Hepatobiliary Flashcards
Epiploic foramen boundaries
Anterior - CBD , Hepatic Artery , Portal vein
Posterior - IVC , Right adrenal gland
Superior - caudate lobe of liver
Inferior - 1st part of duodenum
Liver
Rt & Lt lobes are divided anatomically by
Anteriorly - Falciform ligament
Posteriorly - fissures of ligamentum venosum & ligamentum teres
H-shaped fossae
Lobes of Liver
- Rt lobe
- Lt lobe
- Caudate lobe
- Quadrate lobe
- Base area ( between superior & inferior coronary ligament )
- Porta hepatis
Lobes of Liver
Anatomically & Functionally
Anatomically
Rt Lobe ( Caudate + Quadrate ) > Lt Lobe
Functionally
Rt Lobe = Lt Lobe ( Caudate + Quadrate )
Ligaments in Liver
- Falciform ligament
- Ligamentum teres
- Coronary ligaments
- Right triangular ligament
- Left triangular ligament
- Ligamentum venosum
Lesser omentum
from - to ?
contains ?
- from ligamentum venosum & porta hepatis
- passes to lesser curve of stomach
- free edge of lesser omentum contains
DAVE - CBD , Hepatic Artery , Portal vein , Epiploic foramen
the area devoid of peritoneum in liver
Bare area
( in which IVC is embedded )
( between superior & inferior coronary ligaments )
Right triangular ligament is formed by
Fusion of Upper & Lower leaves of coronary ligament
Falciform ligament divides into
Left Triangular ligament & Coronary ligament
Liver nerve supply is from
Coeliac plexuses
What are Posteroinferior to Liver ?
Superior - Diaphragm
- abdominal oesophagus
- stomach
- doudenum
- hepatic flexure
- right kidney
- right suprarenal
Liver inferior surface - Superior to inferior
IVC
Caudate lobe
Porta hepatis
Quadrate lobe
Contents of Porta Hepatis
DAVE
- CBD
- Hepatic artery
- Portal vein
- Epiploic foramen
- Lymph node
Blood supply of Liver
- Portal vein
- Hepatic artery
Calot’s traingle borders
Superior - Inferior surface of liver
Inferior - Cystic duct
Medial - Common hepatic duct
Contents of Calots triangle
- Right hepatic artery
- Cystic artery
- Lymph node of lund
- Lymphatics
CBD is formed by ?
fusion of
- cystic duct from gallbladder &
- common hepatic duct from liver
Blood supply of Gall bladder
Cystic artery ( from right hepatic artery )
Gall bladder consists of
- Fundus
- Body
- Neck
( neck opens into cystic duct - which conveys bile to and from CBD )
Hemorrhage during cholecystectomy or liver trauma can be controlled by
Pringles’s manoeuvre
compressing the hepatic artery & portal vein in the free edge of lesser omentum
Pancreas is divide into
- Head
- Uncinate process
- Neck
- Body
- Tail
Pancreas’s
- peritoneum ?
- plane ?
- Retroperitoneal
- Transpyloric plane ( L1 )
Superior mesenteric vessels in relation to pancreas
- posterior to Head of pancreas
- anterior to uncinate process
Head of Pancreas is anterior to
IVC
Renal vessels
Superior mesenteric vessels
Which vessels ?
join at Where ?
- to form the portal vein
- SMV & Splenic vein
- joins behind neck of pancreas
To for the portal vein
Where does splenic artery run along ?
Superior border of pancreas
Where does splenic vein runs ?
Behind pancreas
Where does main pancreatic duct ( of Wirsung ) enters into digestive system ?
Medial aspect of 2nd part of duodenum
- at the ampulla of Vater
Blood supply of head & uncinate process of pancreas
- superior pancreaticoduodenal A ( gastroduodenal A )
- inferior pancreaticoduodenal A ( SMA )
Blood supply of pancreas
except head & uncinate process
From splenic artery
via arteria pancreatica magna
Origin of pancreas
embroyamal development
Ventral & Dorsal endodermal outgrowths of the duodenum
Posterior relations of pancreas
- Aorta
- SMV
- Portal vein
- CBD
- left crus of diaphragm
- left suprarenal
- left kidney
Rule of odds of Spleen
1 3 5 inches
7 ounces ( 150g ) 9 - 11 ribs ( site )
Gastrosplenic ligaments
- contents
- connects
Left Gastroepiploic artery
+
Short Gastric arteries
- connects spleen to greater curve of stomach
Lieonrenal ligament
- contents
- connects
Splenic Artery
+
Tail of pancreas
- connects spleen to posterior abdominal wall
Relations of the spleen
Anterior - stomach
Posterior - left lung
- left part of diaphragm ( seperate it from pleura )
- 9,10,11 ribs
Inferiorly - splenic flexure of colon
Medially - left kidney
- tail of pancreas
Blood supply of spleen
- Splenic artery
- Hilum contains splenic vessels
Spleen - red pulps & white pulps function
Red pulps - vessels
White pulps - immune
Where are accessory spleen found ?
Splenunculi
- near hilum
- tail of pancreas
- gonads
- omentum
- small bowel mesentery
- splenorenal ligament
Division of what will be necessary during a splenectomy
Short gastric vessels
splenic flexure may need to be mobilises but not divided
Most superficial structure at L1 right of rectus sheath
Fundus of GB
Identify a large vessel passing inferiorly over the anterior aspect of the pancreatic head
SMA
Blood supply of CBD
Hepatic artery
Blood supply of pancreatic head & tail
Head - Pancreaticoduodenal artery
Tail - branches of splenic artery
Granulomata arise from which type of cells
Macrophageso
Mobilisation of left lobe of liver will facilitate surgical access to ?
Abdominal oesophagus
