Liver and Hepatobillary System Flashcards
What relations does the liver have on its visceral surface?
1) stomach
2) kidney
3) dueodenum
4) hepatic flexure (large intestine)
What is the area called between the top of the liver and the diaphragm?
The sub-phrenic space
What is the area called between the liver and the kidney below it?
The hepatorenal pouch
What divides the sub-phrenic space into right and left by connecting the liver to the anterior abdominal wall?
The falciform ligament
Where may liver pain in the sub-phrenic space be felt and why?
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.
What are the different lobes of the liver?
1) right
2) Left
3) quadrate
4) caudate
What the divisions which split the liver into X8 functional lobes?
Couinaud’s divisions (kwee-nodes)
Which ligament separates the liver into right and left anatomical nodes?
The falciform ligament
How many ligaments attach the liver to the anterior abdominal wall and diaphragm in total?
Can you name them?
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)
The caudate and quadrate lobes sit between the right and left lobes of the liver.
Which sits below and which above?
Caudate = above
Quadrate = below
Are the caudate and quadrate atomically on the left or right side of the liver?
Right
What are the X3 vessels in the hilum of the liver and what are they collectively called?
The portal hepatis
1) colon hepatic duct
2) hepatic portal vein
3) proper hepatic artery
What is the difference between hepatic veins and hepatic portal veins?
Hepatic portal veins = carry blood to the liver from GI tract
Hepatic veins = carry blood from liver to the IVC
What is the structure of the bile ducts?
The hepatic duct leaves the liver
It joins the cystic duct
To from the common bile duct which travels to the pancreas/duodenum
Which X2 liver ligaments fuse anteriorly to form the falciform ligament?
The coronary ligaments
What is the ligament formed by the fusion of the right and left coronary ligaments posteriorly to the liver?
The lesser omentum
Which liver ligament is on its posterior surface and is a remnant of a duct connecting the umbilical vein to the IVC?
The ligament venosum
Where is the portal triad located?
Inferior to the liver and enclosed in the free edge of the lesser omentum
How many exocrine ducts does the pancreas have?
What are they called?
X2
The main and accessory
Which opens into the duodenum first, the main or accessory pancreatic duct?
The accessory
How many parts is the pancreas split into?
What are they called?
X5
1) tail
2) body
3) neck
4) head
5) uncinate process
Is the pancreas retroperitoneal or intraperitoneal?
Retroperitoneal
Where does the superior mesenteric artery travel in relation to the pancreas and duodenum?
It arises behind the pancreas and travels under it but above the duodenum to supply the midgut
Where does the tail of the pancreas sit?
In the hilum of the spleen
Which artery supplies the gall bladder and where does it arise from?
The cystic artery
Proper hepatic bifurcates —> right and left hepatic —> right hepatic gives cystic branch
What is the name of the triangle used to identify the cystic artery?
Callous triangle?
Which veins drain the GI tract and join to form the hepatic portal vein?
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
Which X2 sites are the location of Porto-systemic anastomoses?
The lower oesophagus
The anal canal
What structures signify the start and end of the small intestines?
End of the stomach to the ceacum
What is the length of the small intestine?
What are it’s X3 different sections?
6m = Englishman’s kilt
1) duodenum
2) jejunum
3) ileum
What mesentary attaches the small intestines to the posterior wall of the abdomen?
The mesentery
Where does the mesentery extend to/from?
It extends from the duodenuojejunal flexure to the ileocaecal junction (15cm)
Which small intestine division is the largest?
Ileum = 60%
Duodenum = 5% = retroperitoneal Jejunum = 35%
At what level is the umbilicus?
L4
How many parts of the dueodenum are there?
4
Which ligaments holds the duodenojejunal flexure in place?
Where does this ligament arise from?
The ligament of treitz
It is slips of diaphragm muscle
In relation to the 2nd part of the duodenum, what is located:
1) behind it
2) in front of it
1) the right kidney’s hilum
2) the transverse colon
What are the names of the circular folds in the mucous membrane found in the 2nd, 3rd and 4th parts of the duodenum?
Plicae circularis
Which vessel travels over the top of the 3rd part of the duodenum?
The superior mesenteric artery
What joins to form the ampulla of vater?
What should the ampulla actually be called?
The common bile duct and the main pancreatic duct
The major duodenal papilla
Which sphincter controls the major duodenal papilla?
The sphincter of oddi
What is the difference between the duodenum and jejunum with regards to its internal structure?
It has more plicae circularis
Through which structure does the blood supply to the small intestine travel?
What are it’s terminal branches called?
From the superior mesenteric artery through the mesentery
The vasa recta
What is a volvulus?
A twist in the bowel
What are some anatomical differences between the previous small intestine and the ileum?
1) some but few plicae circularis
2) arteriole arcades = more complex and vasa recta shorter
3) much thicker mesentery
4) Peyers patches present!
At what level does the superior mesenteric artery exit the abdominal aorta?
L1
What is the lymphatic drainage of the small intestine?
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
Where is the cysterna chyli located?
Why is this something to note?
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)
What parts make up the large intestine?
Where does the midgut become hindgut?
1) caecum
2) veriform appendix
3) ascending colon
4) transverse colon
5) descending colon
6) sigmoid colon
2/3 along the transverse colon
What X2 things things are formed with respect to the muscle layers of the GI tract in the large intestine?
1) the outer longitudinal layer is reduced to X3 strips called teniae coli
2) the teniae coli create sacculations called haustra
What small, fat filled extensions of the serosa are seen in the large intestine?
Epiploic appendages
What are the X2 flexures in the large intestine called?
1) hepatic
2) splenic
3) sigmoid
Which parts of the large intestine are retroperitoneal and which are intraperitoneal?
All intraperitoneal
Except appendix, transverse colon and sigmoid colon
What name is given to the point at which the appendix sits?
How would you locate this point?
McBurney’s point
2/3 close to the ASIS from the umbilicus
What is the name of the mesentery of the appendix?
The mesoappendix
Which artery supplies the appendix by running through the mesoappendix?
The appendicular artery
Where does the appendicular artery come from?
The superior mesenteric artery
What are the names of the branches of the superior mesenteric artery which supply the ascending and transverse colon?
The right and middle colic artery
What is the name of the vessel which joins the superior mesenteric artery with the inferior mesenteric artery?
The marginal artery of Drummond
What is the blood supply to the hindgut?
The inferior mesenteric artery
What are the branches of the inferior mesenteric artery?
1) left colic
2) sigmoid
3) superior rectal (rectum and upper half of anal canal)
What is the venous drainage of the midgut?
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
What are the main nerves which supply the gut with sympathetic innervation?
The X3 splanchnic nerves:
1) greater splanchnic
2) lesser splanchnic
3) least splanchnic
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?
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
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?
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
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?
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
What part of the gut does the vagus nerve supply sympathetic innervation to?
Only up to midgut
What is the parasympathetic nerve supply to the hindgut?
Via the pelvic splanchnic nerves
These arise from S2, 3 and 4
They form an inferior hypogastric plexus within the pelvis
