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Funtional Anatomy & Embryology > Liver and Hepatobillary System > Flashcards

Liver and Hepatobillary System Flashcards

1
Q

What relations does the liver have on its visceral surface?

A

1) stomach
2) kidney
3) dueodenum
4) hepatic flexure (large intestine)

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2
Q

What is the area called between the top of the liver and the diaphragm?

A

The sub-phrenic space

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3
Q

What is the area called between the liver and the kidney below it?

A

The hepatorenal pouch

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4
Q

What divides the sub-phrenic space into right and left by connecting the liver to the anterior abdominal wall?

A

The falciform ligament

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5
Q

Where may liver pain in the sub-phrenic space be felt and why?

A

As referred pain in the shoulder due to the same nerves supplying the diaphragm (C3, 4 and 5) also supplying the shoulder (C3 and 4) as they are part of the brachial plexus.

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6
Q

What are the different lobes of the liver?

A

1) right
2) Left
3) quadrate
4) caudate

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7
Q

What the divisions which split the liver into X8 functional lobes?

A

Couinaud’s divisions (kwee-nodes)

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8
Q

Which ligament separates the liver into right and left anatomical nodes?

A

The falciform ligament

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9
Q

How many ligaments attach the liver to the anterior abdominal wall and diaphragm in total?

Can you name them?

A

X5

1) right triangular ligament
2) Left triangular ligament
3) right coronary ligament
4) Left coronary ligament
5) falciform
6) fibrous round ligament (umbilical vein remnant)

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10
Q

The caudate and quadrate lobes sit between the right and left lobes of the liver.

Which sits below and which above?

A

Caudate = above

Quadrate = below

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11
Q

Are the caudate and quadrate atomically on the left or right side of the liver?

A

Right

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12
Q

What are the X3 vessels in the hilum of the liver and what are they collectively called?

A

The portal hepatis

1) colon hepatic duct
2) hepatic portal vein
3) proper hepatic artery

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13
Q

What is the difference between hepatic veins and hepatic portal veins?

A

Hepatic portal veins = carry blood to the liver from GI tract

Hepatic veins = carry blood from liver to the IVC

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14
Q

What is the structure of the bile ducts?

A

The hepatic duct leaves the liver

It joins the cystic duct

To from the common bile duct which travels to the pancreas/duodenum

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15
Q

Which X2 liver ligaments fuse anteriorly to form the falciform ligament?

A

The coronary ligaments

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16
Q

What is the ligament formed by the fusion of the right and left coronary ligaments posteriorly to the liver?

A

The lesser omentum

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17
Q

Which liver ligament is on its posterior surface and is a remnant of a duct connecting the umbilical vein to the IVC?

A

The ligament venosum

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18
Q

Where is the portal triad located?

A

Inferior to the liver and enclosed in the free edge of the lesser omentum

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19
Q

How many exocrine ducts does the pancreas have?

What are they called?

A

X2

The main and accessory

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20
Q

Which opens into the duodenum first, the main or accessory pancreatic duct?

A

The accessory

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21
Q

How many parts is the pancreas split into?

What are they called?

A

X5

1) tail
2) body
3) neck
4) head
5) uncinate process

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22
Q

Is the pancreas retroperitoneal or intraperitoneal?

A

Retroperitoneal

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23
Q

Where does the superior mesenteric artery travel in relation to the pancreas and duodenum?

A

It arises behind the pancreas and travels under it but above the duodenum to supply the midgut

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24
Q

Where does the tail of the pancreas sit?

A

In the hilum of the spleen

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25
Q

Which artery supplies the gall bladder and where does it arise from?

A

The cystic artery

Proper hepatic bifurcates —> right and left hepatic —> right hepatic gives cystic branch

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26
Q

What is the name of the triangle used to identify the cystic artery?

A

Callous triangle?

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27
Q

Which veins drain the GI tract and join to form the hepatic portal vein?

A

The splenic vein drains the foregut

The superior mesenteric vein drains the midgut and ascends vertically to join the splenic artery

The inferior mesenteric retry drains the hindgut and merges with the other two (already joined) to form the hepatic portal vein

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28
Q

Which X2 sites are the location of Porto-systemic anastomoses?

A

The lower oesophagus

The anal canal

29
Q

What structures signify the start and end of the small intestines?

A

End of the stomach to the ceacum

30
Q

What is the length of the small intestine?

What are it’s X3 different sections?

A

6m = Englishman’s kilt

1) duodenum
2) jejunum
3) ileum

31
Q

What mesentary attaches the small intestines to the posterior wall of the abdomen?

A

The mesentery

32
Q

Where does the mesentery extend to/from?

A

It extends from the duodenuojejunal flexure to the ileocaecal junction (15cm)

33
Q

Which small intestine division is the largest?

A

Ileum = 60%

Duodenum = 5% = retroperitoneal
Jejunum = 35%
34
Q

At what level is the umbilicus?

A

L4

35
Q

How many parts of the dueodenum are there?

A

4

36
Q

Which ligaments holds the duodenojejunal flexure in place?

Where does this ligament arise from?

A

The ligament of treitz

It is slips of diaphragm muscle

37
Q

In relation to the 2nd part of the duodenum, what is located:

1) behind it
2) in front of it

A

1) the right kidney’s hilum

2) the transverse colon

38
Q

What are the names of the circular folds in the mucous membrane found in the 2nd, 3rd and 4th parts of the duodenum?

