ILT Liver, Gallbladder, Pancreas

Question 1

What is the location of the liver?

Answer 1

Mainly in the RUQ deep to ribs 7-11 and crosses the midline toward the left nipple.

Question 2

What are the anatomical liver lobes?

Answer 2

Right and left lobes are separated by the falciform ligament. Quadrate and caudate are accessory lobes that are anatomically part of the RIGHT lobe.

Question 3

What are the Functional liver lobes?

Answer 3

Based on distribution of arteries and bile ducts. Caudate and quadrate lobes are functionally part of the LEFT lobe.

Question 4

What organs lie adjacent to the liver?

Answer 4

You can actually see impression from these organs on the visceral surface of the liver.
-Right side of the anterior aspect of the stomach (gastric and pyloric areas) -Superior part of duodenum -Lesser omentum -Gallbladder -Right colic flexure and right transverse colon -Right kidney and suprarenal gland

Question 5

What arteries directly supply the liver?

Answer 5

1. Hepatic portal vein (75-80 percent) - sustains liver parenchyma (hepatocytes)
2. Hepatic artery (20-25 percent) - distributed initially to nonparenchymal structures like the intrahepatic bile ducts

Question 6

What are the sources of inflowing blood to the liver?

Answer 6

1. Hepatic portal vein (SMA plus splenic veins) –> right and left portal veins –> segmental branches branching –> sinusoid capillaries
2. Hepatic artery (branch of celiac trunk) –> common hepatic artery –> proper hepatic artery –> divides into right and left hepatic arteries –> segmental branching –> sinusoid capillaries

Question 7

What are the sources of outflowing blood from the liver?

Answer 7

? from capillaries –> Central veins –> right/middle/left hepatic veins –> inferior vena cava

Question 8

What cells are responsible for the production of bile?

Answer 8

Hepatocytes in the liver

Question 9

What path does bile take as it exits the liver?

Answer 9

Fresh bile from the liver drains out via the right and left hepatic ducts –> join to become the common hepatic duct –> if sphincter of oddi is closed (between meals) it enters gallbladder via cystic duct

Question 10

What happens to bile when you eat?

Answer 10

Eat –> sphincter of Oddi relaxes (NO/VIP) –> cystic duct –> joins common hepatic duct to form common bile duct –> into duodenum

Question 11

Where is the Gallbladder located?

Answer 11

Lies in the fossa for the gallbladder on the visceral surface of the liver. Body of the gallbladder lies anterior to the superior part of the duodenum and the neck is superior to duodenum (sits on duodenum and turns it green)

Question 12

What are the four main parts of the gallbladder?

Answer 12

1. Fundus
2. Body
3. Neck
4. Cystic duct

Question 13

What is the fundus of the gallbladder?

Answer 13

Wide blunt end the projects below the inferior border of the liver at the tip of the right 9th costal cartilage.

Question 14

What is the body of the gallbladder?

Answer 14

Main portion that contacts the visceral surface of the liver, transverse colon, and superior part of the duodenum.

Question 15

What is the neck of the gallbladder?

Answer 15

Narrow end that connects to the cystic duct

Question 16

What is the cystic duct of the gallbladder?

Answer 16

Connects neck to common hepatic duct

Question 17

What relation does the (common) bile duct have to the pancreas?

Answer 17

Common bile duct lies in a groove on the posterosuperior surface of the head of the pancreas OR it is actually embedded in the tissue –> joins the pancreatic duct to empty into the duodenum through the hepatopancreatic ampulla

Question 18

Where does the bile duct enter the duodenum?

Answer 18

Hepatopancreatic ampulla - opens into the descending part of the duodenum at the summit of the major duodenal papilla.

Question 19

What sphincter is associated with bile ducts?

Answer 19

Sphincter of Oddi –> controls bile going into duodenum

Question 20

What is the blood supply to the gallbladder?

Answer 20

Cystic artery (branches from the right hepatic artery)

Question 21

Where is the pancreas located?

