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Anatomy > Liver, Gall Bladder, and Pancreas > Flashcards

Liver, Gall Bladder, and Pancreas Flashcards

1
Q

Liver location

A

Upper right and part of the upper left quadrants of the abdomen

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2
Q

Liver functions

A

. Exocrine (bile) and endocrine secretion
. Removal of toxins from the blood
. Glycogen storage
. Synthesis of clotting factor and other essential proteins

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3
Q

Inferior border of liver

A

. Sharply defined margin separating diaphragmatic and visceral surfaces
. Extends inf. To costal margin in epigastric region

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4
Q

Diaphragmatic surface of liver

A

. Related to diaphragm and ant. Body wall

. Covered w/ visceral peritoneum except for the bare area that contacts the diaphragm posteroinferiorly

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5
Q

Visceral surface of liver

A

. Posteroinferiorly and toward the left
. Covered by visceral peritoneum and attached to adjacent structures by peritoneal ligaments
. Subdivided by fissures and grooves including porta hepatis, cystic fossa, IVC groove, ligamentum teres hepatis fissure, and ligamentum venosum fissure

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6
Q

Porta hepatis

A

Transverse fissure transmitting the hepatic aa., hepatic ducts, branches of hepatic portal v., nerves, and lymphatics

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7
Q

Cystic fossa

A

Gallbladder bed

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8
Q

Ligamentum teres hepatis

A

Obliterated fetal umbilical v.

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9
Q

Ligamentum venosum

A

Obliterated fetal ductus venosus

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10
Q

Falciform ligament

A

. Derivative of embryonic ventral mesentery
. Attaches liver to diaphragm and ant. Abdominal wall
. Ligamentum teres hepatis lies in its free inf. Margin

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11
Q

Coronary ligaments

A

. Reflections of peritoneum from diaphragmatic surface of the liver to the inf. Surface of the diaphragm
. Encircle bare area of the liver

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12
Q

Subphrenic recess

A

. Potential space btw visceral peritoneum on liver’s diaphragmatic surface and parietal peritoneum lining inf. Surface of diaphragm
. Divided by falciform ligament into separate R/L recesses

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13
Q

Hepatorenal recess (pouch of Morison)

A

. Potential space btw parietal peritoneum ant. To R kidney and visceral peritoneum on the liver’s visceral surface
. Communicates w/ R subphrenic recess and omental bursa
. In supine a potential site of fluid accumulation

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14
Q

Liver anatomical lobes

A 
. Defined by fissures for ligamentum teres hepatis and ligamentum venosum, cystic fossa, porta hepatis, and IVC groove 
. Right lobe: largest
. Left lobe: 1/6 of liver volume 
. Quadrate: inf. And ant. 
. Caudate: inf. And post.
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15
Q

Hepatobiliary functional lobes

A

. Functional units defined by branching of biliary ducts and blood vessels
. R/L hepatobiliary lobes

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16
Q

Right hepatobiliary lobe

A

. Supplied by R hepatic a. And right branch of hepatic portal v.
. Drained by R hepatic duct
. Includes parts of R anatomical and caudate lobes

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17
Q

Left hepatobiliary lobe

A

. Supplied by L hepatic a. And left branch of hepatic portal v.
. Drained by L hepatic duct
. Includes L anatomical and quadrate lobes as well as portions of R anatomical and caudate lobes

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18
Q

Hepatobiliary divisions and segments

A

. Further branching of the biliary tree and its accompanying vessels
. Each lobe divided into 2 divisions
. 3 of 4 divisions are divided horizontally into 2 segments
. 4th division and the caudate lobe are considered separate segments, yielding 8 segments
. Self-contained functional units and segmental hepatic aa. Are end aa.

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19
Q

Liver transplant

A

1+ hepatobiliary segments are harvested w/ blood vessels and duct system intact
. Has inherent capacity for regeneration

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20
Q

Liver receives ____% of total cardiac output

A

20

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21
Q

Proper hepatic a.

A

. Only 20% of liver blood supply but majority of O2
. R hepatic a.: supplies R hepatobiliary lobe and gives rise to cystic a.
. L hepatic a.: supplies L hepatobiliary lobe

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22
Q

Hepatic portal v.

A

. 80% of liver blood supply
. Nutrient rich but O2 poor
. Formed by sup. Mesenteric and splenic vv. Union
. Connects capillary beds of GI tract and liver sinusoids
. Courses in R free margin of hepatoduodenal ligament post. To proper hepatic a. And bile duct

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23
Q

Portal v. Conveys _____ to the liver

A

. Substances absorbed by intestines

. Bilirubin and other products of RBC breakdown that are metabolized and secreted as bile pigment

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24
Q

Hepatic vv.

A

. Arterial and venous blood mingle in liver sinusoids before draining to IVC via R/L/middle hepatic vv.
. Tributaries of hepatic vv. Are intersegmental
. Drain more than one hepatobiliary segment

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25
Q

Intrasegmental branches in liver

A

. Occurs in portal vein and hepatic aa.

