Liver & Gall Bladder

Question 1

Site ?

Answer 1

It lies in the right portion of the abdomen, involving rt hypochondriam , epigastric and extends to lt hypochondriam

Question 2

Size ?

Answer 2

• the largest gland
• the 2nd largest organ after skin
• it weighs 1/50 of total adult weight
• it weighs 1/20 of total infant weight

Question 3

Shape ?

Answer 3

Wedge , triangler , pyramidal shape

Question 4

Surfaces , borders ?

Answer 4

• superior surface ( diaphragmatic )
- smooth
- convex
- 3 parts ( ant, right lateral , sup)

• posteroonferior surface ( visceral)
-2 parts ( post, inf)

• one border : inferior border that is related to the fundus of gallbladder at the level of 9th rib

Question 5

Lobes ?

Answer 5

4 lobes

• large rt lobe , small lt lobe
That is divided by falciform ligament

• 2 sagittal lines
Rt line is formed by groove for ivc , gallbladder
Lt line is formed by fissure of ligamentum venosom , teres hepates

The 2 lines are united in a horizontal line called porta hepatis

Upper to porta is caudate lobe
Lower to porta is quadrate lobe

Question 6

Anatomical, functional divisions of caudate , quadrate lobes ?

Answer 6

Caudate , quadrate are anatomically part of rt lobe

But functionally are part of lt lobe as they have the same blood supply

Question 7

Talk about porta hepatis ?

Answer 7

(3)

1- it the hilem of liver
2- found in posteroinferior surface between quadrate, caudate lobes , upper part of free margin of lesser omentum is attached to it then to fissure for ligamentem venosum
3- contents :
• portal vein
• hepatic artery
• hepatic duct
• sympathetic, parasympathetic nerves
• hepatic lymph nodes

Question 8

Function ?

Answer 8

It has more than 200 function
Mainly
• production of bile
• heparin synthesis
• filtration of blood
• detoxification of toxins
• metabolism of fat, protein and cho
• storage of nutrients ( vitamins, glycogen)

Question 9

Ligaments of liver ?

Answer 9

Visceral:
Hepatogastric
Hepatoduodenal
Which are part of lesser omentum

Diaphragmtic:
Coronary
Rt triangler
Lt triangler

A.A.W
Falciform
Ligamentum teres hepates
Ligamentum venosum

Question 10

Talk about coronary ligament

Answer 10

• it has 2 layers
  Superior layer attached to sup surface of liver and diaphragm

Inferior layer attached to inferior surface of liver
Till its attachment in diaphragm leaving a bare area

Rt border of attachment is rt trianglar ligament that attaches the right part of it to diaphragm

Lt border of attachment is lt triangler ligament that attaches the left part of it to diaphragm

Question 11

Talk about bare area of liver

Answer 11

• triangler area not covered by peritonium ( coronary ligament )
• apex : rt triangler ligament
• base : i.v.c

Question 12

Talk about other areas not covered by peritoneam

Answer 12

(H )

1- fossa or groove for ivc
2- fossa or groove for gallbladder
3- fissure for ligamentum venosum
4- fissure for ligamentum teres hepates
5- porta hepatis
6- the bare area

Question 13

Talk about falciform ligamet

Answer 13

1- separates rt lobe from lt one
2- there is 3 borders
Anterior border : concave
Related to a.a.w , under surface of diaphram

Posterior border: convex
Ends in sup, ant surfaces of liver
free inferior border attached to ligamentum teres
3- sickle shaped fold of peritoneam

Question 14

Origin of ligamentum teres

Answer 14

Lt obliterated umbilical vein

Question 15

Relations ?

Answer 15

Anterior : a.a.w
Superior : diaphragm that separates it from rt lung , part of lt lung and base of heart

Right sides : 7:11 ribs

Posterior : esophages , stomach , 2nd part of duedonam , rt coloc flexure and transverse colon , rt kidney , rt suprarenal gland
( impressions)

Question 16

Factors that fix the liver

Answer 16

1- ligaments
2- ivc , entrance of hepatic veins
3- intra abdominal pressure

Question 17

Functional segments ?

Answer 17

حدوتة مصرية 😉

Question 18

Porto systemic anastomosis

Answer 18

• umbilical
  Para umbilical vein ( portal ) and superficial epigastric vein ( systemic ) anastomosis

When portal hypertension: caput medosa exists

• anal canal
  Superior rectal vein ( portal ) anastomosis eith inferior rectal vein ( systemic)

When portal hypertension: internal piles exist

Question 19

Blood supply

Answer 19

Liver receives
- 30% from the oxygenated blood of hepatic artery
- 70% from the nutriented blood of portal vein

Portal vein ~> 2 terminal ( rt/ lt) ~> hepatic sinusoids ~> drain into central vein in each lobule ~> 2 hepatic veins from each lobe ( coming from central veins of each of lobule of each lobe ) ~> ivc

Question 20

Nerve supply

Answer 20

Parasympathetic: vagus ( anterior )

Sympathetic : hepatic plexus from celiac plexus from thoracic ganglion chain ( t1-12)

( celiac plexus is composed of both sympathetic, para)

Question 21

Lymphatics

Answer 21

• celiac nodes
• posterior mediastinal nodes

Question 22

Biliary system is composed of ?

Answer 22

Liver : producing bile
Gallbladder: storage and concentration of bile
Duodunem : in which bile is secreted

Question 23

Biliary tree ?

Answer 23

2 hepatic duct ~> common hepatic duct ++cystic duct ~> common bile duct drain with main pancreatic duct into 2nd part of duodenum through ampulla of vater at the summit of major duodenul papilla

( accessory pancreatic duct drain at the summit of minor duodenul papilla)

Question 24

Talk about common bile duct

Answer 24

(5)
1- formed by common hepatic + cystic duct
2- 3 inch
3- 3 parts & relations
1st ( supra duodenal ) : anterior to portal vein , at the right of hepatic artery
2nd ( retroduodenal) : anterior to portal vein , at the right of gastrodudonul artery
3rd ( retropancreatic ) : anterior to ivc

4-termination : along with main pancreatic duct forming ampulla of vater that drain in 2nd part of dudenum at the summit of major papilla

5- blood supply : cystic artery , pancreaticodudenol artery

Question 25

Describe gallbladder

Answer 25

• green , muscler , pear shaped hollow organ

Question 26

Size and capacity of gallbladder

Answer 26

4* 10 cm

30 - 50 ml bile

Question 27

Site , parts of gallbladder

Answer 27

Site

• right hypochondriam , epigastric part
• at the inferior surface of liver
• at the level of 9 th rib
• between right lobe and quandrate lobe

Parts
- neck : hartmann pouch , ends giving cystic duct
- body
- fundus

Question 28

B
L
N
Of gallbladder

Answer 28

B
Cystic artery from right hepatic artery
Cystic vein drain into portal vein

L
Cystic nodes
Hepatic nodes
Celiac nodes

N
Parasympathetic, sympathetic from celiac plexus

Parasympathetic: vagus ( anterior)