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Anatomy > Hepatopancreatic System > Flashcards

Hepatopancreatic System Flashcards

1
Q

Function of liver

A

Storage, metabolism and release of nutrients and some vitamins.

Detoxification and elimination of toxins, drugs and metabolites.

Synthesis of proteins: albumin, clotting factors.

Synthesis and secretion of bile, important for lipid digestion and absorption.

Role in immune function and clearance of intestinally absorbed bacteria.

Removal of red blood cells. Kupfer cells – specialised macrophages in liver.

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2
Q

Location of liver

A

Right hypochondrium and extends out to epigastrium

(Sometimes lobes of liver can be seen in left hypochondrium)

Inferior to diaphragm- moves with it in respiration

INTRAPERITONEAL

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3
Q

Blood from GI tract goes where?

A

Blood from digestive system first goes to liver to be processed then circulated around rest of body

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4
Q

Which ribs protect the liver?

A

Ribs 7-11

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5
Q

Which ribs protect the liver?

A

Ribs 7-11

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6
Q

Lobes of the liver

A

Left
Right
Cordate (tail)
Quadrate

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7
Q

Caudate vs Quadrate lobes

A

Caudate lobe is an independent lobe. (arises from right lobe)
Quadrate lobe to be considered part of left lobe (though it arises from right lobe)

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8
Q

Functional Anatomical Divisions / segments of liver

A

8 functional segments
Based on distribution of portal venous branches- each segment has own individual blood supply, so can remove one segment and will not affect rest of functioning units of liver (eg can remove cancerous part of liver)
Important for surgical resection surgery

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9
Q

Falciform ligament

A

Double fold of peritoneum connecting liver to anterior abdominal wall.

Divides left lobe into right lobe

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10
Q

Diaphragmatic surface vs Visceral surface of liver

A
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11
Q
A
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12
Q

Ligaments of the lung

A

Falciform ligament:
- Double fold of peritoneum connecting liver to anterior abdominal wall.

Fissure for ligamentum venosum:

  • Remnant of ductus venosus
  • Shuts umbilical blood directly into IVC

Round ligament / ligamentum teres:

  • Remnant of umbilical vein
  • Carries oxygenated blood from placenta
  • Small paraumbilical veins may remain in substance of ligament
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13
Q

How is bile transported to duodenum?

A

Via common bile duct- receives it from cystic duct or from liver via common hepatic duct (right and left hepatic duct come together to form common hepatic duct)

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14
Q

Round ligament of liver

A

Embryological remnant of umbilical vein

Continuous with ligament venosum

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15
Q
A

Umbilical vein goes to ductus venosus, inters IVC to right atrium of heart -> blood pumped through fossa ovale into left ventricle and up into aorta to main circulation

Ductus venosus becomes ligament venosum post birth

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16
Q

Bare area of liver

A

No peritoneum on top surface of liver.

Fenced by ant. and post. coronary which meet as the left and right triangular ligament.

Results from massive embryonic growth of liver within ventral mesogastrium.

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17
Q

Recesses of liver

A

Sites where peritoneal fluid or metastases can localise.

Recesses important for pooling of fluid and indication of pathological process

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18
Q

Peritoneal folds: lesser omentum

A

Double ford of peritoneum that connects the inferior surface of the liver to the lesser curvature of the stomach and first part of duodenum
Hepatogastric ligament
Hepatoduodenal ligament

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19
Q

What part of the liver is not covered in peritoneum?

A

Superior surface

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20
Q

Coronary ligaments of liver

A

Falciform ligament split into two going over superior surface of liver

Fuse with as triangular ligaments - fenced off area they create is the Bare area

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21
Q

From where does the common hepatic artery arise?

A

Coeliac trunk

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22
Q

Subphrenic space

A

Gap between diaphragm and liver

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23
Q

Hepatorenal pouch of Morrison

A

Gap between kidney and liver

If patient supine, this is where fluid is likely to accumulate

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24
Q

Subhepatic space

A

Gap under liver

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25
Q

What runs in the free edge of the lesser omentum?

A

Portal triad:

  1. Common bile duct
  2. Proper hepatic artery
  3. Hepatic portal vein
  4. Vagus nerve
  5. Lymphatics
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26
Q

What acts as the opening into the lesser sac (omental bursa)?

A

Lesser omentum

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27
Q

Boundaries of lesser sac

A

Superior: Caudate process of liver
Inferior: 1st part of duodenum
Posterior: Inferior vena cava and right crus of diaphragm
Anterior: Portal triad (in free edge of lesser omentum)

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28
Q

Pringle’s manoeuvre

A

Haemostat used to clamp hepatoduodenal ligament.

Stops blood flow through hepatic duodenal artery and portal vein

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29
Q

Blood supply of liver

A

Dual system

25% from Hepatic artery proper
75% from Hepatic portal vein (GI tract)

Then processed in sinusoids -> hepatic veins x3 -> IVC -> right atrium

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30
Q

Hepatic portal system

A
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31
Q

What vessels make up the hepatic portal vein?