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26
Q

Portal venous system

A

. Valveless venous system

. Conveys nutrient-rich venous blood from GI system to liver via hepatic portal v.

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27
Q

Portosystemic (portacaval) anastomses

A

. Regions of overlap btw portal and system venous return

. Located at either end of GI tract and wherever GI organs come into direct contact w/ body wall (retroperitoneal)

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28
Q

Lower esophagus portosystemic anastomoses

A

. Esophageal tributaries of azygos system anastomose w/ esophageal tributaries of L gastric v.

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29
Q

Anal canal portosystemic anastomosis

A

. Rectal vv. Anastomose w/in rectal submucosa

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30
Q

Ant. Abdominal wall paraumbilical vv. Portosystemic. Anastomosis

A

. W/in falciform ligament

. Anastomose w/ sup. Veins in ant. Abdominal wall

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31
Q

Bare area of liver portosystemic anastomosis

A

Btw liver parenchyma and tributaries fo inf. Phrenic vv.

32
Q

Portal hypertension

A

. Obstruction of venous return through liver
. Leads to inc. pressure in portal system and enlargement of anastomatic channels
. Can be caused by alcohol cirrhosis

33
Q

Gastroesophageal varices

A

. Engorged vv. In esophageal submucosa

. Rupture leads to life-threatening

34
Q

Caput medusae

A

Enlarged superficial vv. Radiated from umbilicus

. Observed in most extreme cases of portal hypertension

35
Q

Ascites

A

Accumulation of serous fluid in peritoneal cavity

36
Q

Portosystemic shunts

A

. Portal hypertension causes portal venosus pressure may be dec. by creation of surgical anastomoses btw portal v. And systemic venous return

37
Q

Portacaval shunt

A

Diversion of the portal vein into IVC

38
Q

Splenorenal shunt

A

Diversion of splenic v. Into left renal vein

. Necessitates removal of spleen

39
Q

Transjugular intrahepatic portosystemic shunting (TIPS)

A

. Stent used to create a shunt btw hepatic portal v. And hepatic v.

40
Q

Liver innervation

A

Hepatic plexus

41
Q

Liver sympathetic fibers

A

. Presynaptic Conveyed by greater splanchnic nn.
. Synapse in celiac plexus
. Post-synaptic fibers follow arterial pathways to reach liver

42
Q

Liver parasympathetic fibers

A

. Carried by ant. And post. Vagal trunks contribute to celiac plexus
. Follow arterial pathways to synapse on or near their target tissues

43
Q

Visceral sensory liver fibers

A

. Cell bodies are located in dorsal root ganglia of T5-9(10)

. Fibers conveyed by greater splanchnic nn. And folllow sympathetic pathways in a retrograde direction

44
Q

Liver lymphatics

A

. Liver produces 1/3 of lymph drained by thoracic duct
. Superficial lymphatics: deep to fibrous capsule of liver, post. Liver branches drain to phrenic lymph nodes or accompany hepatic vv. And IVC to each post. Mediastinal lymph nodes
. Deep lymphatics: follow branching of biliary tree
. Deep and superficial drain to cisterna chyli

45
Q

Gallbladder

A

. Pear-shaped sac 10 cm long
. Adherent to cystic fossa on visceral surface of the liver at the function of the R and quadrate anatomical lobes
. Inf. Surface invested w/ peritoneum continuous w/ visceral peritoneum of the liver
. Stores and concentrates bile
. Contracts to discharge bile into duodenum via biliary duct system in response to hormones

46
Q

Gall bladder anatomical relations

A

. Sup: separated from visceral surface of liver by fibrous liver capsule (no intervening peritoneum)
. Ant: projects on ant. Abdominal wall at level of transpyloric plane, at tip of R 9th costal cartilage
. Inf.: contact w/ transverse colon and 2st sup. Portion of duodenum

47
Q

Gall bladder anatomical divisions

A

. Fundus: rounded ant. End
. Body: main saccular portion
. Neck: narrow post. Portion continuous w/ cystic duct
. Infundibulum (Hartmann’s pouch): dilation at junction of neck and cystic duct, assoc. w/ gallbladder disease, not always present

48
Q

Cystic duct

A

. Continuous w/ neck of gallbladder

. Mucosa is thrown into spiral folds which maintain patency of the duct and function as a valve

49
Q

Hepatic ducts (R/L)

A

. Intrahepatic biliary ducts unite to form the right and left hepatic ducts
. Drain the right and left hepatobiliary lobes

50
Q

Common hepatic duct

A

. Formed by union of the right and left hepatic ducts

51
Q

Bile duct

A

. Formed by union of cystic and common hepatic ducts
. Lies in free right margin of hepatoduodenal ligament, ant. To hepatic portal v. And right of proper hepatic a.
. Passes post. To 1st (sup.) portion of duodenum and head of the pancreas
. Joins terminal portion of main pancreatic duct to form hepatopancreatic ampulla of Vater

52
Q

Major duodenal papilla

A

. Ampulla empties into 2nd (descending) portion of duodenum

53
Q

Sphincter of the bile duct

A

. Duct joins ampulla
. Regulates flow of bile
. Circular smooth muscle fibers in walls of bile duct and ampulla

