hepatobiliary and foregut

Question 1

hiatal hernias:

-sliding hernias

Answer 1

• part of stomach herniates through diaphragm because the r. crus is weakened
• common in patients with GERD

*These are a relatively common type of hernia

Question 2

hiatal hernias:

-paraesophageal hernia

Answer 2

• normal LES and Z-line
• part of the stomach herniates through a weakening in the diaphragm
• Can be dangerous: herniated portion may become strangulated and necrotic

Question 3

4 common causes of liver cirrhosis

Answer 3

1. alcohol abuse
2. hepatitis infection
3. autoimmune disease
4. industrial solvents

Question 4

cirrhosis:

-presentation

Answer 4

• “hobnail” appearance
• splenomegaly*
• ascites*

*both these caused by portal hypertension

Question 5

Portal hypertension can reduce portal blood flow resulting in blood being shunted where in the systemic circulation? (4)

Answer 5

1. Esophageal veins
2. retroperitoneal veins
3. rectal vein
4. paraumbilical vein

Question 6

Increased blood flow can cause different pathologies in each location. what are they?

Answer 6

1. esophageal veins (esophageal varices
2. retroperitoneal veins (colonic varices)
3. rectal vein (hemorrhoids
4. paraumbilical vein (caput medusa)

Question 7

What does the dorsal bud of the pancreas develop into?

Answer 7

forms part of the head, the neck, the body and the tail

Question 8

What does the ventral bud of the pancreas develop into?

Answer 8

part of the head of the pancreas.

Question 9

Which pancreatic bud forms the accessory pancreatic duct?

Answer 9

-the dorsal bud

Question 10

Which pancreatic bud forms the main pancreatic duct?

Answer 10

-the ventral bud

Question 11

What is the role of the ductus venosus in fetal life?

Answer 11

-to shunt blood from the fetal liver to the IVC

Question 12

What does the ductus venosus scar over to become?

-where is this structure found?

Answer 12

• scars over to become the ligamentum venosum

- This is seen in a posterior view of the liver

Question 13

What role does the falciform ligament play during fetal life?

Answer 13

-the umbilical vein travels along the inferior aspect of the falciform ligament, between its two layers

Question 14

How does the umbilical vein travel to the liver in fetal life?

• what does the umbilical vein scar over to become
• where is all this stuff?

Answer 14

• umbilical vein travels along the inferior aspect of the falciform ligament.
• the umbilical vein scars over to become the round ligament of the liver (also called the ligamentum teres hepatis)
• All this stuff can be seen in an anterior view of the liver

(the falciform ligament divides the anatomic right and left lobes of the liver anteriorly)

Question 15

Which lobe of the liver also contains the caudate and quadrate lobes?

Answer 15

-the right lobe of the liver

Question 16

What artery supplies the right lobe of the liver?

Answer 16

-the right hepatic artery

Question 17

Which artery supplies the left lobe of the liver

Answer 17

-the left hepatic artery

Question 18

Which artery supplies the quadrate lobe of the liver?

Answer 18

-the left hepatic artery

Question 19

Which artery supplies the caudate lobe of the liver?

Answer 19

• half of the caudate lobe is supplied by the right hepatic artery and half is supplied by the left hepatic artery
• caudate means tail and its blood supply is divided in half like the tail of a fish

Question 20

Which artery supplies the gallbladder?

Answer 20

-the right hepatic artery.

Question 21

What is the papillary process of the liver?

Answer 21

-part of the caudate lobe

Question 22

Where are the caudate and quadrate lobes?

Answer 22

• anatomically, they are both part of the right lobe of the liver
• the caudate is near the IVC in the inferior portion of the liver (remember caudate means tail so it makes sense that it is located in the posterior portion of the liver
• the quadrate is located near the gallbladder in the middle anterior portion of the liver