Liver anatomy Flashcards
What are the 3 branches of the abdominal aorta?
coeliac trunk, superior mesenteric artery (SMA), inferior mesenteric artery (IMA)
What is the largest gland of the body?
Liver
Which anatomical position does the liver sit in?
It extends from the right hypochondrium into the epigastrium
What is the significance of the hepatic-renal ouch of Morrison?
A space where ascites may accumulate. This can be detected via ultrasound.
The bare area of the liver is fenced by which structures?
anterior and posterior coronary ligaments = peritoneal reflections which pass the liver surface to the diaphragm.
Which major blood vessel passes through the bare area of the liver?
IVC
What is the embryological significance of the bare area of the liver?
First contact point between the liver and diaphragm.
Why is the bare area vulnerable to infection?
It is not covered by peritoneum, and therefore can easily travel between the abdomen and thorax
What was the embryological relevance of the ligament teres (round ligament)
Remnant of the umbilical vein
Which ligament is an embryological remnant of the ductus venosus?
ligamentum venosum.
What was the function of the ductus venosus in utero?
To shunt oxygenated blood from the umbilical vein -> IVC-> RA thereby bypassing the liver (highly metabolic organ)
What structures lie at the free edge of the lesser omentum?
common hepatic bile duct, hepatic artery proper, hepatic portal vein
What is the lesser omentum?
double fold of peritoneum, which attaches the liver to the stomach
Where is the porta hepatis located on the visceral surface of the liver?
between the caudate and quadrate lobes
What is the function of the porta hepatis?
This is a transverse fixture that allows the passage of the portal triad
Which 5 structures are contained within the porta hepatis?
proper hepatic artery, hepatic portal vein, common bile duct, lymphatic vessels, branch of vagus nerve
What is the dual supply to the liver?
hepatic portal vein (75%), hepatic artery (25%)
blood %
What is the function of the hepatic portal vein?
carries nutrient rich (but relatively oxygen poor) blood from the small intestine to the liver (where it is cleaned)
Define a portal vessel
A vessel which carries blood from a capillary blood in one organ to a capillary blood in another organ
Which 3 veins unite to form the hepatic portal vein (and go on to drain into the IVC)?
SMA, IMA, splenic vein
Portal hypertension can cause varices and bleeding in 5 locations. Name them.
Oesophagus (portal vein), spleen (hepatic portal vein), anorectal (superior rectal veins), abdominal wall (superficial epigastric veins), stomach (portal vein)
What is the function of the gallbladder?
To store bile (<50ml/day)
What is the anatomical position of the gall bladder?
posterior to the 9th costal cartilage on RHS, where the lateral edge of the rectus abdominus crosses the costal margin
What are the 3 segments of the common bile duct?
supraduodenal, retroduodenal, pancreatic
What is the ampulla of Vater?
The point at which the main pancreatic duct joins the common bile duct
What importance structure is located at the ampulla of Vater?
Major duodenal papilla
What drains into the minor duodenal papilla?
Accessory pancreatic duct
What is cholelithiasis?
Lithiasis = stones, chole- = gall bladder
What is cholangitis?
inflammation of the gall bladder
What is Murphy’s sign?
Inspiratory arrest that occurs upon palpation of the RUQ during a deep breath
Common methods of imaging the heptobiliary tree.
Ultrasound, endoscope, MRI
How do you distinguish biliary colic from cholecystitis?
Biliary colic results in sudden onset pain in RUQ due to stone obstruction
Cholecystis pain is worse on movement and on inspiration. Patient likely to appear septic and may have post-hepatic jaundice.
Where can gall bladder pain be referred to?
Tip of scapula; irritation of the phrenic nerve. Visceral pain has broad dermatomes -> much brain confusion
What is Hartmann’s pouch (infundibulum)?
a pouch that can appear at the junction between the gall bladder and cystic duct during inflammation or disease
What are common demographic associations with gall stones?
female, fair, fat, forty, fertile
What are the 3 types of jaundice?
pre-hepatic, hepatic, post-hepatic
What is the classical presentation for post-hepatic jaundice?
dark urine, pale stools
List the main complications of gall stones
gall bladder inflammation, bile duct infection (acute cholangitis), acute pancreatitis, gallstone ileus (small bowel obstruction)
The pancreas is largely retroperitoneal, except which part?
The tail is intraperitoneal.
It is closely associated with the hilum of the spleen.
How does the superior mesenteric artery and vein run in relation to the pancreas?
They run anterior to the ucinate process, but posterior to the neck of the pancreas (alongside the portal vein too)
Which anatomical structure does the pancreatic tail sit within?
the splenorenal ligament
What is the Kocher’s (surgical) manoeuvre?
Allows exploration of the retroperitoneum behind the duodenum and pancreas.
Can be used to stop bleeding in IVC or aorta.
How is the spleen connected to the stomach?
Via the gastrosplenic ligament
What vertebral level does the coeliac trunk arise from?
T11
Where does the splenic artery arise from?
The coeliac trunk
