Hepatobiliary System, Pancreas, Spleen

Question 1

Liver Functions

Answer 1

 Storage of glycogen
 Synthesis of blood plasma proteins (albumin, globulins, clotting factors)
 Synthesis of urea
 Modification of fats so cells can use them efficiently
 Manufacture of bile
 Recycling/elimination of break down products of RBC once eliminated in spleen; breakdown products are eliminated in bile and gives stool its characteristic dark color
 Detoxification of alcohol and drugs
 Storage of some vitamins and iron

Question 2

Liver relationships

Answer 2

 Superior: diaphragm
• BARE AREA OF LIVER – part that is not covered by diaphragm and is in direct contact with the diaphragm (superior/posterior portion)
• Visceral peritoneum reflects around margins of bare area and becomes parietal peritoneum (coronary ligaments)
 Inferior (from lateral/right to median/left)
• Right colic flexure and right transverse colon
• Gallbladder
• Lesser omentum
• Superior part of duodenum
• Right side of anterior aspect of the stomach
 Posterior
• Right kidney and right adrenal gland
• Inferior vena cava

Question 3

Hepatomegaly

Answer 3

More than 12 cm long at midclavicular line

Question 4

Liver Anatomy and Anatomical Divisions

Answer 4

 2 lobes (right and left) with falciform ligament in between
• Left lobe is single lobe
• Right lobe divided into 3 lobes: right, quadrate, caudate
o Quadrate lobe (anterior) (bound on left by fissure for ligamentum teres) and right by gallbladder; more superior
 Divided in middle by porta hepatis
o Caudate lobe (posterior) (bound on left by fissure of ligamentum venosum) and right by groove of IVC
 Round ligament of liver (ligamentum teres) - inferior portion of falciform ligament

Question 5

Functional Divisions of Liver

Answer 5

-determined by the position of the hepatic artery and when it divides into left and right hepatic arteries

Question 6

Liver Plumbing

Answer 6

– most important vessels enter and exit liver through Hepatic Triad formed by hepatoduodenal ligament (hepatic artery, portal vein, common bile duct)
 2 in (arterial and portal blood); 3 out (venous blood, bile, lymph)
 Right and Left hepatic artery (30% of blood)
• Abdominal aorta  celiac  hepatic artery proper  right/left hepatic artery
 Portal vein (70% of blood) – drains GI tract, pancreas, spleen, gallbladder
• Inferior mesenteric v.  splenic & superior mesenteric v.  portal vein
• NO VALVES; therefore pressure changes will cause retrograde flow
 Biliary System
• Right & left hepatic ducts  common hepatic duct that joins cystic duct (from gallbladder)  common bile duct (enters pancreas) joins pancreatic duct  empties into 2nd part of duodenum

Question 7

Portal System Anastomoses

Answer 7

– alternate routes for venous blood during portal hypertension
 Esophageal varices – left gastric vein & azygous vein/system
• 30% are fatal
 Internal hemorrhoids – superior rectal vein & and middle/inferior rectal veins
 Caput medusa – anterior abdominal wall around umbilicus (superficial veins and paraumbilical veins)
 Retroperitoneal – colic veins & posterior abdominal wall

Question 8

Liver Lymphatics

Answer 8

 From anterior diaphragmatic and visceral surface and from portal triad
• Superficial hepatic lymphatics join deep hepatic lymphatics  hepatic lymph nodes (in lesser omentum)  celiac lymph nodes  cistern chili
 From Posterior diaphragmatic and visceral service
• Superficial hepatic lymphatics drain towards the Bare Area  phrenic lymph nodes or join deep lymphatics posterior mediastinal lymph nodes  right lymphatic and thoracic ducts

Question 9

Gallbladder (function, suface anatomy, relationships)

Answer 9

o Function
 Stores up to 30-50ml and releases bile once chyme enters duodenum
o Lies on inferior surface of liver in fossa between right and quadrate lobe
o Surface Anatomy
 Fundus located at junction of right 9th costal cartilage at mid-clavicular line
o Relationships
 Superior – liver
 Inferior – transverse colon
 Posterior – duodenum

Question 10

Gall Stones

Answer 10

 Gallbladder stones cause problem if lodged in Ampulla of Vater because it will block pancreatic juices from exiting and increase risk for pancreatitis

Question 11

Pancreas Location and Function

Answer 11

o Accessory digestive gland that lies posterior to stomach; bound on left by spleen and right by duodenum
 Retroperitoneal organ at level of T12/L1/L2
o Function
 Produces exocrine (pancreatic juice) and endocrine secretions (glucagons & insulin)

Question 12

Pancreas Anatomy

Answer 12

 Head – duodenum curves around head
• Pancreatic duct runs entire length of pancreas (duct of Wirsung) and joins bile duct here then enters the 2nd part of duodenum in major papilla
• Accessory pancreatic duct (of Santorini); enters duodenum at the minor papilla
• Bile duct travels within posterior groove of head of pancreas
o Hepatopancreatic ampulla is narrowest part of biliary tract
 Uncinate process projects from lower part of head and extends posterior to superior mesenteric vessels
 Neck – posterior to 1st part of duodenum and anterior to superior mesenteric vessels
 Body – anterior to left kidney
 Tail – extends anteriorly to spleen
 Posterior – superior

Question 13

Pancreas Blood Supply

Answer 13

 Pancreatic arteries – branches of splenic artery
 Head supplied by anterior/posterior superior pancreaticoduodenal arteries (branches of gastroduodenal artery) and by anterior/posterior inferior pancreaticoduodenal arteries (branches of superior mesenteric artery)

Question 14

Panceatitis & Pancreatic Cancer

Answer 14

o Acute Pancreatitis – 10% fatal; most common causes – gall stones and alcoholism
o Pancreatic Cancer – obstructive jaundice is common complication (esp. in head of pancreas)

Question 15

Spleen Function

Answer 15

 Immunity (largest lymphoid organ in body)
 Fetal Hematopoiesis
 Destroys aged/worn-out RBC in adulthood
 Platelet storage

Question 16

Spleen Location and Relations

Answer 16

o	Size of fist and located in upper left abdomen; projects posterior to mid-axillary line at level of ribs 9-11; lies on posterior abdominal wall
o	Relations
	Anterior - stomach, tail of pancreas
	Posterior/medial – kidney
	Inferior -  splenic flexure of colon

Question 17

Spleen Blood Supply, Injuries, Splenomegaly

Answer 17

o Blood Supply – splenic artery (largest branch of celiac trunk)
o Penetrating (stabbing) or blunt trauma can cause splenic rupture; can cause penumothorax because pleural space runs down lateral side of spleen along inner costal surface
o Splenomegaly – must enlarge 3x normal size before it can be palpable; will feel the notches of the spleen