A

Plicae circularis

39
Q

Which vessel travels over the top of the 3rd part of the duodenum?

A

The superior mesenteric artery

40
Q

What joins to form the ampulla of vater?

What should the ampulla actually be called?

A

The common bile duct and the main pancreatic duct

The major duodenal papilla

41
Q

Which sphincter controls the major duodenal papilla?

A

The sphincter of oddi

42
Q

What is the difference between the duodenum and jejunum with regards to its internal structure?

A

It has more plicae circularis

43
Q

Through which structure does the blood supply to the small intestine travel?

What are it’s terminal branches called?

A

From the superior mesenteric artery through the mesentery

The vasa recta

44
Q

What is a volvulus?

A

A twist in the bowel

45
Q

What are some anatomical differences between the previous small intestine and the ileum?

A

1) some but few plicae circularis
2) arteriole arcades = more complex and vasa recta shorter
3) much thicker mesentery
4) Peyers patches present!

46
Q

At what level does the superior mesenteric artery exit the abdominal aorta?

A

L1

47
Q

What is the lymphatic drainage of the small intestine?

A

It begins by mirroring the blood supply.

Nodes follow the superior mesenteric arteries and back to the aorta.

The nodes located here are called PRE-AORTIC nodes.

The inferior mesenteric nodes drain to the superior which drain eventually to the coeliac trunk nodes.

From the coeliac trunk nodes the lymph follows the same pattern as the foregut = cisterna chyli = thoracic duct (once the cisterna chyli nodes have entered the thoracic cavity) = left lymphovenous portal

48
Q

Where is the cysterna chyli located?

Why is this something to note?

A

Just below and RIGHT of the aortic opening in the diaphragm

This is something to note as the thoracic duct above drains to the LEFT lymphovenous portal (opposite side to cysterna chyli)

49
Q

What parts make up the large intestine?

Where does the midgut become hindgut?

A

1) caecum
2) veriform appendix
3) ascending colon
4) transverse colon
5) descending colon
6) sigmoid colon

2/3 along the transverse colon

50
Q

What X2 things things are formed with respect to the muscle layers of the GI tract in the large intestine?

A

1) the outer longitudinal layer is reduced to X3 strips called teniae coli
2) the teniae coli create sacculations called haustra

51
Q

What small, fat filled extensions of the serosa are seen in the large intestine?

A

Epiploic appendages

52
Q

What are the X2 flexures in the large intestine called?

A

1) hepatic
2) splenic
3) sigmoid

53
Q

Which parts of the large intestine are retroperitoneal and which are intraperitoneal?

A

All intraperitoneal

Except appendix, transverse colon and sigmoid colon

54
Q

What name is given to the point at which the appendix sits?

How would you locate this point?

A

McBurney’s point

2/3 close to the ASIS from the umbilicus

55
Q

What is the name of the mesentery of the appendix?

A

The mesoappendix

56
Q

Which artery supplies the appendix by running through the mesoappendix?

A

The appendicular artery

57
Q

Where does the appendicular artery come from?

A

The superior mesenteric artery

58
Q

What are the names of the branches of the superior mesenteric artery which supply the ascending and transverse colon?

A

The right and middle colic artery

59
Q

What is the name of the vessel which joins the superior mesenteric artery with the inferior mesenteric artery?

A

The marginal artery of Drummond

60
Q

What is the blood supply to the hindgut?

A

The inferior mesenteric artery

61
Q

What are the branches of the inferior mesenteric artery?

A

1) left colic
2) sigmoid
3) superior rectal (rectum and upper half of anal canal)

62
Q

What is the venous drainage of the midgut?

A

Via the superior mesenteric artery, which ascends to join the splenic artery which will eventually merge with the inferior mesenteric artery to form the hepatic portal vein

63
Q

What are the main nerves which supply the gut with sympathetic innervation?

A

The X3 splanchnic nerves:

1) greater splanchnic
2) lesser splanchnic
3) least splanchnic

64
Q

Where does the greater splanchnic nerve arise from?

What does it supply?

Where does its pre-ganglionic nerve fibres travel to?

Where do they synapse with post-ganglionic fibres?

A

It arises from T5-T9

It supplies the foregut

The pre-ganglionic nerves bypass the sympathetic chain and synapse at ganglia around the coeliac trunk

65
Q

Where does the lesser splanchnic nerve arise from?

What does it supply?

Where does its pre-ganglionic nerve fibres travel to?

Where do they synapse with post-ganglionic fibres?

A

It arises from T10-T11

It supplies midgut

The pre-ganglionic nerve fibres also bypass the sympathetic chain to synapse at ganglia around the superior mesenteric artery

66
Q

Where does the least splanchnic nerve arise from?

What does it supply?

Where does its pre-ganglionic nerve fibres travel to?

Where do they synapse with post-ganglionic fibres?

A

It arises from T12

It supplies hindgut

The pre-ganglionic nerve fibres also bypass the sympathetic chain to synapse at ganglia around the inferior mesenteric artery

67
Q

What part of the gut does the vagus nerve supply sympathetic innervation to?

A

Only up to midgut

68
Q

What is the parasympathetic nerve supply to the hindgut?

A

Via the pelvic splanchnic nerves

These arise from S2, 3 and 4

They form an inferior hypogastric plexus within the pelvis

Funtional Anatomy & Embryology (20 decks)

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