Hepato-biliary Anatomy and Hepatic Portal System

Question 1

Where are the borders of the liver (surface anatomy)?

Answer 1

• Right mid-clavicular 5th intercostal space
• Left mid-clavicular 5th intercostal space
• Right mid-clavicular 10th rib

Question 2

What are the two surfaces and recesses of the liver

Answer 2

1) Visceral above the Hepatorenal

2) Diaphragmatic below the Subphrenic recess

Question 3

What are the ligaments which run in-between and above the liver?

Answer 3

in-between = falciform ligament
Above = coronary ligament which joins to right and left triangular ligaments (which attach to diaphragm)

Question 4

What are structures which enter through the Porta Hepatis

Answer 4

Hepatic Portal Vein (larger than hepatic artery)
Hepatic Artery Proper
Bile Duct

Question 5

What are the lobes of the liver?

Answer 5

Right lobe
Left lobe
Quadrate lobe (right of gallbladder)
Caudate Lobe (right of IVC)
\+ Bare area, no peritoneum (Left of IVC)

Question 6

What is the function of the Hepatic Portal Vein?

Answer 6

Carries nutrient rich blood to the liver from GI

Question 7

What is the drainage channel of the gallbladder called

Answer 7

Cystic Duct

Question 8

What are the three regions of the gallbladder?

Answer 8

Neck (attaches to cystic duct)
Body
Fundus (bottom)

Question 9

Where is the fundus of the gallbladder located (SA)?

Answer 9

tip of 9th Costal cartilage

Question 10

Where does the biliary tree drain into?

Answer 10

2nd part of duodenum
minor pancreatic duct into minor duodenal papillae
hepatopancreatic duct into major duodenal papillae

Question 11

Describe the structures in the Biliary tree?

Answer 11

• Within liver find Right and left hepatic arteries
• which joint form common hepatic duct
• which on addition of cystic duct becomes the bile duct
• bile duct is joined by pancreatic duct to from heptopancreatic ampulla which is surrounded by sphincter of Oddi
• HP ampulla enters the second part of duodenum as does the minor pancreatic duct

Question 12

Which two vessels join to form the Hepatic Portal vein?

Answer 12

Splenic vein and superior mesenteric vein join posterior to the neck of pancreas

Question 13

What are Porto-systemic Anastomoses and why do they exist?

Answer 13

• channels which connect portal system and systemic venous system
• In Patients with portal hypertension where hepatic arteries will not be able to return all of the blood that is coming in through the portal vein will help blood return to systemic venous system

Question 14

What are the three porto-systemic anastomosis?

Answer 14

1) gastro-oesophageal junction = Left gastric vein joins tributaries of azygous vein
2) Anterior-abdominal wall = para-umbilical veins join anterior abdominal wall veins
3) Ano-rectal junction = superior rectal vein joins inferior and middle rectal veins

Question 15

What are varies and where will they appear in patients with portal hypertension?

Answer 15

Enlarged veins which form at sites of anastomoses

1) Oesophageal varices (gastro-oesophageal)
2) Caput Medusae (anterior abdominal wall)
3) just called varices (ano-rectal)