Hepatobiliary System Flashcards
liver
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)
liver is suspended from the
IVC and diaphragm
liver and gallbladder are part of the
foregut
major duodenal papilla
opening for bile duct and main pancreatic duct into duodenum
liver, gall bladder, pancreas develop from outgrowth from ____________________
2nd pt of duodenum (explaining common duct system opening)
T/F, neuromuscular structures are found in peritoneal cavity
F. Instead must pass to organs encased between two peritoneal layers
Mesentery
double layer of peritoneum between body wall (usu posterior) and organ (“meso” prefix used)
Ligament
double layer of peritoneum between stomach and another organ
Omentum
double layer of peritoneum between stomach and another organ
Developing liver forms w/i a _____ mesentery
ventral mesentery…this forms the adult lesser omentum and falciform ligament
2 ligaments of lesser omentum
hepatogastric ligament (between liver and stomach)
hepatoduodenal ligament (linear to 1st pt of duodenum)
epiploic foramen of Winslow
opening into lesser sac
omental bursa
lesser sac
has only one opening (epiploic foramen of Winslow)
portal hepatis
doorway to the liver
portal triad
w/i hepatoduodenal ligament
portal vein
hepatic a.
common bile duct
pouch of morison
hepatorenal recess
space between liver an R kidney
blood pools here during abd bleed (lowest pt of abd in person laying down)
umbilical vein travels through _____ mesentery to get to heart
ventral mesentery
falciform ligament
derived from ventral mesentery between ventral wall and the liver
What structure is on lower free border of falciform ligament?
Ligamentum teres (aka round ligament of the liver)
obliterated umbilical vein
The fetal ___________ allowed maternal blood to bypass the fetal liver
ductus venosus
Obliterated ductus venosus
ligamentum venosum
caudate lobe
portion on the posterior surface between the IVC and the ligamentum venosum
lies anterior to the IVC
has a papillary process
umbilical fissure
ligamentum venosum
ligamentum teres hepatis (round ligament)
quadrate lobe
posterior surface of liver, between fossa for gall bladder and the ligamentum teres
hepatic portal vein carries blood that is
nutrient rich
oxygen poor
main arterial blood supply to liver is from…
R and L hepatic a. (arise from the hepatic a. proper which is ascending in the hepatoduodenal ligament
venous supply to liver
75% of inflow via hepatic portal vein
arterial supply to liver lipids as
lipoproteins (indirectly from GI via lymphatics)
L hepatic a. supplies
left lobe
quadrate
1/2 caudate
R hepatic a. supplies
right lobe
1/2 caudate
gall bladder
hepatic segments
(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)
causes of cirrhosis
alcohol abuse
hepatitis infection
AI disease
industrial solvents
cirrhosis presents as
hobnail appearance (nodules due to contraction of scar tissue and hepatic cellular regeneration)
splenomegaly (due to portal HTN)
ascites
which hepatic cells play critical role in generating cirrhotic scar tissue?
Ito/stellate cells
Reduced portal blood flow (portal HTN) can cause blood to be shunted to the systemic circulation via
esophageal v.
retroperitoneal v.
rectal v.
paraumbilical v.
(Portocaval (portosystemic) anastamoses)
esophageal varices
portal HTN –> chronic shunting through L. esophageal v. (anastomoses w/ azygos v.) –> twisted, dilated v. in esophagus
intestinal varices
portal HTN –> chronic shunting through retroperitoneal v. –> colonic varices (less common than esophageal)
caput medusa
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“
transjugular intrahepatic portosystemic shunt (TIPS)
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
common bile duct formed by union of ______ and ______, and is joined by ______ just as it enters the duodenum.
common bile duct formed by union of cystic duct and hepatic duct, and is joined by pancreatic duct just as it enters the duodenum.
hepatopancreatic ampulla
receives fluid from liver and pancreas
common bile duct and main pancreatic duct enter duodenum together and form
major duodenal papilla (Vater) w/ sphincter of Oddi (closes ampulla when bile is not to be released into the duodenum)
spiral valve function w/i galbladder
keeps cystic duct open (constitutively making bile)
complications of gallstones
cholecystitis
jaundice
pancreatitis
autonomic (sympathetic) input to hepatobiliary system
preganglionic fibers: greater splanchnic n. (T5-T9)
^ synapse in celiac ganglia
postganglionic fibers: accompany blood vessels
autonomic (parasympathetic) n. to hepatobiliary system
vagus n. has br. that extend to liver and gallbladder
- stimulate bile prod
- stimulate glycogen synthesis
What controls most function of the hepatobiliary system
HORMONES
- cholecystokinin (gallbladder contraction)
- secretin (inc bile flow)
First 2 big branches off abd aorta
coeliac trunk
superior mesenteric a.
technically first 2 branches (smaller) are R/L inferior phrenic a.
Usually portal vein is joined by
superior mesenteric v.
splenic v. (joined by inferior mesenteric v.)