54
Q

Hepatopancreatic sphincter of Oddi

A

. Ampulla opens on the major duodenal papilla

. Regulates discharge of bile and pancreatic secretions

55
Q

Gall bladder blood supply

A

. Cystic a. Supplies majority of blood to gallbladder, cystic duct, and portions of hepatic and bile ducts
. Cystic a. Arises as branch of R hepatic a. And courses post. To common hepatic duct to reach cystic duct and gall bladder
. cystic a. Located w/in cystohepatic triangle of Calot
. Cystic vv. Drain to portal v. Or directly to liver

56
Q

Cystohepatic triangle of Calot

A

. Visceral surface of the liver
. Cystic duct
. Common hepatic duct

57
Q

Cholecystectomy complications

A

. Small vv. From gallbladder drain directly to liver and produce bleeding
. Variations in branching patterns of biliary ducts and blood vessels are common and contribute to high incidence of complications in gallbladder surgeries

58
Q

Lymphatic drainage of gallbladder

A

. Follows blood supply

. Drains to cystic and hepatic lymph nodes before reaching celiac lymph nodes

59
Q

Gallbladder innervation

A

. Gallbladder and biliary ducts supplied by hepatic plexus fibers

60
Q

Biliary function

A

. When sphincter of bile duct is closed, bile secreted by liver is diverted to gallbladder for storage and concentration
. Ingestion of fatty foods triggers release of hormones that cause gallbladder to contract and sphincters relax, delivering bile to duodenum
. Blockage of biliary ducts causes bile to back up into liver producing jaundice

61
Q

Biliary colic

A

. Gallbladder pain referred to epigastric region of ant. Abdominal wall (T5-9) and is typically diffuse
. Severe inflammation involves parietal peritoneum which is innervated by somatic afferent fibers
. Sharp pain to R hypochondriac region can radiate to inf. Angle of R scapula
. Reflexive contraction of muscles innervated by involved nn. Causes abdominal rigidity
.

62
Q

Inflammation of diaphragmatic region innervated by phrenic n. (C3-5) may cause ____

A

Referred pain in right neck and shoulder

63
Q

Cholecystitis

A

. Gall bladder disease
. Most common in obese women of middle age that had have multiple pregnancies
. Chronic symptoms may be exacerbated after eating and when supine due to shifting of stones into bladder neck
. Gallstone impaction produces severe, acute symptoms
. May require surgical innervation

64
Q

Pancreas anatomical relations

A

. Secondarily retroperitoneal
. Lies transversely across post. Abdominal wall at L2 level
. Located post. To stomach, ant. To sup. Mesenteric vessels btw duodenum and spleen

65
Q

Pancreas head

A

. Lies w/in C-loop of duodenum and immediately ant. To and in contact w/ IVC, R renal vessels, and L renal v.

66
Q

Uncinate process of pancreas

A

. Inferomedial projection of the head post. To sup. Mesenteric vessels

67
Q

Pancreas neck

A

. Narrowing btw head and body

. Lies ant. To sup. Mesenteric vessels and post. To pyloric of stomach

68
Q

Pancreas body

A

. Extends transversely to left

. Lies immediately ant. To abdominal aorta, L suprarenal glands, L kidney, and renal vessels

69
Q

Pancreas tail

A

Tapering terminal portion related to L kidney, hilus of spleen, and L colic flexure

70
Q

Main pancreatic duct

A

. Drains tail and body of pancreas
. Turns inf. W/in head of pancreas and joins bile duct to form hepatopancreatic ampulla that drains to duodenum at major duodenal papilla

71
Q

Accessory pancreatic duct

A

. Drains head of pancreas and empties at the minor duodenal papilla sup. To major papilla
. Communicates w/ main pancreatic duct, provides alternate outlet for pancreatic secretions

72
Q

Pancreas blood supply

A

. Head of pancreas supplied by parallel arterial arcades domed by ant. And post. Branches of sup. And inf. Pancreaticoduodenal aa.
. Body and tail of pancreas are supplied by pancreatic branches of splenic a.
. Pancreatic vv. Drain to hepatic portal v.

73
Q

Pancreas lymphatics

A

. Follow arterial pathways
. Filtered through pancreaticosplenic lymph nodes distributed along splenic a. But some passes to pyloric lymph nodes before reaching Celiac lymph nodes

74
Q

Pancreas sympathetic fibers

A

. Presynaptic Thoracic splanchnic nn.

. Postsynaptic: celiac and sup. Mesenteric plexuses and follow arterial fibers

75
Q

Parasympathetic fibers on pancreas

A

. Ant. And post. Vagal trunks
. Participate in formation of celiac and sup. Mesenteric plexuses and follow arterial pathways to synapse near target tissue

76
Q

Pancreas visceral sensory

A

. Cell bodies located in dorsal root ganglia of T5-10

. Follow sympathetic pathways in retrograde direction

Anatomy (49 decks)

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