A

Superior mesenteric vein - brings blood from midgut

Splenic vein - unites with superior mesenteric to form hepatic portal vein

Inferior mesenteric vein - brings blood from hindgut, usually enters into splenic vein (in 1/3 of people also enters in hepatic portal vein)

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32
Q

Portal hypertension

A

Obstruction in liver increases pressure in hepatic portal vein (eg. Cirrhosis).

–> May cause enlargement of spleen bc blood can’t flow back out of spleen due to HBP in liver

Collateral (alternative) pathways open up between portal and systemic venous systems = Portosystemic anastomoses.
Caput medusa of para-umbilical veins.

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33
Q

Portosystemic Anastomoses

A

Collateral circulation between systemic and portal circulation

Occurs in:
Oesophageal veins
Peri-umbilical region
Anal canal

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34
Q

Oesophageal vein portosystemic anastomoses

A

Portal via left gastric vein

Systemic via azygos veins

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35
Q

Anal canal portosystemic anastomoses

A

Portal via Inferior mesenteric vein

Systemic via inferior and middle rectal veins

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36
Q

Peri-umbilical region portosystemic anastomoses

A

Portal via paraumbilical veins

Systemic via epigastric veins

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37
Q
A
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38
Q

Sites of gallstone obstruction

A

Sites of obstruction:
Hepatopancreatic ampulla
Cystic duct
Hartmann’s pouch (infundibulum)

Jaundice occurs when bile cannot leave the gallbladder and enters the blood.

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39
Q

Referred gallbladder pain

A

Back of shoulder due to right phrenic nerves C3 C4 C5 corresponding to dermatomes of shoulder region

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40
Q

Where does the inferior mesenteric vein normally drain?

A

Splenic vein

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41
Q

Location of pancreas

A

Posterior to stomach.
Transpyloric plane passes through neck (L1).

Secondary retroperitoneal apart from tail (splenorenal ligament).

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42
Q

Function of pancreas

A

Exocrine:
Pancreatic juice: acinar cells.
Enters duodenum through main and accessory ducts.

Endocrine:
Produces Glucagon and insulin: Pancreatic islets of Langerhans.
Enters blood.

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43
Q

Ampulla of Vater

A

formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla.

The ampulla of Vater is an important landmark halfway along the second part of the duodenum that marks the anatomical transition from foregut to midgut, and hence the point where the celiac trunk stops supplying the gut and the superior mesenteric artery takes over.

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44
Q

What opens cystic duct to release bile?

A

Spiral valve (spiral folds)

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45
Q
A
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46
Q

Function of duodenum

A

Receives:
Chyme from pyloric part of stomach.

Bile from liver and gallbladder via common bile duct.

Enzymes from pancreas via main and accessory pancreatic duct.

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47
Q

Duodenum structure

A

First part of small intestine.

‘C’-shaped structure.

Widest lumen of small intestine.

First 2-3 cm: intraperitoneal (hepatoduodenal ligament).

Remaining portion is retroperitoneal.

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48
Q

First/superior part of duodenum

A

Referred to as ampulla or duodenal cap
Smooth wall
Common site of duodenal ulcers
Clinical consequence, as gastroduodenal artery runs posteriorly.

49
Q

What is the most common site for diverticula?

A

Second / Descending Part of duodenum

50
Q

Second/descending part of duodenum

A

Opening of:
Hepatopancreatic ampulla –> major duodenal papilla (of vater).
- Marks division of foregut and midgut
- Consequence for neurovasculature.

Opening of:
Accessory pancreatic duct –> minor duodenal papilla

51
Q

What part of the duodenum is intraperitoneal?

A

First part only

52
Q

What can haemorrhage if a duodenal ulcer rips through duodenal wall?

A

Gastroduodenal artery

53
Q

What artery crosses the third/horizontal/inferior part of the duodenum?

A

Superior mesenteric artery (and vein)

54
Q

Where does the ascending part of the duodenum join the jejunum?

A

Duodenojejunal flexure

55
Q

What holds the ascending part of the duodenum in place?

A

Ligament of Treitz

56
Q
A
57
Q

Lymphatics of duodenum

A

Follows arteries superiorly from superior pancreaticoduodenal to gastroduodenal to coeliac nodes.

Follows arteries inferiorly from inferior pancreaticoduodenal to superior mesenteric nodes.

58
Q

Whipple’s procedure

A

Pancreaticoduodenectomy

Cancer in head of pancreas
Remove:
Head of pancreas
Duodenum
Gallbladder 
Bile duct
59
Q

Annular pancreas

A

Congenital condition

Ventral pancreatic bud consists two components.

During development two parts migrate in different directions around the duodenum.

Constrict the duodenum and may result sin complete obstruction.

Causes reflux and vomiting

60
Q

Spleen structure

A

Lymphatic organ.
Protected by 9th – 11th ribs.
Left upper quadrant / left hypochondrium.

Intraperitoneal organ

Size of it depends on blood flow- can get bigger

61
Q

Spleen function

A

White cell proliferation.

Immune surveillance.

Filters and stores red blood cells and platelets.

