liver, gall bladder and pancreas Flashcards
what is Glisson’s capsule
A layer of connective tissue surrounding the liver and ensheathing the hepatic artery, portal vein, and bile ducts within the liver.
how does bile produced in the liver reach the gall bladder
canaliculi > bile ductules> cystic duct > common hepatic ducts > right and left hepatic ducts
what is bile made of
bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water and electrolytes
what do Kupffer cells do
form bile products from haemoglobin
break down old red blood cells
what are the functions of the liver
synthesis of bile, storage of glucose, glycogen, proteins, vitamins and fats
detoxification
synthesis of clotting and anticoagulant factors
describe a liver lobule
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
where is the diaphragmatic surface of the liver
antero superior
where is the visceral surface of the liver
postero-inferior
what separates the right and left lobes of the liver
falciform ligament
where is the quadrate lobe of the liver
next to the gall bladder, inferiorly on the posterior surface of the liver. Part of the right lobe
where is the caudate lobe of the liver
next to the IVC
superior to the quadrate lobe
what is the porta hepatis
houses the portal triad: portal vein, hepatic artery and bile ducts
where is ligamentum teres (obliterated umbilical vein)
in the free border of the falciform ligament at the inferior border of the liver
where is the ligamentum venosum (obliterated ductus venosus)
in the lesser omentum
from a functional perspective, what lobe are the quadrate and caudate lobes part of
the left lobe
how can the liver be functionally divided
into Couinaud liver segments, related to their distribution from the portal veins and artery
what forms the left and right triangular ligament
coronary ligaments
liver ligaments are reflections of peritoneum that surround the bare area
what is the bare area related to
diaphragm, IVC, right kidney, right supra renal gland
what is the blood supply of the liver
proper hepatic artery which is a branch of the coeliac trunk divides into right and left terminal branches that enter the porta hepatis
where do the hepatic veins exit the liver
from the posterior surface of the liver an drain to IVC
where does lymph from the liver go
lymph nodes surrounding the porta hepatis
efferent vessels pass to the coeliac nodes
some go to the posterior mediastinal lymph nodes
how might cancer obstruct the bile ducts
retrograde tumour spread from the coeliac nodes to the hepatic nodes
this would cause jaundice
what is the nerve supply of the liver
sympathetic nerves form the coeliac plexus- T5-9- greater splanchnic
the anterior vagal trunk gives rise to a large parasympathetic hepatic branch
describe the shape and function of the gall bladder
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
where is the gall bladder
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
where does the cystic duct join the hepatic duct
free edge of the lesser omentum
what lies posterior to the duodenum
IVC and hilum of right kidney
what is the spiral valve of Heister
a fold in the cystic duct which functions to keep the lumen constantly open
what is the blood supply of the gall bladder
cystic artery which is a branch of the right hepatic artery
what is the venous drainage of the gall bladder
cystic vein which drains straight to the portal vein
what is the lymph drainage of the gallbladder
cystic lymph node near the neck of the gall bladder
then to the hepatic nodes and coeliac nodes
what is the nerve supply of the gall bladder
sympathetic- foregut T5-9 and parasympathetic vagal fibres from the coeliac plexus
what hormone causes contraction of the gallbladder
cholecystokinin which is produced by the mucous membrane of the duodenum on the arrival of fatty food
what are the boundaries of Calot’s triangle
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
where is referred pain from the gall bladder
epigastrium (T7-9)
irritation of the peritoneum may refer pain to the shoulder tip
what might cause painless jaundice
carcinoma of the head of the pancreas which obstructs the gall bladder
what does ERCP stand for
Endoscopic, retrograde, cholangio pancreaticogram
to look for gallbladder stones
what structures lie at the transpyloric plane (L1, through the tips of the 9th costal cartilage)
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
what hormones are produced in the islets of Langerhans
insulin and glucagon
where is the pancreas
retroperitoneal in epigastrium
lies in the C-shaped curve of the duodenum and extends towards the posterior abdominal wall from spleen to duodenum
what are the relations of the pancreas
duodenum IVC aorta inf mesenteric vein inf mes artery spleen left kidney splenic artery coeliac trunk hepatic portal vein Bile duct
where is the pancreas tail
lienorenal ligament
the rest is secondarily retroperitoneal
where does the pancreatic duct join the bile duct
hepatopancreatic ampulla
what is the Sphincter of Oddi
sphincters:
1 around the end of the pancreatic duct
2 around the end of the bile duct
3 around the combined ducts
where does the pancreas receive its blood supply from
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
where does lymph from the pancreas drain to
coeliac and superior mesenteric lymph nodes
what is the nerve supply of the pancreas
t7-9 and T10-11
so difficult to diagnose pain
what is the venous drainage of the pancreas
sup and inf pancreaticoduodenal veins
sup mes. veins, inf mes veins
splenic vein
portal vein
where is Morison’s pouch
between the liver and the right kidney , aka right hepatorenal space
where is the subphrenic space
between the diaphragm and the liver, anteriorly
what are the branches of the coeliac trunk
left gastric
common hepatic
splenic
what are the branches of the common hepatic artery
proper hepatic
gastroduodenal
right gastric
what are the branches of the splenic artery
greater pancreatic
short gastric
dorsal pancreatic
left gastric omental
where does the cystic duct join the hepatic duct
free edge of the lesser omentum
where is the common bile duct
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
what are the tributaries of the portal vein
splenic vein , IMV and SMV
found posterior to the neck of the pancreas
where does the accessory pancreatic duct empty to
the minor duodenal papilla
what does infrahepatic mean
below the liver- portal vein thrombosis or splenic vein thrombosis - causes of portal hypertension or splenomegaly
where is the portal vein in relation to the hepatic artery
behind
what is the sympathetic supply of the liver
greater splanchnic nerve T5-9 from the coeliac plexus
what are the relations of the gall bladder
pylorus
transverse colon
1st part of duodenum
quadrate lobe of the liver
