Liver

Question 1

What are the first 2 organs injured in stab epigastrium?

Answer 1

• Liver (left lobe)
• Stomach

Question 2

What demarcates the left and right lobes?

Answer 2

• Anatomical:
  
  • Falciform ligament (anteriorly)
  • Fissure for ligamentum teres and ligamentum venosum (posteroinferiorly)
• Surgical:
  
  • A line passing from IVC to the fossa of GB

Question 3

What is the venous drainage?

Answer 3

Hepatic veins to IVC

Question 4

What artery of the celiac trunk supplies both liver and stomach?

Answer 4

Hepatic artery (runs in the free border of lesser omentum to porta hepatis)

Question 5

What are the porta hepatis structures?

Answer 5

1. Right and left hepatic ducts
2. Hepatic artery
3. Portal vein

Question 5

What are the ligaments supporting the liver?

Answer 5

• Falciform ligament (to the diaphragm and AAW)
• Lesser omentum (to the stomach and 1st part of duodenum)
• Right and left triangular ligament (to the diaphragm)
• Upper and lower coronary ligament (to the diaphragm)

Question 6

What is the surface marking of the gallbladder?

Answer 6

The angle between the 9th costal cartilage and the lateral margin of the rectus sheath.

Question 7

Why is there shoulder pain in cholecystitis?

Answer 7

• An inflamed gallbladder may irritate the diaphragm causing irritation of the phrenic nerve.
• The phrenic nerve shares innervation with the C3 and C4 dermatomes, which refer pain to the shoulder.
• The pain is typically located on the right side of the shoulder (supplied by supraclavicular N (c3, c4).