lecture 3 liver portal system

Question 1

dorsal mesogastrium

Answer 1

pancreas develops; liver develops in ventral mesogastrium

Question 2

revision slide of embryo at 5th week

Answer 2

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

Question 3

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

Answer 3

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

Question 4

where does liver develop

Answer 4

ventral foregut mesentery

Question 5

what does the bare area of the liver have contact with

Answer 5

right dome of diaphragm - no visceral peritoneum

Question 6

surface anatomy of liver

Answer 6

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)

Question 7

what does the falciform ligament separate

Answer 7

2 anatomical lobes of liver

Question 8

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

Answer 8

ligamentum teres, obliterated fibrous remnant of the left umbilical vein

Question 9

what divides liver into 2 main lobes and 2 accessory lobes

Answer 9

peritoneal reflections

Question 10

what ligament is present superiorly on left lobe

Answer 10

left triangular ligament

Question 11

what ligament is present superiorly on right lobe

Answer 11

coronary ligament

Question 12

4 lobes of liver

Answer 12

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

Question 13

3 sections of gall bladder

Answer 13

fundus, body, neck

Question 14

what divides functional (vascular) lobes of liver

Answer 14

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

Question 15

quadrate and caudate

Answer 15

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

Question 16

lobule structure

Answer 16

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

Question 17

liver segments - can remove one without damaging others

Answer 17

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

Question 18

what mark separation of liver into functional right and left lobes

Answer 18

gall bladder, inferior vena cava

Question 19

what marks out minor parts of functional left lobe

Answer 19

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

Question 20

what separates quadrate and caudate lobes

Answer 20

porta of liver (carries several structures)

Question 21

what does the porta carry

Answer 21

hepatic artery, portal vein, common bile duct, lymphatics

Question 22

anatomical relations of liver

Answer 22

slide 14

Question 23

what covers liver

Answer 23

costal margin except in upper gastrium

Question 24

shape of diahphragmatic surface

Answer 24

convex

Question 25

what is complex visceral surface in contact with

Answer 25

stomach, duodenum, right kidney, colon

Question 26

visceral surface relations of liver

Answer 26

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

Question 27

arterial blood supply of liver

Answer 27

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

Question 28

what do superior pancreaticoduodenal arteries anastomose with

Answer 28

inferior pancreaticoduodenal arteries from superior mesenteric artery

Question 29

revision slide: portal venous system

Answer 29

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)

Question 30

where is hepatic artery derived from

Answer 30

coeliac axis

Question 31

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

Answer 31

via 3 short hepatic veins - difficult to see

Question 32

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

Answer 32

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)

Question 33

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

Answer 33

slide 20

Question 34

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

Answer 34

dilate

Question 35

what anasomoses are haemorrhages common

Answer 35

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

Question 36

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

Answer 36

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

Question 37

what guards the ampulla of Vater

Answer 37

sphincter of Oddi

Question 38

what can obstruct ducts at sphincter of Oddi

Answer 38

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

Question 39

pancreas may have accessory duct

Answer 39

proximal to major papilla

Question 40

what do left and right hepatic ducts form

Answer 40

common hepatic duct

Question 41

what joins the common hepatic duct and what does this form

Answer 41

cystic duct from gall bladder, forming common bile duct

Question 42

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

Answer 42

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

Question 43

relations of gall bladder with first part of duodenum

Answer 43

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

Question 44

fundus of gall bladder

Answer 44

palpate

Question 45

what is the largest lymphoid organ in the body

Answer 45

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

Question 46

what suspends the spleen

Answer 46

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

Question 47

where does the spleen lie

Answer 47

posteriorly on left side under ribs 9-11

Question 48

what does spleen have relations with

Answer 48

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

Question 49

what does traumatic rupture of spleen cause

Answer 49

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

Question 50

surface anatomy of spleen

Answer 50

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

Question 51

hilar surface of spleen

Answer 51

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

Question 52

what are both splenic ligaments

Answer 52

gastrosplenic, splenorenal

Question 53

what are both splenic ligaments part of

Answer 53

greater ommentum

Question 54

function of splenic ligaments

Answer 54

blood vessels to spleen enter through them