Answer 21

Elongated accessory digestive gland lying retroperitoneally over and across the bodies of the L1 and L2 vertebra on the posterior abdominal wall. Lies posterior to the stomach between the duodenum on the right and spleen on the left

Question 22

Where is the uncinate process of the pancreas?

Answer 22

Projects from the inferior part of the head, medially to the left posterior to the SMA.

Question 23

Where is the head of the pancreas?

Answer 23

Expanded part of the gland held in the C-shaped curve of the duodenum to the R of the superior mesenteric vessels. Posteriorly, the head lies on the IVC, R renal artery/vein and L renal vein. The bile duct lies in a groove on the posterosuperior surface of the head

Question 24

What is the most common site of cancer in the pancreas? What type of cancer is most common?

Answer 24

Head of pancreas. Adenocarcinoma of exocrine cells.

Question 25

Where is the neck of the pancreas?

Answer 25

Short, overlies the superior mesenteric vessels which form a groove in its posterior. The anterior surface of the neck is adjacent to the pylorus of the stomach. SMV joins the splenic vein posterior to the neck to form the hepatic portal vein.

Question 26

Where is the body of the pancreas?

Answer 26

Continues from the neck, lies to the L of the superior mesenteric vessels, passes over the aorta to the omental bursa.

Question 27

Where is the tail of the pancreas?

Answer 27

Lies anterior to the L kidney, close to the splenic hilum and L colic flexure.

Question 28

What parts of the pancreas are retroperitoneal?

Answer 28

All parts of the pancreas are retroperitoneal except the tail which lies in the splenorenal ligament at the hilus of the spleen.

Question 29

What is the arterial supply to the pancreas?

Answer 29

Arterial supply to the pancreas is mainly derived from branches of the splenic artery. Up to 10 pancreatic branches from the splenic artery feed the body and tail.

Question 30

What is the arterial supply to the head of the pancreas?

Answer 30

The head of the pancreas is mainly supplied by arcades from: 1.Gastroduodenal --> anterior and posterior superior pancreaticoduodenal arteries. 2. SMA --> anterior and posterior inferior pancreaticoduodenal arteries

Question 31

What is the venous drainage of the pancreas?

Answer 31

Pancreatic veins --> splenic and superior mesenteric veins --> hepatic portal vein

Question 32

How many people have a small accessory pancreatic duct? What is its significance?

Answer 32

25 percent of people have a small accessory pancreatic duct that drains the head of the pancreas. This opens at the minor duodenal papilla in the second part of the duodenum.

Question 33

How does the pancreas discharge its secretions?

Answer 33

Pancreatic duct empties thru the sphincter of the pancreatic duct. Opening the main pancreatic duct fuses with the common bile duct to form the hepatopancreatic ampulla (ampulla of Vater). Enters the 2nd part of the duodenum posteriorly via the major duodenal papilla.

Question 34

Where is pain referred to from the Liver?

Answer 34

Right Shoulder and Neck

Question 35

Where is pain referred to from the Gallbladder?

Answer 35

Right Shoulder and Neck

Question 36

Where is pain referred to from the Pancreas?

Answer 36

T5-T9 inferior epigastric region

Question 37

What innervates the liver?

Answer 37

Nerves of liver are derived from the hepatic plexus (derivative of celiac plexus) which consists of sympathetic fibers from celiac plexus and parasympathetic fibers from the anterior and posterior vagal trunks.

Question 38

What innervates the gallbladder?

Answer 38

1. Celiac nerve plexus -> sympathetic and visceral afferent (pain) fibers 2. Vagus nerve -> parasympathetic -> contracts gallbladder and relaxes sphincters at hepatopancreatic ampulla 3. Right phrenic nerve -> somatic afferent fibers

Question 39

What innervates the pancreas?

Answer 39

1. Vagus -> parasympathetic (secretomotor fibers) 2. Sympathetic -> Abdominopelvic splanchnic nerves (greater/lesser/least) that pass thru the diaphragm - follow the arteries of the celiac and superior mesenteric plexus