Lecture 27. Liver, gallbladder, pancreas, spleen. Portocaval anastomoses Flashcards
The liver is predominantly located in (1)____ and ___ and extends into (2)___ as well.
- theright hypochondrium and epigastricareas
2. the left hypochondrium
Border of Epiploic foramen (Winslow):
ant. : hepatoduodenal lig.
post. : hepatorenale lig.
inf. : duodenorenal lig.
sup. : liver (caudate lobe)
Identify
What are Subphrenic spaces?
between the anterior and superior aspects of the liver and the diaphragm; (right and left spaces divided by the falciform ligament)
What is Subhepatic space?
between the transverse colon and the inferior surface of the liver
Identify
Morison’s pouch– a potential space between the visceral surface of the liver and the right kidney
What is special about Morison’s pouch?
Morison’s pouch– a potential space between the visceral surface of the liver and the right kidney; the deepest part of the peritoneal cavity lying position
Hepatic recesses and position of the liver
-> the liver is an intraperitoneal organ (except: ___)
bare area
Identify liver lobes
Liver covered by a fibrous layer, known as___
Glisson’s capsule
two further liver ‘accessory‘ lobes
Caudate lobe
Quadrate lobe
which surface of liver is this?
Diaphragmatic surface
- anterosuperior surface of the liver
- smooth and convex, fitting snugly beneath the curvature of thediaphragm
the posterior aspect is not covered by visceral peritoneum: known as bare area (area nuda)
Which surface of liver is this?
Visceral surface: posteroinferior surface of the liver
(it is moulded by the shape of the surrounding organs, making it flat but irregular
relations: right adrenal gland, rightkidney, right colic flexure, transverse colon, superior part of the duodenum,gallbladder,esophagus and stomach)
Name the impressions and groove of liver
Visceral surface of liver
Sagittal section from the liver
-> Identify
The role of Lesser omentum
attaches the liver to the lesser curvature of the stomach and superior part of the duodenum;
3 ligaments you can find in lesser omentum
hepatoduodenal ligament (portal triad!)
hepatogastric ligament
The hepatoduodenal ligament surrounds the portal triad.
Innervation of the liver
The parenchyma of the liver is innervated by _____.
thehepatic plexus: it contains sympathetic (coeliac plexus) and parasympathetic (vagus nerve) nerve fibres
anterior aspect: lymphatic vessels drain into____; these lie along the hepatic vessels and ducts in the lesser omentum, and empty in the colic lymph nodes which in turn, drain into the cisterna chyli
posterior aspect: lymphatic vessels drain into___,which join the right lymphatic and thoracic ducts
hepatic lymph nodes
phrenicandposterior mediastinal nodes
Identify
Identify
Identify
Identify
Identify the white space and name the borders
CALOT’s trigone
-> Borders: liver; common hepatic duct; cystic duct
Innervation of the gallbladder
sympathetic and sensory innervation: ___
parasympathetic innervation: ___
coeliac plexus
vagus nerve
lymph drains into the___ which are situated close to the neck of the gallbladder
-> empties into __ and ___
cystic lymph nodes
the hepatic lymph nodes and the coeliac lymph nodes
Relations of pancreas
duodenum transverse mesocolon common bile duct stomach spleen
identify parts of pancreas
Identify
Arterial supply of pancreas
pancreatic branchesof thesplenic artery
Innervation of the pancreas
parasympathetic innervation: ___
sympathetic innervation: ___
vagus nerve
greater and lessersplanchnic nerves(T5-T12)
Lymphatic drainage of the pancreas
- the lymphatic vessels follow the arterial supply
- > empty into___ and __, which in turn drain into __ and ___
thepancreaticosplenal nodesand the pyloric nodes
the superior mesenteric and coeliac lymph nodes
Identify
Identify
Lesser omentum
Peritoneal relation of spleen
intraperitoneal organ
What are the 2 ligaments of spleen?
- gastrosplenic ligament
2. splenorenal ligament
Identify and describe (position) this ligament
gastrosplenic ligament
- anterior to the splenic hilum
The role of gastrosplenic ligament
connects the spleen to the greater curvature of the stomach
Identify and describe (position) this ligament
Sphenorenal ligament
- posterior to the splenic hilum
The role of Sphenorenal ligament
connects the hilum of the spleen to the left kidney
The splenic vessels and tail of the pancreas lie within ___
Splenorenal ligament
5 organs or structures in relation with spleen
(1) Stomach
(2) Diaphragm
(3) Left colic flexure
(4) Left kidney
(5) Tail of pancreas
Describe blood supply of spleen
Splenic artery and vein
innervation of spleen
coeliac plexus
What is portocaval anastomosis
venous anastomoses between the portal system and vena cava system
Clinical significance! – liver cirrhosis
What are the 4 portocaval anastomoses? (1 -> 4)
portocaval anastomoses
Identify and describe anastomosis 1
(1) Anastomosis of esophageal veins
- Portal vein - Left gastric vein
- Systemic vein - Esophageal branch of azygos vein
Identify and describe anastomosis 2
(2) Anastomosis of paraumbilical veins
- Portal vein - para umbilical vein
- Systemic vein - Superficial epigastric vein
Identify and describe anastomosis 3
(3) Anastomosis of colonic (retroperitoneal) veins
- Portal vein - Colic veins
- Systemic vein - veins of posterior abdominal wall (retroperitoneal veins)
Identify and describe anastomosis 4
(4) Anastomosis of rectal veins
- Portal vein - superior rectal vein
- Systemic vein - middle and inferior rectal vein
