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OS 206: Abdomen and Pelvis > Liver, Gall Bladder and Stomach > Flashcards

Liver, Gall Bladder and Stomach Flashcards

1
Q

What is the largest gland in the body?

A

Liver

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2
Q

T/F

The liver is the third largest single organ.

A

F

The liver is the SECOND largest single organ (next to the skin).

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3
Q

The liver is ___ % of an adult’s body weight, ___ % of the total fetal weight.

A

2.5 %, 5 %

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4
Q

During fetal development, what is the function of the liver?

A

It is a hematopoetic organ.

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5
Q

The liver can be found in which quadrant and region of the body?

A

RUQ of the abdomen;

R Hypochondrium, Epigastric, and L Hypochondrium

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6
Q

T/F

The liver is enclosed by peritoneum.

A

F

The liver is surrounded by peritoneum except on the BARE AREA of the liver.

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7
Q

Where can one find the bare area of the liver?

A

Posterosuperior aspect of the liver;

Closely related to the diaphragm

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8
Q

What is the tight fibrous capsule that encloses the liver?

A

Glisson’s Capsule

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9
Q

What is the location of the liver with respect to the ribs and surface anatomy?

A

It is deep to the 7th-11th ribs and crosses the midline towards the left nipple.

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10
Q

What structures protect the liver?

A

Anteriorly: Lower rib cage
Posteriorly: muscles and bones of the abdominal cavity

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11
Q

Identify the functions of the liver.

A

(1) Glycogen storage
(2) Bile secretion
(3) other metabolic actities

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12
Q 
T/F
All nutrients (except fat) absorbed from the digestive tract are initially conveyed to the liver by the portal venous system.
A

T

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13
Q

Path of Bile (from liver)

A

Liver (via biliary ducts/ R and L hepatic ducts) -> Common Hepatic Duct -> (+ cystic duct) -> Common Bile Duct

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14
Q

What are the five ligaments of the liver?

A

(1) Falciform Ligament
(2) Coronary Ligament
(3) R Triangular Ligament
(4) L Triangular Ligament
(5) Round Ligament

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15
Q

The falciform can be divided into:

A

R and L leaflet

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16
Q

Location of the falciform

A

from the umbilical notch on the inferior surface of the liver portal hepatis

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17
Q

Function of the falciform ligament:

A

(1) subdivided the subphrenic spac

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18
Q

T/F

The R leaflet becomes the R triangular ligament while the L leaflet becomes the coronary ligament

A

The R leaflet becomes the coronary, while the L leaflet becomes the L triangular ligament.

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19
Q

Function of the Right Triangular Ligament

A

It attaches the liver to the undersurface of the right leaflet of the diaphragm.

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20
Q

Location of the round ligament

A

found at the base of the falciform from the umbilicus

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21
Q

The round ligament is continuous with what structure?

A

Ligamentum Venosum

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22
Q

Embryonic Function of the ligamentum venosum

A

fibrous remnant of the fetal ducts venosus;

Shunts blood from the umbilical vein to the IVC

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23
Q

Enumerate the “H” Fissures of the liver

A

Right Limb:
Anterior Right - Fossa for the Gall Bladder
Posterior Right - Groove for the IVC

Left Limb:
Anterior Left - fissure for ligamentum teres
Posterior Left - fissure for ligamentum venosum

Crossbar of "H": Porta Hepatis, which contains:
Common Hepatic Duct
Hepatic Artery
Hepatic Portal Vein
Hepatic Nerve Plexus
Lymphatic vessels
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24
Q

What is the significance of the “H” fissure?

A

It divides the liver into four lobes (R, L, caudal, quadrate).

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25
Q

T/F

The liver is divided into four anatomical lobes.

A

F

The liver is divided into two anatomical lobes and two accessory lobes.

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26
Q

T/F

The R and L lobes do not communicate.

A

T

Each lobe has own arterial supply, venous drainage, and biliary drainage.

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27
Q

T/F

The caudate lobe is not located in the caudal position.

A

T
The caudate lobe is not positioned caudally. It is named as such because of the “tail” or the ELONGATED PAPILLARY PROCESS.

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28
Q

What is the function of the elongated papillary process?

A

It connects the caudate and right lobes of the liver.

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29
Q

T/F

The right and left livers are functionally dependent with one another.

A

F

The two lobes of the liver are functionally independent.

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30
Q

What are the vessels that supply and drain the liver? What drains the liver contents?

A

Hepatic artery and Hepatic Portal Vein

Hepatic Duct

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31
Q

What vessels drain and supply the caudate lobe?

