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MD3002 > liver, gall bladder and pancreas > Flashcards

liver, gall bladder and pancreas Flashcards

1
Q

what is Glisson’s capsule

A

A layer of connective tissue surrounding the liver and ensheathing the hepatic artery, portal vein, and bile ducts within the liver.

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2
Q

how does bile produced in the liver reach the gall bladder

A

canaliculi > bile ductules> cystic duct > common hepatic ducts > right and left hepatic ducts

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3
Q

what is bile made of

A

bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water and electrolytes

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4
Q

what do Kupffer cells do

A

form bile products from haemoglobin

break down old red blood cells

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5
Q

what are the functions of the liver

A

synthesis of bile, storage of glucose, glycogen, proteins, vitamins and fats
detoxification
synthesis of clotting and anticoagulant factors

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6
Q

describe a liver lobule

A

hepatocytes radiate outwards from the central vein (axis)

sinusoids lie between the sheets and carry blood from the hepatic artery and portal vein to the central vein

bile flows in the opposite direction in canaliculi

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7
Q

where is the diaphragmatic surface of the liver

A

antero superior

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8
Q

where is the visceral surface of the liver

A

postero-inferior

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9
Q

what separates the right and left lobes of the liver

A

falciform ligament

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10
Q

where is the quadrate lobe of the liver

A

next to the gall bladder, inferiorly on the posterior surface of the liver. Part of the right lobe

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11
Q

where is the caudate lobe of the liver

A

next to the IVC

superior to the quadrate lobe

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12
Q

what is the porta hepatis

A

houses the portal triad: portal vein, hepatic artery and bile ducts

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13
Q

where is ligamentum teres (obliterated umbilical vein)

A

in the free border of the falciform ligament at the inferior border of the liver

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14
Q

where is the ligamentum venosum (obliterated ductus venosus)

A

in the lesser omentum

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15
Q

from a functional perspective, what lobe are the quadrate and caudate lobes part of

A

the left lobe

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16
Q

how can the liver be functionally divided

A

into Couinaud liver segments, related to their distribution from the portal veins and artery

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17
Q

what forms the left and right triangular ligament

A

coronary ligaments

liver ligaments are reflections of peritoneum that surround the bare area

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18
Q

what is the bare area related to

A

diaphragm, IVC, right kidney, right supra renal gland

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19
Q

what is the blood supply of the liver

A

proper hepatic artery which is a branch of the coeliac trunk divides into right and left terminal branches that enter the porta hepatis

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20
Q

where do the hepatic veins exit the liver

A

from the posterior surface of the liver an drain to IVC

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21
Q

where does lymph from the liver go

A

lymph nodes surrounding the porta hepatis
efferent vessels pass to the coeliac nodes
some go to the posterior mediastinal lymph nodes

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22
Q

how might cancer obstruct the bile ducts

A

retrograde tumour spread from the coeliac nodes to the hepatic nodes

this would cause jaundice

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23
Q

what is the nerve supply of the liver

A

sympathetic nerves form the coeliac plexus- T5-9- greater splanchnic

the anterior vagal trunk gives rise to a large parasympathetic hepatic branch

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24
Q

describe the shape and function of the gall bladder

A

rounded fundus, body and a neck that narrows towards the cystic duct
this combines with the common hepatic duct to form the bile duct and enter the 2nd part of the duodenum with the pancreatic duct at the ampulla of Vater

function-store and concentrate bile

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25
Q

where is the gall bladder

A

between the right and quadrate lobes on the visceral surface of the liver
related to the first part of the duodenum, transverse colon and pylorus

26
Q

where does the cystic duct join the hepatic duct

A

free edge of the lesser omentum

27
Q

what lies posterior to the duodenum

A

IVC and hilum of right kidney

28
Q

what is the spiral valve of Heister

A

a fold in the cystic duct which functions to keep the lumen constantly open

29
Q

what is the blood supply of the gall bladder

A

cystic artery which is a branch of the right hepatic artery

30
Q

what is the venous drainage of the gall bladder

A

cystic vein which drains straight to the portal vein

31
Q

what is the lymph drainage of the gallbladder

A

cystic lymph node near the neck of the gall bladder

then to the hepatic nodes and coeliac nodes

32
Q

what is the nerve supply of the gall bladder

A

sympathetic- foregut T5-9 and parasympathetic vagal fibres from the coeliac plexus

