreatic duct.
Arteries of the tail (caudal pancreatic branches)
branches from the splenic artery to the tail of the pancreas
Inferior pancreatic artery
The dorsal, magna, and caudal pancreatic arteries anastomose within the inferior edge of the pancreas forming the inferior pancreatic artery.
Left gastro-omental a.
branches from the splenic artery inferiorly near its termination
reaches the stomach by traversing the gastrosplenic ligament
travels within the gastrocolic ligament inferiorward along the mid-portion of the greater curvature.
provides gastric branches to the anterior and posterior surfaces of the stomach as well as epiploic branches to the greater omentum
anastomoses with the right gastro-omental artery
Short gastric aa.
4 or 5 in number
branch from the terminal portion of the splenic a superiorly
travel within the gastrosplenic ligament to reach the superior portion of the greater curvature and fundus of the stomach
provides gastric branches to the anterio and posterior surfaces of the stomach
anastomose with the left gastro-omental and left gastric arteries