A

The caudate receives blood from branches of both hepatic arteries and is drained by two or three small hepatic veins that enter directly to the IVC.

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32
Q

The liver can be divided into four divisions and into eight surgically resectable hepatic segments. Clinical Significance?

A

minimize bleeding during hepatic lobectomies and segmentectomies

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33
Q

What encloses the portal triad?

A

Lesser Omentum

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34
Q

Enumerate and differentiate the the two ligaments of the lesser omentum

A

Hepatogastric Ligament: connects stomach to liver

Hepatoduodenal Ligament: connects the liver to the duodenum

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35
Q

What are the three main hepatic veins?

A

Right, Central and Peripheral Hepatic Veins

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36
Q

Aside from the venous drainage, what is the importance of the hepatic veins? (Hint: related to the pathway of the veins)

A

The connection of the hepatic veins with the IVC helps hold the liver in position.

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37
Q

T/F

The liver is a major lymph-producing organ.

A

T

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38
Q

How much of the lymph entering the thoracic duct comes from the liver?

A

1/4 to 1/2

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39
Q

Where does most of the lymph form in the liver and where does it drain?

A

Most of the lymph form in the perisinusoidal spaces of Disse and it drain to the DEEP LYMPHATICS in the surrounding intralobular portal triads.

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40
Q

T/F

The liver only receives sympathetic fibers.

A

F

The liver receives both sympathetic and parasympathetic fibers via the CELIAC PLEXUS.

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41
Q

What nerves contribute fibers for the innervation of the liver?

A

L and R vagus and R phrenic nerve

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42
Q

What are the spaces between the diaphragm, transverse colon and transverse mesocolon?

A

Perihepatic Spaces

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43
Q

What are the two divisions of the perihepatic spaces?

A

Infrahepatic space

Suprahepatic space

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44
Q

Where is the suprahepatic space located?

A

between the diaphragm and the liver;

anterosuperior surface of the liver

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45
Q

Where is the infrahepatic space located?

A

between the visceral surface of the liver and the transverse colon;
inferior surface of the liver

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46
Q

During liver biopsy, through which ICS is the needle inserted in?

A

right 10th ICS in the midaxillary line

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47
Q

T/F

Before liver biopsy, the patient is asked to hold his/her breathe in .

A

F
Before liver biopsy, the patient is asked to hold his/her breath in full expiration to reduce the costodiaphragmatic recess.

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48
Q

What is one cause of the hepatomegaly?

A

Congestive heart failure tumor and bacterial/viral disease (e.g hepatitis)

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49
Q

What is a proposed underlying cause of “runner’s stitch”?

A

Enlargement of the liver + sustained/increased diaphragmatic activity

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50
Q

What is the progressive destruction of hepatocytes and replacement by fat?

A

Cirrhosis of the liver

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51
Q

What can cause cirrhosis of the liver?

A

Chronic Alcoholism, Industrial Solvents (e.g. carbon tetrachloride)

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52
Q

Treatment for cirrhosis of the liver?

A

Surgical creation of a portosytemic or,portocaval shunt, anastomosing the portal and systemic systems

53
Q

What can be used as a guide during hepatic segmentectomies?

A

The right, immediate, and the left hepatic arteries can be used as guides to the fissures between the divisions.

54
Q

T/F

The liver is easily ruptures because it is a large, fixed in position and friable.

A

T

Liver lacerations can often cause considerable hemorrhage and RUQ pain.

55
Q

T/F

The liver is the most common site of metatastic carinoma.

A

T

56
Q

Enumerate the four surfaces of the liver

A

(1) Anterosuperior
(2) Posterosuperior
(3) Right Lateral
(4) Inferior

57
Q

What structure is closely related to the anterosuperior surface of the liver?

A

This surface snugly fits into the cupola of the diaphragm.

58
Q

What structures can be found/associated with the posterosuperior surface of the liver?

A

IVC (found on the posterior surface of the caudate lobe)
Suprarenal Impression
Bare Area of the liver

59
Q

What is the significance of the inferior surface?

A

Separates the diaphragmatic and visceral surfaces

60
Q

What organs come in contact with the inferior surface of the liver?

A

Stomach, Colon, Kidney, Duodenum, Esophagus, Right Suprarenal Gland

61
Q

Another name for the hepatorenal recess

A

Hepatorenal pouch, Morrison’s pouch

62
Q

Where is the hepatorenal pouch located?

