Liver and Pancreas

Question 1

What are the functions of the liver?

Answer 1

Glycogen storage, bile secretion, detoxification and synthesis of blood clotting and anticoagulant factors

Question 2

What are the anatomical relations of the luver?

Answer 2

• Gallbladder (posterior and inferior),
• Hepatic flexure (inferior),
• Right kidney, adrenal gland, IVC and abdominal aorta (posterior)
• Stomach (posterior at left side)

Question 3

Describe how the liver is held in place?

Answer 3

Anteriorly to abdo wall via falciform ligament and ligamentum teres.
Superiorly to diaphragm via coronary ligaments and triangular ligaments

Question 4

The umbilical vein and ductus venosus in utero become what in the adult?

Answer 4

• Ligamentum teres and ligamentum venosum respectfully.

Question 5

Name the 4 visible anatomical lobes of the liver

Answer 5

Right and left lobes (separated by falciform ligament) and then posteriorly is the caudate lobe and quadrate lobe (closer to gallbladder)

Question 6

What is porta hepatis?

Answer 6

Site of entrance for portal triad structures; Bile duct, hepatic artery proper and hepatic portal vein.

Question 7

Explain the blood supply to the liver

Answer 7

Dual blood supply comes from the right and left hepatic arteries which are branches of the hepatic artery proper. This gives 20-25% of blood supply. The rest comes from the hepatic portal vein.

Question 8

Explain the lymphatic drainage of the liver

Answer 8

• Liver produces a large amount of lymph, some of the lymph enters the several lymph nodes in the porta hepatis, some efferent vessels pass to hepatic node then to coeliac nodes and a few vessels pass through the bare area through diaphragm to pos mediastinal LNs

Question 9

Describe the nerve supply of the liver

Answer 9

Sympathetics from coeliac plexus, greater splanchnic (T5-9) and PSNS - anterior vagal trunk

Question 10

Explain the functional anatomy of the liver

Answer 10

• Divided into 8 functionally independent segments. Each of which has its own vascular inflow, outflow and biliary drainage. Therefore each can be surgically removed

Question 11

Explain the flow of blood and vile through hepatic lobules

Answer 11

• Blood from the hepatic artery proper and portal vein pass into sinusoids and into the central vein. Each sinusoid lies between sheets of hepatocytes
• Bile flows in canaliculi between hepatocytes towards biliary ducts

Question 12

Explain the anatomy, functions and blood supply of the Gallbladder

Answer 12

Anatomy - Fundus, body, neck and cystic duct (has spiral valve)
Functions - Store and concentrate bile.
Blood supply - Cystic artery which is a branch of the right hepatic artery which lies in the hepatobiliary triangle.

Question 13

Explain the surface anatomy of the gallbladder

Answer 13

Fundus is located at Murphy’s point which is where the right midclavicular line crosses the costal margin. This is at the tip of the right 9th CC.

Question 14

Describe the neurovasculature of the gallbladder.

Answer 14

Blood - Cystic artery and numerous small veins from body and neck into segmental portal veins within liver.

Lymph - Cystic LN near gallbladder neck and to hepatic nodes which then drain to coeliac.

Nerve - Coeliac plexus (SNS from T5-T9) and PSNS - vagus

Question 15

Explain the extra-hepatic billary tree

Answer 15

Right and left hepatic ducts unit to form the common hepatic duct. This then unites with the cystic duct to form the common bile duct

Question 16

What controls in inflow of bile and pancreatic enzymes into the duodenum?>

Answer 16

The sphincter of odi in the hepatopancreatic ampulla

Question 17

What is ERCP?

Answer 17

Investigation used to study biliary tree and pancreas and treat pathologies associated with it. Endoscope via oral cavity to duodenum and dye injected into major duodenal papilla.

Question 18

Explain the anatomy of the pancrease

Answer 18

It has a head which lies in the duodenal arch, body, neck, tail and uncinate process (UP extends posterior to superior mesenteric vessels

Question 19

Briefly explain the functions of the pancreas

Answer 19

Exocrine via acinar cells - Pancreatic digestive enzymes.

Endocrine - Islets of Langerhans (insulin and glucagon

Question 20

Explain what can occur with carcinoma of pancreas

Answer 20

If it is of the head then is can obstruct the common bile duct which can lead to painless jaundice

Question 21

What is the blood supply of the pancreas?

Answer 21

Greater pancreatic artery and dorsal pancreatic arteries which are branches of the splenic artery. Then superior pancreaticoduodenal artery (from gastroduodenal) anastomoses with inferior pancreaticoduodenal artery (from SMA) around the head of pancreas.

Question 22

Describe the lymph drainage and nerve supply of the pancreas

Answer 22

Lymph nodes are situated along the arteries that supply the pancreas. They then drain to coeliac and superior mesenteric LNs. Sympathetics from T7-9 and PSNS from vagus

Question 23

Describe features of acute pancreatitis

Answer 23

It can be caused by gallstone obstruction which can lead to reflux of bile and pancreatic juice into main prancreatic duct. In more advanced cases vascular haemorrhage can occur leading to blood/fluid accumulation in retroperitoneal space.

Question 24

What is Grey-Turner’s sign and Cullen’s sign?

Answer 24

GT’s - Fluid collecting in right/left flank due to paracolic gutters.
Cullen’s - Fluid around umbilicus via falciform

Question 25

Where is the trans-pyloric plane located?

Answer 25

• (L1) Midway between umbilicus and xiphisternal joint

Question 26

What is found at the level of the trans-pyloric plane

Answer 26

• Fundus of gallbladder,
• Pylorus of Stomach,
• Neck of pancreas,
• 1st Part of duodenum,
• Hilum of kidney,
• Duodenojejunal flexure,
• Termination of spinal cord,
• Origin of superior mesenteric artery,
• Formation of portal vein

Question 27

What are the constituents of bile?

Answer 27

• Bile pigments (chiefly bilitubin), cholesterol, phospholipids, fatty acids, water and electrolytes