L11 - Gastrointestinal System IV - Liver, Pancreas, and Spleen Flashcards
Feb 13, 2019
In what two surface regions does the liver occupy on the abdomen?
1) right hypochondrium
2) epigastric region
What are some wounds that might cause liver trauma?
1) blunt abdominal trauma
2) fractured ribs
3) penetrating wounds of the thorax
What is the most frequent cause of portal HTN?
cirrhosis
Where is the needle placed for a percutaneous liver biopsy?
Between 9th and 10th R intercostal, mid axillary line
What are the two surfaces of the liver?
1) diaphragmatic
2) visceral
What two organs is the subphrenic space located between?
diaphragm and liver
Which lobe is larger? Right or left?
Right lobe is bigger.
Which two areas of the liver are not covered by peritoneum?
1) bare area
2) gallbladder fossa
The falciform ligament separates what from what?
The left from the right lobe of the liver
Where do the structures/vessels enter the liver?
Porta hepatis
The caudate and quadrate lobes belong to which lobe:
1) functionally?
2) anatomically?
Functionally caudate and quadrate lobes are part of the LEFT lobe. Anatomically they are part of the right lobe
Where is the IVC positioned with respect to the liver?
Superior and posterior
What do liver segments represent? How many are in the liver?
Each segment has their own arterial, venous, and biliary supply. Liver has 8 segments
What does the falciform ligament morph into? What embryological structure does this come from?
Ligament teres. Comes from obliterated umbilical vein
The ligamentum venosum is a remnant of what?
Ductus venosus
What are the four ligaments to the diaphragm from the liver?
Right and left triangular
Superior and inferior coronary
Where the coronary ligaments unite is called what?
Triangular ligaments
In terms of the mesentery, where is the location of the hepatoduodenal ligament?
right free margin of the lesser omentum
What two parts make up the lesser omentum?
Hepatogastric and hepatoduodenal
What is the Pringle maneuver?
Clamping the hepatoduodenal ligament to prevent bleeding from the proper hepatic artery
What percentage of bloody supply do the hepatic artery and portal vein contribute?
70% portal vein, 30% hepatic artery
Where does the liver’s lymph flow to?
Celiac nodes
The fundus of the gallbladder projects beyond the inferior margin of the liver. Where is this in terms of surface anatomy?
Right 9th costal cartilage mid-clavicular line
Where does bile enter in the duodenum?
2nd part
The right and left hepatic ducts merge and form the what? Which duct drains into this duct afterward?
1) form common hepatic duct
2) cystic duct then drains into this
The bile duct passes ______ to the _____ part of the duodenum.
1) inferiorly
2) first
What is the sphincter that controls gallbladder secretion? What type of control is it under? Approximately how long after a meal are there signals for gallbladder contraction?
1) Sphincter of Oddi
2) under autonomic and hormonal control
3) thirty minutes
How does the biliary system empty into the duodenum?
Through the major duodenal papilla
What are the four risk factors for gallstones?
1) fat
2) fertile
3) female
4) ~40 yrs old
Where is referred pain from gallstones felt?
Right shoulder
Why can a biliary obstruction cause pancreatitis?
Autolytic enzymes will start to digest the pancreas
What is ERCP?
ERCP is the injection of dye into the biliary tree through an endoscope passed through the stomach and duodenum. XR fluoroscopy is used to visualize structures
What is the triangle of Calot? What does it contain?
The triangle made by the liver and cystic and common hepatic ducts. It contains the cystic artery
The mnemonic 1,3,5,7,9,11 is used to remember the spleen. What does this stand for?
Spleen is 1” by 3” by 5”. It weighs 7 oz. and spans the 9th to the 11th ribs.
Where is the spleen found?
left hypochondrium
What organ is associated with the hilum of the spleen?
Tail of the pancreas
What is the most frequently injured organ in the abdomen?
The spleen
What are the two major vessels that make up the portal vein?
Splenic vein and superior mesenteric vein
What forms the esophageal porto-caval anastomosis?
Esophageal tributaries of the left gastrict vein (portal system) and esophageal tributaries of azygos and hemiazygos veins (caval system)
What forms the rectal porto-caval anastomosis?
Superior rectal vein (drains into IMA of portal system) and inferior and middle rectal veins (drain into the internal iliacs
What forms the caput medsae?
Para-umbilical veins of the portal system and the superior and inferior epigastric veins (specifically the superior)
How does cirrhosis cause hepatic encephalopathy?
Cirrhosis causes portal HTN which causes ammonia to wash into the systemic circulation and will affect the brain
What vessels constitute the anastomosis around the head of the pancreas?
Superior and inferior pancreaticoduodenal arteries (anterior and posterior branches)
What type of organ is the pancreas?
retroperitoneal
Why is pancreatic cancer so dangerous?
1) access to IVC, portal system, spleen, bile duct, and lymph; all are very close to pancreas and leads to cancer metastasis
2) retroperitoneal organ so symptoms are not always readily apparent
3) pancreatic tissue is very friable making surgical excision hard
