Liver anatomy

Question 1

What is contained in a portal triad? Describe flow throughout liver

Answer 1

in portal triad, there is the bile duct, a branch of the portal vein, and a branch of the hepatic artery. bile flows toward the bile ducts. blood from the portal vein (from the intestine) flows towards the central vein (which will flow back to the heart).
oxygen diffuses from the hepatic artery.

Question 2

zone I in liver

Answer 2

periportal zone. first affected by viral hepatitis and by toxins like cocaine

Question 3

zone III in liver

Answer 3

nearest the central vein. affected first by ischemia. contains cytochrome P-450 system. most sensitive to metabolic toxin and the site of alcoholic hepatitis.

Question 4

describe the biliary flow, including names

Answer 4

from the liver, the left and right hepatic ducts join to form the common hepatic duct. the common HEPATIC duct joins the cystic duct (from the gall bladder) to form the common BILE duct. eventually, the common bile duct and the main pancreatic duct both dump into the duodenum through the ampulla of vater (sphincter of oddi is around the ampulla of vater)

Question 5

What kinds of pathologies could obstruct bile secretion?

Answer 5

gallstones. if they reach the common area at the ampulla of vater, gallstones block both bile and pancreatic ducts.
tumors in the head of the pancreas can cause obstruction of the common bile duct

Question 6

What is the organization of the femoral region

Answer 6

lateral to medial: nerve, artery, vein, (empty) lymphatics.

go lateral to medial to find your NAVEL

Question 7

What is contained in the femoral triangle?

Answer 7

lateral to medial: nerve, artery vein. (“venous near the penis”)

Question 8

What is the femoral sheath?

Answer 8

tube of fascia below the inguinal ligament

contains the femoral vein, artery, and canal (where the deep inguinal lymph nodes are), but NOT the nerve

Question 9

What are the layers of the spermatic cord? origin of each layer? what are the contents?

Answer 9

external spermatic fascia from the external oblique; cremasteric muscle and fascia from the internal oblique; internal spermatic fascia from the transversus abdominus fascia (it basically picks up another external layer as it moves through the abdomen).

Question 10

what is the most common diaphragmatic hernia?

Answer 10

hiatal hernia: stomach herniates through the esophageal hiatus of the diaphragm

Question 11

sliding hiatal hernia vs. paraesophageal hernia

Answer 11

sliding hiatal is more common. this is where the gastroesophageal junction is displaced upward- causes an hourglass stomach.
paraesophageal hernia: normal gastroesophageal junction but protrusion of the fundus into the thorax.

Question 12

indirect inguinal hernia: who gets it? what is the anatomy? what fascia covers it? Complications?

Answer 12

often congenital due to failure of closure of the processus vaginalis. much more common in males.
this is lateral to the inferior epigastric artery. it goes through the deep inguinal ring, the superficial inguinal ring, and out into the scrotum.
it is covered by all three layers of the spermatic fascia and follows the path of the descent of the testes

Question 13

direct inguinal hernia: who gets it? what is the anatomy? what fascia covers it?

Answer 13

usually older men
protrusion through the inguinal (hesselbach’s) triangle, medial to the inferior epigastric artery. only goes thought the external/superficial inguinal ring.
only covered by the external spermatic fascia.

Question 14

What is a femoral hernia? What is the anatomy, and what are complications?

Answer 14

protrudes below the inguinal ligament through the femoral canal below. lateral to the pubic tubercle.
leading cause of bowel incarceration