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LSS Anatomy of the Abdomen, Pelvis and Perineum > lecture 3 liver portal system > Flashcards

lecture 3 liver portal system Flashcards

1
Q

dorsal mesogastrium

A

pancreas develops; liver develops in ventral mesogastrium

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2
Q

revision slide of embryo at 5th week

A

slide 2; left lateral sagittal view: bare area means in direct contact with inferior surface of diaphragm (not enclosed in visceral peritoneum of liver)

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3
Q

transverse view of mesenteries in relation to stomach, liver, spleen from top

A

posterior peritoneum → splenorenal ligament → spleen → gastrosplenic ligament → stomach (lesser curvature) → lesser omentum (gastrohepatic and hepatoduodenal ligaments) → liver → falciform ligament → anterior peritoneum

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4
Q

where does liver develop

A

ventral foregut mesentery

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5
Q

what does the bare area of the liver have contact with

A

right dome of diaphragm - no visceral peritoneum

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6
Q

surface anatomy of liver

A

deep to ribs 7-11, mostly under cover of ribs, extends across right and left hypochrondrium and epigastrium; palpate on right hypochondriac region but can’t palpate normally as under costal margin (epigastrium under rectus abdominis)

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7
Q

what does the falciform ligament separate

A

2 anatomical lobes of liver

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8
Q

what protrudes out of falciform ligament anteriorly and what is it a remnant of

A

ligamentum teres, obliterated fibrous remnant of the left umbilical vein

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9
Q

what divides liver into 2 main lobes and 2 accessory lobes

A

peritoneal reflections

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10
Q

what ligament is present superiorly on left lobe

A

left triangular ligament

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11
Q

what ligament is present superiorly on right lobe

A

coronary ligament

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12
Q

4 lobes of liver

A

right, left, quadrate (anterior, right of fissure for ligamentum teres), caudate (posterior, right of fissure for ligamentum teres); both quadrate and caudate are accessory lobes on right side of liver

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13
Q

3 sections of gall bladder

A

fundus, body, neck

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14
Q

what divides functional (vascular) lobes of liver

A

imaginary line between inferior vena cava and gall bladder (left hepatic artery and right hepatic artery supply just 1 lobe separately)

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15
Q

quadrate and caudate

A

caudate gets blood supply from both arteries, quadrate only receives from left hepatic artery

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16
Q

lobule structure

A

portal triad (hepatic artery branch, portal vein branch, bile ducts), sinusoids, central veins to hepatic veins, 1/3rd = 1/2 acinus

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17
Q

liver segments - can remove one without damaging others

A

I-VIII, each with own blood, venous supply, inferior vena cava, left, intermediate and right hepatic veins, right and left branches of hepatic artery, portal triad, gallbladder

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18
Q

what mark separation of liver into functional right and left lobes

A

gall bladder, inferior vena cava

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19
Q

what marks out minor parts of functional left lobe

A

grooves for foetal veins (from ligamentum teres) into quadrate and caudate lobes

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20
Q

what separates quadrate and caudate lobes

A

porta of liver (carries several structures)

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21
Q

what does the porta carry

A

hepatic artery, portal vein, common bile duct, lymphatics

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22
Q

anatomical relations of liver

A

slide 14

23
Q

what covers liver

A

costal margin except in upper gastrium

24
Q

shape of diahphragmatic surface

A

convex

25
Q

what is complex visceral surface in contact with

A

stomach, duodenum, right kidney, colon

26
Q

visceral surface relations of liver

A

slide 16; at corners where peritoneum folds over, forms triangular ligament; coronary ligament anterior

27
Q

arterial blood supply of liver

A

left gastric artery, coeliac artery, splenic artery, common hepatic artery, cystic artery (right and left branches, gall bladder), anterior and posterior superior pancreaticoduodenal arteries

28
Q

what do superior pancreaticoduodenal arteries anastomose with

A

inferior pancreaticoduodenal arteries from superior mesenteric artery

29
Q

revision slide: portal venous system

A

portal vein formed from mesenteric arteries, splenic vein, inferior mesenteric vein (splenic flexure; left colon - descending, rectum), superior mesenteric vein (ascending colon, caecum, transverse colon); most oxygen from venous system (portal vein)

30
Q

where is hepatic artery derived from

A

coeliac axis

31
Q

how does venous blood from liver drain directly into inferior vena cava

A

via 3 short hepatic veins - difficult to see

32
Q

4 sites of portal-systemic anastomoses (systemic then portal)

A

oesophageal vein and left gastric veins; inferior rectal vein and superior rectal vein both important); epigastric vein and paraumbilical vein; retroperitoneal vein and visceral vein (less important)

33
Q

if portal pressure increases, blood diverted into systemic veins - if enlarge are liable to rupture

A

slide 20

34
Q

what may happen to portal-systemic anastomoses if portal flow through liver is obstucted in liver disease

A

dilate

35
Q

what anasomoses are haemorrhages common

A

oesophageal vein and left gastric veins; inferior rectal vein and superior rectal vein

36
Q

what do pancreatic duct and bile duct have and join to form

A

each have separate sphincters and join to form hepatopancreatic ampulla of Vater

37
Q

what guards the ampulla of Vater

A

sphincter of Oddi

38
Q

what can obstruct ducts at sphincter of Oddi

A

neoplasms of head of pancreas - blocks pancreatic and bile duct exits so bile accumulates - jaundice

39
Q

pancreas may have accessory duct

A

proximal to major papilla

40
Q

what do left and right hepatic ducts form

A

common hepatic duct

41
Q

what joins the common hepatic duct and what does this form

A

cystic duct from gall bladder, forming common bile duct

42
Q

what does the common bile duct pass behind and where does it enter and join

A

passes behind 1st part of duodenum and head of pancreas to enter 2nd part of duodenum at major papila, joining major pancreatic duct

43
Q

relations of gall bladder with first part of duodenum

A

between gall badder and duodenum is the site of cholecystoenteric fistula, where large gall stones may enter directly into duodenum

44
Q

fundus of gall bladder

A

palpate

45
Q

what is the largest lymphoid organ in the body

A

spleen (fist-sized) - not part of GI but in abdomen

46
Q

what suspends the spleen

A

gastro-splenic and lieno-renal ligaments in dorsal foregut mesentery

47
Q

where does the spleen lie

A

posteriorly on left side under ribs 9-11

48
Q

what does spleen have relations with

A

stomach, left kidney, left (splenic) flexure of colon, tail of pancreas

49
Q

what does traumatic rupture of spleen cause

A

severe haemorrhage (e.g. if ribs break) - can’t repair so removed

50
Q

surface anatomy of spleen

A

left hypochondrion, under ribs 9-11 (left lateral view)

51
Q

hilar surface of spleen

A

gastrosplenic ligament, superior gastric area of hilum, splenorenal ligament inferior renal area of hilum, anterior colic area

52
Q

what are both splenic ligaments

A

gastrosplenic, splenorenal

53
Q

what are both splenic ligaments part of

A

greater ommentum

54
Q

function of splenic ligaments

A

blood vessels to spleen enter through them

LSS Anatomy of the Abdomen, Pelvis and Perineum (10 decks)

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