L11 - Gastrointestinal System IV - Liver, Pancreas, and Spleen

Question 1

In what two surface regions does the liver occupy on the abdomen?

Answer 1

1) right hypochondrium

2) epigastric region

Question 2

What are some wounds that might cause liver trauma?

Answer 2

1) blunt abdominal trauma
2) fractured ribs
3) penetrating wounds of the thorax

Question 3

What is the most frequent cause of portal HTN?

Answer 3

cirrhosis

Question 4

Where is the needle placed for a percutaneous liver biopsy?

Answer 4

Between 9th and 10th R intercostal, mid axillary line

Question 5

What are the two surfaces of the liver?

Answer 5

1) diaphragmatic

2) visceral

Question 6

What two organs is the subphrenic space located between?

Answer 6

diaphragm and liver

Question 7

Which lobe is larger? Right or left?

Answer 7

Right lobe is bigger.

Question 8

Which two areas of the liver are not covered by peritoneum?

Answer 8

1) bare area

2) gallbladder fossa

Question 9

The falciform ligament separates what from what?

Answer 9

The left from the right lobe of the liver

Question 10

Where do the structures/vessels enter the liver?

Answer 10

Porta hepatis

Question 11

The caudate and quadrate lobes belong to which lobe:

1) functionally?
2) anatomically?

Answer 11

Functionally caudate and quadrate lobes are part of the LEFT lobe. Anatomically they are part of the right lobe

Question 12

Where is the IVC positioned with respect to the liver?

Answer 12

Superior and posterior

Question 13

What do liver segments represent? How many are in the liver?

Answer 13

Each segment has their own arterial, venous, and biliary supply. Liver has 8 segments

Question 14

What does the falciform ligament morph into? What embryological structure does this come from?

Answer 14

Ligament teres. Comes from obliterated umbilical vein

Question 15

The ligamentum venosum is a remnant of what?

Answer 15

Ductus venosus

Question 16

What are the four ligaments to the diaphragm from the liver?

Answer 16

Right and left triangular

Superior and inferior coronary

Question 17

Where the coronary ligaments unite is called what?

Answer 17

Triangular ligaments

Question 18

In terms of the mesentery, where is the location of the hepatoduodenal ligament?

Answer 18

right free margin of the lesser omentum

Question 19

What two parts make up the lesser omentum?

Answer 19

Hepatogastric and hepatoduodenal

Question 20

What is the Pringle maneuver?

Answer 20

Clamping the hepatoduodenal ligament to prevent bleeding from the proper hepatic artery

Question 21

What percentage of bloody supply do the hepatic artery and portal vein contribute?

Answer 21

70% portal vein, 30% hepatic artery

Question 22

Where does the liver’s lymph flow to?

Answer 22

Celiac nodes

Question 23

The fundus of the gallbladder projects beyond the inferior margin of the liver. Where is this in terms of surface anatomy?

Answer 23

Right 9th costal cartilage mid-clavicular line

Question 24

Where does bile enter in the duodenum?

Answer 24

2nd part

Question 25

The right and left hepatic ducts merge and form the what? Which duct drains into this duct afterward?

Answer 25

1) form common hepatic duct | 2) cystic duct then drains into this

Question 26

The bile duct passes ______ to the _____ part of the duodenum.

Answer 26

1) inferiorly | 2) first

Question 27

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?

Answer 27

1) Sphincter of Oddi 2) under autonomic and hormonal control 3) thirty minutes

Question 28

How does the biliary system empty into the duodenum?

Answer 28

Through the major duodenal papilla

Question 29

What are the four risk factors for gallstones?

Answer 29

1) fat 2) fertile 3) female 4) ~40 yrs old

Question 30

Where is referred pain from gallstones felt?

Answer 30

Right shoulder

Question 31

Why can a biliary obstruction cause pancreatitis?

Answer 31

Autolytic enzymes will start to digest the pancreas

Question 32

What is ERCP?

Answer 32

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

Question 33

What is the triangle of Calot? What does it contain?

Answer 33

The triangle made by the liver and cystic and common hepatic ducts. It contains the cystic artery

Question 34

The mnemonic 1,3,5,7,9,11 is used to remember the spleen. What does this stand for?

Answer 34

Spleen is 1" by 3" by 5". It weighs 7 oz. and spans the 9th to the 11th ribs.

Question 35

Where is the spleen found?

Answer 35

left hypochondrium

Question 36

What organ is associated with the hilum of the spleen?

Answer 36

Tail of the pancreas

Question 37

What is the most frequently injured organ in the abdomen?

Answer 37

The spleen

Question 38

What are the two major vessels that make up the portal vein?

Answer 38

Splenic vein and superior mesenteric vein

Question 39

What forms the esophageal porto-caval anastomosis?

Answer 39

Esophageal tributaries of the left gastrict vein (portal system) and esophageal tributaries of azygos and hemiazygos veins (caval system)

Question 40

What forms the rectal porto-caval anastomosis?

Answer 40

Superior rectal vein (drains into IMA of portal system) and inferior and middle rectal veins (drain into the internal iliacs

Question 41

What forms the caput medsae?

Answer 41

Para-umbilical veins of the portal system and the superior and inferior epigastric veins (specifically the superior)

Question 42

How does cirrhosis cause hepatic encephalopathy?

Answer 42

Cirrhosis causes portal HTN which causes ammonia to wash into the systemic circulation and will affect the brain

Question 43

What vessels constitute the anastomosis around the head of the pancreas?

Answer 43

Superior and inferior pancreaticoduodenal arteries (anterior and posterior branches)

Question 44

What type of organ is the pancreas?

Answer 44

retroperitoneal

Question 45

Why is pancreatic cancer so dangerous?

Answer 45

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