Hepatobiliary System

Question 1

liver

Answer 1

lgst gland (2.5% body weight)
processes all digested materials, venous blood from spleen and pancreas

exocrine gland –> secretes bile
endocrine gland –> serum albumin, lipoproteins, thyroid hormone (active form) etc.

occupies most fo RUQ (R hypochondrium) and into epigastrium

displaced several inches w/ excursions of diaphragm during respiration (6-12cm in midclavicular line)

Question 2

liver is suspended from the

Answer 2

IVC and diaphragm

Question 3

liver and gallbladder are part of the

Answer 3

foregut

Question 4

major duodenal papilla

Answer 4

opening for bile duct and main pancreatic duct into duodenum

Question 5

liver, gall bladder, pancreas develop from outgrowth from ____________________

Answer 5

2nd pt of duodenum (explaining common duct system opening)

Question 6

T/F, neuromuscular structures are found in peritoneal cavity

Answer 6

F. Instead must pass to organs encased between two peritoneal layers

Question 7

Mesentery

Answer 7

double layer of peritoneum between body wall (usu posterior) and organ (“meso” prefix used)

Question 8

Ligament

Answer 8

double layer of peritoneum between stomach and another organ

Question 9

Omentum

Answer 9

double layer of peritoneum between stomach and another organ

Question 10

Developing liver forms w/i a _____ mesentery

Answer 10

ventral mesentery…this forms the adult lesser omentum and falciform ligament

Question 11

2 ligaments of lesser omentum

Answer 11

hepatogastric ligament (between liver and stomach)

hepatoduodenal ligament (linear to 1st pt of duodenum)

Question 12

epiploic foramen of Winslow

Answer 12

opening into lesser sac

Question 13

omental bursa

Answer 13

lesser sac

has only one opening (epiploic foramen of Winslow)

Question 14

portal hepatis

Answer 14

doorway to the liver

Question 15

portal triad

Answer 15

w/i hepatoduodenal ligament

portal vein
hepatic a.
common bile duct

Question 16

pouch of morison

Answer 16

hepatorenal recess

space between liver an R kidney

blood pools here during abd bleed (lowest pt of abd in person laying down)

Question 17

umbilical vein travels through _____ mesentery to get to heart

Answer 17

ventral mesentery

Question 18

falciform ligament

Answer 18

derived from ventral mesentery between ventral wall and the liver

Question 19

What structure is on lower free border of falciform ligament?

Answer 19

Ligamentum teres (aka round ligament of the liver)

obliterated umbilical vein

Question 20

The fetal ___________ allowed maternal blood to bypass the fetal liver

Answer 20

ductus venosus

Question 21

Obliterated ductus venosus

Answer 21

ligamentum venosum

Question 22

caudate lobe

Answer 22

portion on the posterior surface between the IVC and the ligamentum venosum

lies anterior to the IVC

has a papillary process

Question 23

umbilical fissure

Answer 23

ligamentum venosum

ligamentum teres hepatis (round ligament)

Question 24

quadrate lobe

Answer 24

posterior surface of liver, between fossa for gall bladder and the ligamentum teres

Question 25

hepatic portal vein carries blood that is

Answer 25

nutrient rich | oxygen poor

Question 26

main arterial blood supply to liver is from...

Answer 26

R and L hepatic a. (arise from the hepatic a. proper which is ascending in the hepatoduodenal ligament

Question 27

venous supply to liver

Answer 27

75% of inflow via hepatic portal vein

Question 28

arterial supply to liver lipids as

Answer 28

lipoproteins (indirectly from GI via lymphatics)

Question 29

L hepatic a. supplies

Answer 29

left lobe quadrate 1/2 caudate

Question 30

R hepatic a. supplies

Answer 30

right lobe 1/2 caudate gall bladder

Question 31

hepatic segments

Answer 31

(8) hepatic v. run thru R/mid/L fissures and join IVC portal v/ and hepatic a. run horizontally --> transverse fissure (separates upper and lower segments)

Question 32

causes of cirrhosis

Answer 32

alcohol abuse hepatitis infection AI disease industrial solvents

Question 33

cirrhosis presents as

Answer 33

hobnail appearance (nodules due to contraction of scar tissue and hepatic cellular regeneration) splenomegaly (due to portal HTN) ascites

Question 34

which hepatic cells play critical role in generating cirrhotic scar tissue?

Answer 34

Ito/stellate cells

Question 35

Reduced portal blood flow (portal HTN) can cause blood to be shunted to the systemic circulation via

Answer 35

esophageal v. retroperitoneal v. rectal v. paraumbilical v. (Portocaval (portosystemic) anastamoses)

Question 36

esophageal varices

Answer 36

portal HTN --> chronic shunting through L. esophageal v. (anastomoses w/ azygos v.) --> twisted, dilated v. in esophagus

Question 37

intestinal varices

Answer 37

portal HTN --> chronic shunting through retroperitoneal v. --> colonic varices (less common than esophageal)

Question 38

caput medusa

Answer 38

paraumbilical veins located in the falciform ligament near the ligamentum teres (round ligament) communicate with the systemic para-umbilical veins on the superficial abdominal wall (thoraco-epicastric v. and lateral thoracic v.) engorgement of these v. --> “Caput Medusa“

Question 39

transjugular intrahepatic portosystemic shunt (TIPS)

Answer 39

to treat cirrhotic liver internal jugular v. --> SVC --> RV --> IVC --> central tendon of diaphragm --> turn anteriorly to enter hepatic v. gets blood from portal system back into systemic

Question 40

common bile duct formed by union of ______ and ______, and is joined by ______ just as it enters the duodenum.

Answer 40

common bile duct formed by union of cystic duct and hepatic duct, and is joined by pancreatic duct just as it enters the duodenum.

Question 41

hepatopancreatic ampulla

Answer 41

receives fluid from liver and pancreas

Question 42

common bile duct and main pancreatic duct enter duodenum together and form

Answer 42

major duodenal papilla (Vater) w/ sphincter of Oddi (closes ampulla when bile is not to be released into the duodenum)

Question 43

spiral valve function w/i galbladder

Answer 43

keeps cystic duct open (constitutively making bile)

Question 44

complications of gallstones

Answer 44

cholecystitis jaundice pancreatitis

Question 45

autonomic (sympathetic) input to hepatobiliary system

Answer 45

preganglionic fibers: greater splanchnic n. (T5-T9) ^ synapse in celiac ganglia postganglionic fibers: accompany blood vessels

Question 46

autonomic (parasympathetic) n. to hepatobiliary system

Answer 46

vagus n. has br. that extend to liver and gallbladder - stimulate bile prod - stimulate glycogen synthesis

Question 47

What controls most function of the hepatobiliary system

Answer 47

HORMONES - cholecystokinin (gallbladder contraction) - secretin (inc bile flow)

Question 48

First 2 big branches off abd aorta

Answer 48

coeliac trunk superior mesenteric a. technically first 2 branches (smaller) are R/L inferior phrenic a.

Question 49

Usually portal vein is joined by

Answer 49

superior mesenteric v. | splenic v. (joined by inferior mesenteric v.)