Liver & Gall Bladder Flashcards
Site ?
It lies in the right portion of the abdomen, involving rt hypochondriam , epigastric and extends to lt hypochondriam
Size ?
• 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
Shape ?
Wedge , triangler , pyramidal shape
Surfaces , borders ?
• 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
Lobes ?
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
Anatomical, functional divisions of caudate , quadrate lobes ?
Caudate , quadrate are anatomically part of rt lobe
But functionally are part of lt lobe as they have the same blood supply
Talk about porta hepatis ?
(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
Function ?
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)
Ligaments of liver ?
Visceral:
Hepatogastric
Hepatoduodenal
Which are part of lesser omentum
Diaphragmtic:
Coronary
Rt triangler
Lt triangler
A.A.W
Falciform
Ligamentum teres hepates
Ligamentum venosum
Talk about coronary ligament
- 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
Talk about bare area of liver
• triangler area not covered by peritonium ( coronary ligament )
• apex : rt triangler ligament
• base : i.v.c
Talk about other areas not covered by peritoneam
(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
Talk about falciform ligamet
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
Origin of ligamentum teres
Lt obliterated umbilical vein
Relations ?
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)
Factors that fix the liver
1- ligaments
2- ivc , entrance of hepatic veins
3- intra abdominal pressure
Functional segments ?
حدوتة مصرية 😉
Porto systemic anastomosis
- 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
Blood supply
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
Nerve supply
Parasympathetic: vagus ( anterior )
Sympathetic : hepatic plexus from celiac plexus from thoracic ganglion chain ( t1-12)
( celiac plexus is composed of both sympathetic, para)
Lymphatics
- celiac nodes
- posterior mediastinal nodes
Biliary system is composed of ?
Liver : producing bile
Gallbladder: storage and concentration of bile
Duodunem : in which bile is secreted
Biliary tree ?
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)
Talk about common bile duct
(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
Describe gallbladder
- green , muscler , pear shaped hollow organ
Size and capacity of gallbladder
4* 10 cm
30 - 50 ml bile
Site , parts of gallbladder
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
B
L
N
Of gallbladder
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)
