Liver, Bile duct, & Gall bladder

Question 1

the liver is?

Answer 1

a triangular shaped intraperitonal organ, which is covered by visceral peritoneum (except the bare area)

Question 2

ligaments of the liver

Answer 2

• flaciform ligament (liver connected with parietal surafce of abdominal wall)
• hepatoduodenal ligament (liver connected with duodenum, starts from porta hepatis)
• lesser omentuem (hepatoduodenal ligament + hepatograstric ligament)

Question 3

surface’s of the liver

Answer 3

diaphgramatic surface (with anterior and superior surfaces), & visceral

Question 4

what is morison’s pouch

Answer 4

a cavity between right part of visceral surface of liver and right kidney & it’s supra renal gland where fluid can accumulate

Question 5

projection of the liver

Answer 5

• medioclavicular line
• medioinguinal line
• middle line
• *left edge of liver does not reach medioclavicular line, located on the 5th rib

Question 6

the anterior diaphragmatic surface

Answer 6

divided sagitally by falciform ligament forming the right and left lobes of the liver

Question 7

features of the superior diaphragmatic surface

Answer 7

• IVC is visible
• bare area
• left coronary ligament
• right coronary ligament
• hepatorenal ligament
• right triangular ligament
• left triangular ligament
• falciform ligament

Question 8

what is the bare area? and where is it located?

Answer 8

the region on the liver where there is no visceral perioneum lining,(the liver attaching on the diaphragm),
-located between the right coronary ligament (ant) and hepatorenal ligament (post)

Question 9

what is the termination of the left triangular ligament called?

Answer 9

in a fibrous band called fibrous appendix of liver

Question 10

the visceral surface

Answer 10

extends diagonally from posterosuperior to anteroinferior

and subdivides by a set of H-shaped grooves

Question 11

• what does the porta hepatis form?
• what is it surrounded by?
• the structures it contains

Answer 11

• it forms a cross bar of the H
• surrounded by the hepatoduodenal ligament
• bile duct (ant right),hepatic artery (ant, left), portal vein (middle post) (also nerves and lymphatic vessels)

Question 12

what does the left saggital limb of H form?

Answer 12

formed by the fissure for the round ligament/ ligamentum teres (anteriorly) &; fissure of ligamentum venosum posteriorly (remenants of ductus venosum)

Question 13

what does the right limb of H form?

Answer 13

fissure for the gall bladder anteriorly,& fissure for the IVC inferiorly

Question 14

what does the left and right limb of H divide into

Answer 14

• LEFT (right and left lobe)

- RIGHT (quadrate lobe anteriorly & caudate lobe posteriorly)

Question 15

impressions & tuberosities in visceral surface of adjacent organs remember mnemonic (DOC RESpect God)

Answer 15

• duodenal impression (right side)
• omental tuberosity (left side)
• colic impression (right side)
• renal impression (right side)
• esophageal impression (left side)
• supra-renal (right side)
• gastric impression (left side)

Question 16

arterial supply of the liver

Answer 16

-hepatic artery (passes in the hepatoduodenal ligament) it divides into right and left hepatic proper arteries

Question 17

venous supply/ drainage of the liver

Answer 17

• blood drains from the liver by the short hepatic veins draining into the IVC
• portal vein: which transfer blood from the gastrointestinal tract to liver

Question 18

nervous supply of the liver

Answer 18

• autonomic nerves from the celiac nerve plexus

* *** right phrenic nerve (sensory innervation) of the peritoneum of the liver

Question 19

the portal vein is made by?

Answer 19

the splenic vein and the superior messenteric vein

Question 20

what happens to the portal vein when it enters the liver?

Answer 20

divides into right and left branch of portal vein

Question 21

what vein drains in to right and left branches of the portal vein?

Answer 21

interlobular vein

Question 22

what is the function of the portal vein?

Answer 22

filtration of substances absorbed by the gastrointestinal tract

Question 23

what is the portal caval anastomosis?

and what are its contribution?

Answer 23

• is specific regions of the body, where blood is drained to the hepatic portal vein and it communicates with the SVC & IVC
• esophagus, abdominal wall, rectum, retroperitonuem

Question 24

portal caval (esophagus)

Answer 24

left gastric vein connects with esophageal vein which drains via the azygous vein and hemiazygous vein into the SVC

Question 25

portal caval (abdominal wall)

Answer 25

paraumbilical vein, empties via the thoracoepigastric vein into SVC

Question 26

portal caval (rectum)

Answer 26

superior rectal vein connects with middle and inferior recatal veins which drain via the internal ilac vein, which drains into the IVC

Question 27

portal caval (retroperitoneum)

Answer 27

by the colic vein with the retroperitoneal vein

Question 28

what is the bile duct divided into?

Answer 28

extrahepatic and intrahepatic

Question 29

extrahepatic features:

Answer 29

- common hepatic duct (created after fusion of R. & L. hepatic duct in the hepatoduodenal ligament) - cystic duct - sphincter of the bile duct - hepatopancreatic ampulla

Question 30

where is the begining of the bile duct located?

Answer 30

hepatoduodenal ligament

Question 31

pathway of the bile duct

Answer 31

descends behind the superior part of the duodenum to the medial side of the descending part of the duodenum where it usually fuses with the pantreatic duct (which opens on the major duodenal papilla)

Question 32

what is the function of the sphincter of the bile duct?

Answer 32

to suround the bile duct before its junction with the pancreatic duct

Question 33

what is the hepatopancreatic ampulla?

Answer 33

an expansion of the junction of the junction between the bile and pancreatic duct

Question 34

what is the gall bladder

Answer 34

a thin walled pear shpae sac, which stores and concentrates bile, the bile duct transports the bile

Question 35

what are the parts of the gall bladder?

Answer 35

fundus, body and neck

Question 36

where does the gall bladder rests? and where is it attached to?

Answer 36

rests on the depression on the liver and is attached to it by connective tissue

Question 37

what is the internal surface of the gall bladder covered by?

Answer 37

peritoneum

Question 38

neurovascular supply of the gall bladder

Answer 38

- arterial supply: cystic artery - venous: cystic vein which empties directly into the portal vein - nervous: autonomic nerve fibers from celiac nerve plexsus which innervated the bile duct & the gall bladder * *** Right phrenic nerve (sensory innervation of peritoneum of gall bladder and liver)