Gut Book 3: Biliary Tree, Celiac Artery and its Branches

Question 1

Biliary apparatus consists of

Answer 1

gallbladder & biliary tree

Question 2

Gallbladder- contact with abdominal wall

Answer 2

Inferior most portion (fundus) contacts the anterior abdominal wall near the junction of the right semilunar line and the 9th costal cartilage

Question 3

Gall bladder location

Answer 3

in the gall bladder fossa of the right lobe immediately to the right of the quadrate lobe

Question 4

Gall bladder peritonealization

Answer 4

Usually covered with peritoneum on its posterior and inferior surface, however, it may be completely peritonealized and suspended by a mesentery

Question 5

Gall bladder contact with intestines

Answer 5

Contacts the transverse colon superiorly and the first and second portion of the duodenum posteriorly

Question 6

Gall bladder size & shape

Answer 6

pear shaped, 7-10 cm in length, 2.5 cm at its broadest point

Question 7

gall bladder capacity

Answer 7

approx 35 cc

Question 8

Gall bladder divisions

Answer 8

fundus
body
neck

Question 9

gall bladder fundus

Answer 9

most anterior inferior portion

Question 10

gall bladder body contacts…

Answer 10

the visceral surface of the liver, transverse colon and superior duodenum

Question 11

gall bladder neck

Answer 11

tapered, S-shaped curve, continuous with the cystic duct

Question 12

Spiral fold (Valve of Heister)

Answer 12

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.

Question 13

Gallbladder function

Answer 13

concentrate and dehydrate bile

Question 14

Common hepatic duct

Answer 14

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.

Question 15

common bile duct

Answer 15

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.

Question 16

Cystohepatic triangle (Calot)

Answer 16

the area between the common hepatic duct, cystic duct and visceral surface of the liver

Question 17

Common bile duct: location

Answer 17

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.

Question 18

Hepatopancreatic ampulla

Answer 18

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.

Question 19

greater duodenal papilla

Answer 19

the hepatopancreatic ampulla opens into the lumen of the duodenum at the greater duodenal papilla.

Question 20

choledochal sphincter

Answer 20

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.

Question 21

Hepatopancreatic sphincter (Oddi)

Answer 21

encircles the hepatopancreatic ampulla, controls discharge of bile and pancreatic digestive enzymes into the duodenum.

Question 22

pancreatic duct sphincter

Answer 22

controls release of pancreatic enzymes from the main pancreatic duct into the hepatopancreatic ampulla

Question 23

Cholelithiasis

Answer 23

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.

Question 24

cholecystitis

Answer 24

inflammation of the gallbladder (can be caused by gallstones eroding the gallbladder wall due to their abrasive action)

Question 25

cholesystectomy

Answer 25

gallbladder removal

Question 26

chole-cystoenteric fistula

Answer 26

sometimes gallstones erode the gallbladder wall to enter the duodenum and become lodged, usually at the ileocecal junction, causing intestinal blockage (ileus)

Question 27

Celiac (Trunk) Artery

Answer 27

First unpaired branch of the abdominal aorta just after it emerges from the aortic hiatus of the diaphragm; located approx opposite TV12-LV1

Question 28

Celiac artery supplies

Answer 28

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

Question 29

Celiac artery travel

Answer 29

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.

Question 30

Left gastric branch of the celiac artery

Answer 30

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.

Question 31

esophageal branch of left gastric branch of celiac artery

Answer 31

which supplies the distal portion of the esophagus through the esophageal hiatus of the diaphragm.

Question 32

Common hepatic branch of celiac artery

Answer 32

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.

Question 33

Gastroduodenal a.

Answer 33

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.

Question 34

pancreaticoduodenal a.

Answer 34

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.)

Question 35

Right gastro-omental a.

Answer 35

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

Question 36

Anterior superior pancreaticoduodenal a.

Answer 36

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.)

Question 37

Proper hepatic a.

Answer 37

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.

Question 38

Right gastric a.

Answer 38

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

Question 39

Right hepatic artery

Answer 39

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)

Question 40

Left hepatic artery

Answer 40

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

Question 41

accessory or aberrant hepatic artery

Answer 41

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.

Question 42

Splenic artery

Answer 42

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.

Question 43

Branches of the splenic artery include…

Answer 43

Pancreatic branches: Dorsal pancreatic, Greater pancreatic (pancreatica magna), arteries of the tail (caudal pancreatic branches)
Left gastro-omental
Short gastric aa.

Question 44

dorsal pancreatic branch of splenic artery

Answer 44

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.

Question 45

Greater pancreatic a. branch of splenic artery

Answer 45

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.

Question 46

Arteries of the tail (caudal pancreatic branches)

Answer 46

branches from the splenic artery to the tail of the pancreas

Question 47

Inferior pancreatic artery

Answer 47

The dorsal, magna, and caudal pancreatic arteries anastomose within the inferior edge of the pancreas forming the inferior pancreatic artery.

Question 48

Left gastro-omental a.

Answer 48

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

Question 49

Short gastric aa.

Answer 49

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