A

posterosuperior extension of the subhepatic space;

between the right part of the visceral surface of the liver, the right kidney and the suprarenal gland

63
Q

What is the gravity-dependent part of the peritoneal cavity wherein fluid drains into when in the supine position?

A

Morrison’s Pouch

64
Q

What is carried by the hepatic artery? by the hepatic portal vein?

A

Artery: Oxygenated Blood
Vein: Venous Blood

65
Q

Where does the renal, phrenic, lumbar and intercostal veins receive blood from?

A

mesenteric, pancreatic and other veins

66
Q

T/F

The tertiary branches of the hepatic artery is able to supply independently the eight lobes of the liver.

A

F
Only seven of the eight lobes are supplied independently by the tertiary branches of the hepatic artery.

Hepatic artery -> Divide into R and L -> Secondary Branches (to supply medial and lateral) -> Tertiary branches (7 of 8 hepatic segments)

67
Q

What joins to form the hepatic portal vein?

A

The union of the superior mesenteric and splenic veins

68
Q

What is the normal size of a gall bladder (in cm)?

A

7-10 cm long

69
Q

Where is the gall bladder located (vis-à-vis liver)?

A

in the fossa of the gall bladder, on the visceral surface of the liver

70
Q

Where is the gall bladder located (vis-à-vis small intestines)?

A

It naturally lies anterior to the superior part of the duodenum.

71
Q

Where does the neck and cystic duck connect?

A

to the superior part of the duodenum

72
Q

How much bile can the gall bladder hold?

A

50 ml

73
Q

What are the four parts of the gall bladder?

A

(1) Fundus
(2) Body
(3) Infundibulum
(4) Neck

74
Q

What is formed by the angle made by the lateral border of the rectus abdominis and the 9th costal cartilage?

A

Tip of the fundus (of the gall bladder)

75
Q

The fundus of the gall bladder is associated with which part of the duodenum?

A

descending part of the duodenum

76
Q

What is in contact with the body of the gall bladder?

A

Inferior surface of the liver, right part of the transverse and superior part of the duodenum

77
Q

What is the tapering transitional area between the body and the neck?

A

Infundibulum

78
Q

What attaches the first part of the duodenum to the infundibulum? What is its significance?

A 
Cholecystoduodenal ligament
(significance in the operative search for major vascular and ductal structures)
79
Q

What is the bulging inferior surface of the infundibulum of the gall bladder? What is its significance?

A

Hartman’s pouch

significance: used to mark the positions of the neck and cystic duct of the gall bladder

80
Q

What connects the gall bladder to the common hepatic duct?

A

Cystic Duct

81
Q

Course of the Cystic Duct

A

Cystic Duct -> Common Hepatic Duct -> common bile duct

82
Q

What is the function of the spiral valve of Heister?

A

(1) helps keep the cystic duct open

(2) offers additional resistance to sudden dumping of bile

83
Q

What is the clinical significance of the relationship between the gall bladder and the right colon?

A

The biliary stones can pass directly to the colon;

it allows for the early spread of carcinoma

84
Q

What is the arterial supply of the gall bladder?

A

Cystic Artery

85
Q

Where may the cystic artery arise from?

A

R hepatic artery
L hepatic artery
Common hepatic artery
superior mesenteric artery

86
Q

What does the cystic artery supply?

A

Gall Bladder and the Cystic Duct

87
Q

Where does the cystic artery commonly arise from?

A

R hepatic artery

88
Q

Describe the venous drainage of the gall bladder?

A 
There is no major cystic vein.
Cystic Vein (go in the liver ) -> Portal Capillary System
89
Q

Where does the lymphatics of the gall bladder drain into?

A

Cystic Lymph Nodes -> Hepatic Lymph Nodes

Efferent Lymphatic vessels pass to the celiac lymph nodes

90
Q

Referred Pain:

Irritation in the liver can manifest as…

A

pain in the ipsilateral neck and shoulder region

91
Q

Referred Pain:

Irritation in the gall bladder can manifest as…

A

pain in the T7 and T9 (until posterior) and infrascapular area

92
Q

Abdominal pain while in the crouching position may suggest…

A

appendicitis.

93
Q

Term for gall bladder inflammation

A

Cholecystitis

94
Q

What is the most dilated part of the alimentary canal between the esophagus and the small intestines?

A

Stomach

95
Q

In what region does the stomach lie in?

A

Epigastric, Umbilicus, and left hypochondriac region

96
Q

T/F

The stomach is retroperitoneal.

A

F

The stomach in intraperitoneal and is covered by visceral peritoneum except where the blood vessels run along.