33
Q

what hormone causes contraction of the gallbladder

A

cholecystokinin which is produced by the mucous membrane of the duodenum on the arrival of fatty food

34
Q

what are the boundaries of Calot’s triangle

A

the inferior edge of the right lobe of the liver
common hepatic duct
cystic duct

used to surgically locate the cystic artery during cholecystectomy
variation is common
the cystic duct and cystic artery must be ligated during surgery

35
Q

where is referred pain from the gall bladder

A

epigastrium (T7-9)

irritation of the peritoneum may refer pain to the shoulder tip

36
Q

what might cause painless jaundice

A

carcinoma of the head of the pancreas which obstructs the gall bladder

37
Q

what does ERCP stand for

A

Endoscopic, retrograde, cholangio pancreaticogram

to look for gallbladder stones

38
Q

what structures lie at the transpyloric plane (L1, through the tips of the 9th costal cartilage)

A 
fundus of gall bladder
pylorus
neck of pancreas
formation of portal vein hilum of kidney
spinal cord ends at l1/2
aortal and origin of SMA
IVC
2nd part of duodenum
39
Q

what hormones are produced in the islets of Langerhans

A

insulin and glucagon

40
Q

where is the pancreas

A

retroperitoneal in epigastrium

lies in the C-shaped curve of the duodenum and extends towards the posterior abdominal wall from spleen to duodenum

41
Q

what are the relations of the pancreas

A 
duodenum
IVC
aorta
inf mesenteric vein 
inf mes artery
spleen
left kidney
splenic artery
coeliac trunk 
hepatic portal vein
Bile duct
42
Q

where is the pancreas tail

A

lienorenal ligament

the rest is secondarily retroperitoneal

43
Q

where does the pancreatic duct join the bile duct

A

hepatopancreatic ampulla

44
Q

what is the Sphincter of Oddi

A

sphincters:
1 around the end of the pancreatic duct
2 around the end of the bile duct
3 around the combined ducts

45
Q

where does the pancreas receive its blood supply from

A

coeliac trunk to gastroduodenal artery which goes to the pancreas
splenic artery which goes to the greater and dorsal pancreatic branches
SMA which goes to the inferior pancreaticoduodenal artery and then the ant and post branches

46
Q

where does lymph from the pancreas drain to

A

coeliac and superior mesenteric lymph nodes

47
Q

what is the nerve supply of the pancreas

A

t7-9 and T10-11

so difficult to diagnose pain

48
Q

what is the venous drainage of the pancreas

A

sup and inf pancreaticoduodenal veins
sup mes. veins, inf mes veins
splenic vein
portal vein

49
Q

where is Morison’s pouch

A

between the liver and the right kidney , aka right hepatorenal space

50
Q

where is the subphrenic space

A

between the diaphragm and the liver, anteriorly

51
Q

what are the branches of the coeliac trunk

A

left gastric
common hepatic
splenic

52
Q

what are the branches of the common hepatic artery

A

proper hepatic
gastroduodenal
right gastric

53
Q

what are the branches of the splenic artery

A

greater pancreatic
short gastric
dorsal pancreatic
left gastric omental

54
Q

where does the cystic duct join the hepatic duct

A

free edge of the lesser omentum

55
Q

where is the common bile duct

A

lies in the free margin of the lesser omentum. Then behind the first part of the duodenum to the right of the gastroduodenal artery
then on the posterior surface of the head of the pancreas

56
Q

what are the tributaries of the portal vein

A

splenic vein , IMV and SMV

found posterior to the neck of the pancreas

57
Q

where does the accessory pancreatic duct empty to

A

the minor duodenal papilla

58
Q

what does infrahepatic mean

A

below the liver- portal vein thrombosis or splenic vein thrombosis - causes of portal hypertension or splenomegaly

59
Q

where is the portal vein in relation to the hepatic artery

A

behind

60
Q

what is the sympathetic supply of the liver

A

greater splanchnic nerve T5-9 from the coeliac plexus

61
Q

what are the relations of the gall bladder

A

pylorus
transverse colon
1st part of duodenum
quadrate lobe of the liver

MD3002 (56 decks)

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