Liver, billary system and pancreas Flashcards
Where would you find the liver?
Where is the gallbladder?
Under the ribs on the right and some in the epigastric area.
Gallbladder: in the midclavicular line and transpyloric line.
What is the functional line of symmetry?
Functional line of symmetry from IVC to gall bladder which is a little to the right of the falciform ligament: which used to be considered as the point where the right and the left lobe were separated.
What is the bare area of the liver articulating with?
The diaphragm
the capsule forms the anterior coronary ligament, the right triangular ligament, the posterior coronary ligament which goes all the way around until it reaches the left triangular ligament where it continues to the falciform ligament.
Why are these structures important?
Hepatorenal recess and subphrenic recess (which can cause pain in the diaphragm) is a point where the pus can settle if there is perforation.
This is the sort of thing he will ask an exam question on.
Recesses are important because this is where the fluid will accumulate (blood or pus).
Think about where it will accumulate when they are lying down or standing up.
The __________ joins the ________ to form the inferior mesenteric vein. The ______ joins the_________ to drain into the ___________ and this becomes the portal vein.
The _________ also drains into the portal vein.
The superior rectal vein joins the colic vein to form the inferior mesenteric vein. The splenic vein joins the inferior mesenteric vein to drain into the superior mesenteric vein and this becomes the portal vein.
The left gastric vein also drains into the portal vein.
Explain the flow of liquids through the liver?
2 inflows of blood, 1 outflow of blood (central vein into the hepatic vein).
The bile drains back via the bile canaliculi.
The _______ _________ is the doorway to the liver.
Portal hepatis.
________ is the blood supply to the foregut, one of the branches is the _______ hepatic artery, gives off a __________ artery and _________ _______ artery to the stomach and then turns into the ________ ________ artery, this then gives off a left and right _______ artery supplying the liver with oxygen-rich blood. Coming off the proper hepatic artery is the ________ artery.
Coeliac trunk is the blood supply to the foregut, one of the branches is the common hepatic artery, gives off a gastroduodenal artery and right gastric artery to the stomach and then turns into the proper hepatic artery, this then gives off a left and right hepatic artery supplying the liver with oxygen-rich blood. Coming off the proper hepatic artery is the cystic artery.
Importance of arrow and blanked out things?
The triangles boundaries?
Coeliac trunk supplies the foregut.
Calots triangle is the location for the cystic artery. The edges of that are the hepatic duct, the cyscic duct and the edge of the liver if you are doing a cholecystectomy.
Can pass from the greater sac to the lesser sac via the foramen of Winslow/omental foramen (which is the arrow).
What is anterior and posterior to the omental foramen?
The IVC and the portal vein
How long are each of these ducts?
Cystic duct is 2mm in width and 2cm in length.
Common hepatic duct 4mm in width and 4cm in length.
Common bile duct is going to be 8mm in width and 8cm long.
What are the lobes, vessels and ducts?
Explain how he told us how to remember the lobes of the liver?
Based on inflow and outflow.
Left, middle nad right hepatic veins. All of these have a segmental artery.
Cut it into superior and inferior slices. Then separate via the left, middle and right hepatic vein. Then think: 2 x 4 is 8, and 1 + 7 = 8.
Inferiroly it is easier, 3 4 5 and 6. from left to right.
What are these vessels?
Left middle and right hepatic veins.
IVC
How would you stop bleeding in the liver if you had to remove cancer?
Can ligate one of the arteries and it stops the blood supply if you need to get one of the metastatis cancers out.
What is the uncinate process? What lies over the top of it?
The uncinate process looks a little bit like an old fashioned walking stick.
Over the top of the uncinate process is the superior mesenteric artery and vein.
The whole pancreas is underneath the stomach, the tail is associated with the spleen.
What is the curvy wave like artery?
Curving like a wave is the splenic artery which supplies the spleen and pancreas.
Pancreaticoduodenal arteries (superior and inferior).
Explain pancreatic drainage and the structures that it goes through to get to the duodenum
Pancreatic drainage is manly drained by the main pancreatic duct. Which drains out via the major duodenal papilla into the duodenum. The uncinate process is embryologically different which drains via the minor duodenal papilla which switches around and drains more proximally.
Major duodenal papilla joins the bile duct and pancreatic duct. Ampulla=mesenteric control of what comes out.