97
Q

Identify the organs related to the anterior surface of the stomach

A

diaphragm, left lobe of the liver, anterior abdominal wall

98
Q

Identify the organs related to the posterior surface of the stomach

A

omental bursa and pancreas

99
Q

What are the three parts of the stomach?

A

(1) Fundus
(2) Body
(3) Pyloric Region

*The cardia was not considered as a “part” of the stomach by the lecturer.

100
Q

What part of the stomach is related to the left dome of the diaphragm

A

Fundus of the Stomach

101
Q

What structure lies on the horizontal plane which determines the inferior boundary of the fundus?

A

Cardiac Orifice

102
Q

Where is the cardiac notch located?

A

between the esophagus and the fundus

103
Q

What is the major portion of the stomach?

A

Body of the stomach

104
Q

The body of the stomach lies in contact with…

A

the left costal margin and upper anterior abdominal wall on the left side

105
Q

What is the funnel-shaped outflow region of the stomach?

A

Pyloric Region of the stomach

106
Q

What is the widest part of the pyloric region?

A

Pyloric Antrum (More promixal to the stomach proper)

107
Q

What groove divides the pyloric region?

A

Sulcus Intermedius

108
Q

What is the narrow part of the pyloric region?

A

Pyloric Canal (More distal to the stomach proper)

109
Q

What determines the level of the transpyloric plane?

A

It traverses the pyloric canal and sphincter

110
Q

Identify the two curvatures of the stomach

A

(1) Greater Curvature

(2) Lesser Curvature

111
Q

Identify the two orifices of the stomach

A

(1) Cardiac Orifice

(2) Pyloric Orifice

112
Q

Temporary Longitudinal folds; formed when gastric mucosa is contracted

A

Rugae

113
Q

T/F

One has more prominent gastric folds as you eat.

A

F

It diminishes and obliterates as the stomach is distended.

114
Q

What is temporarily formed during swallowing between the rugae of the mucosa along the lesser curvature?

A

Gastric Canal

115
Q

What are the two surfaces of the stomach?

A

(1) Anteriosuperior surface

(2) Posteroinferior surface

116
Q

The stomach bed is composed of the…

A 
Left suprarenal gland
Upper part of the alimentary canal
Splenic Artery
Anterior surface of the the pancreas
Diaphragm
Transverse colon
Left colic flexure
117
Q

What are the three primary branches of the celiac trunk?

A

(1) Splenic Artery
(2) L Gastric Artery
(3) Common Hepatic Artery

118
Q

Where does the arterial supply of the stomach come from?

A

(1) R & L Gastroepiploic Arteries
(2) R & L Gastric Arteries
(3) Short Gastric Arteries
(4) Inferior Gastric Arteries

119
Q

What supplies blood to the greater curvature of the stomach?

A

R & L Gastroepiploic Arteries

120
Q

What supplies blood to the lesser curvature of the stomach?

A

R & L Gastric Arteries

121
Q

What supplies blood to the fundus and upper body of the stomach?

A

Short Gastric Arteries and Inferior Gastric Arteries

122
Q

Describe the venous drainage o the stomach vis-à-vis the arterial supply.

A

The gastric veins are parallel to the arteries in positions and course

123
Q

What is the main draining vein?

A

Portal Vein

124
Q

What are the veins that drain the stomach? Which parts do they specifically drain?

A

(1) R and L Gastric Veins
(2) Splenic Veins - receives from short gastric and L gastroepiploic veins
(3) Superior Mesenteric Vein - receives from L gastroepiploic veins
(4) Prepyloric Vein - to the R gastric artery

125
Q

What is the clinical significance of the Prepyloric vein?

A

It is used to identify the pylorus

126
Q

Where are the lymphatic vessels of the stomach located?

A

(1) Along the left part of the lesser curvature
(2) Along the greater curvature and most of the pyloric region
(3) Along the left of the greater curvature
(4) Along a small part of the pyloric region

127
Q

Describe the parasympathetic nerve supply of the stomach

A

Anterior Vagal Trunk: derived from L vagus nerve and runs along the lesser curvature

AVT -> hepatic, duodenal, and anterior gastric branches

Posterior Vagal Trunk: derived from R vagus nerve and runs along the lesser curvature; supplies the anterior and posterior surface of the stomach

PVT -> celiac branch -> posterior gastric branches

128
Q

Describe the sympathetic nerve supply of the stomach

A

From T6-T9 segments -> celiac plexus -> distributed around the gastric and gastroepiploic arteries

OS 206: Abdomen and Pelvis (5 decks)

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