Recycles iron and globin

62
Q

Where are the splenic artery and vein?

A

Hilum of spleen

Run in splenorenal ligament

63
Q

Splenomegaly

A

May be caused by portal hypertension

10Xs normal size!

May be palpable in right iliac fossa

Can treat with splenectomy.

64
Q

What structure is this

A

Quadrate lobe

65
Q

Identify this structure

A

Falciform Ligament

attaches to anterior abdominal wall

66
Q

Identify this structure

A

Ligamentum teres

was umbilical vein during embryo

67
Q

What structure is this

A

Caudate lobe

68
Q

What is this line

A

Round ligament

69
Q

What is this line

A

Fissure for ligamentum venosum

70
Q

What is the clinical relevance of the fissure for ligamentum venosum?

A

Embryological remnant of ductus venosus

71
Q

What is the entry point into liver?

A

Porta hepatis

72
Q

Identify the vessel

A

Common bile duct

73
Q

Identify the vessel

A

Hepatic portal vein

74
Q

Identify the vessel

A

Proper hepatic artery (brings blood from coeliac trunk)

75
Q

What nerves go into liver?

A

Vagus nerve branches

76
Q

Identify the vessel

A

Proper hepatic artery

77
Q

What 3 structures run in the lesser omentum?

A

Proper hepatic artery
Hepatic portal vein
Common bile duct

78
Q

Where does hepatic portal vein arise from?

A

Superior mesenteric vein and splenic vein form hepatic portal vein

(posterior to pancreas)

79
Q

Name the peritoneal reflection

A

Anterior coronary ligament

80
Q

Name the peritoneal reflection

A

Posterior coronary ligament

81
Q

What do the anterior and posterior coronary ligaments come together to form

A

Triangular ligament

82
Q

Identify the vessel

A

Inferior vena cava

83
Q

What is the space between the diaphragm and liver?

A

Subphrenic space

84
Q

Space between kidney and liver

A

Pouch of Morrison / hepatorenal pouch

85
Q

Why are peritoneal recesses clinically significant?

A

Peritoneal fluid can fill these areas

86
Q

Identify the structure

A

Hartman’s Pouch/infundibulum

87
Q

How is common bile duct formed?

A

Cystic duct of gallbladder unites with common hepatic duct (formed by L and R hepatic ducts)

88
Q

Where in pancreas does common bile duct enter?

A

Head of pancreas

89
Q

What duct does common bile duct fuse with in pancreas?

A

Main pancreatic duct

90
Q

What forms the hepatopancreatic ampulla?

A

Common bile duct

Main pancreatic duct

91
Q

Where does bile enter into duodenum?

A

Major duodenal papilla

92
Q

Endocrine function of pancreas

A

Insulin production

93
Q

Exocrine function

A

Digestive juices travel through duct to enter digestive system

94
Q

Which part of the pancreas is not retroperitoneal?

A

Tail- intraperitoneal

95
Q

What runs behind neck of pancreas?

A

Superior mesenteric vein and artery

96
Q

What vessel runs along body of pancreas?

A

Splenic vein

splenic artery from coeliac trunk on superior surface

97
Q

What leads directly into duodenum?

A

Pylorus of stomach

98
Q

What part of duodenum is not retroperitoneal?

A

Superior part- intraperitoneal

99
Q

What part of duodenum is this?

A

Duodenal cap/ampulla

100
Q

What vessel is this

A

Gastroduodenal artery (can rupture in ulcer)

101
Q

Identify the structure

A

Major duodenal papilla

opening of common bile duct and main pancreatic duct

102
Q

What marks the division between the foregut and midgut?

A

Major duodenal papilla

103
Q

What are the vessels running in the mesentery?

A

Superior mesenteric artery and vein

104
Q

At what point does the duodenum become the jejunum?

A

Duodenojejunal junction (ascending part of duodenum)

105
Q

What hold duodenaljejunal junction in place?

A

Ligament of treitiz

106
Q

What is the largest lymphatic organ and is intraperitoneal?

A

Spleen

107
Q

Spleen blood supply

A

Coeliac trunk and splenic artery

Splenic vein

108
Q

What is spleen closely related to?

A

Kidney

109
Q

What is this large area

A

Greater sac

110
Q

What is greater sac of peritoneal cavity divided into?

A

Supracolic compartment (above transverse colon)

Infracolic compartment (below transverse colon)

111
Q

What allows surgeons to go in behind stomach?

A

Lesser omentum through lesser sac/omental bursa

112
Q

What is this area

A

Epiploic foramen

113
Q

What attaches the transverse colon to the greater omentum?

A

Transverse mesocolon

114
Q

What runs down from duodenal jejunal junction to sacroiliac joint?

A

Root of mesentery

115
Q

What is this structure>

A

Round ligament (remnant of umbilical vein)

116
Q

What are these two points?

A

Paracolic gutters

117
Q

Rectovesical pouch

A

Between superior surface of bladder and rectum

118
Q

What is this space?

A

Vesico uterine pouch

119
Q

What is this space?

A

Recto uterine pouch of Douglas

Anatomy (13 decks)

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