Liver, Gall Bladder, and Stomach Flashcards
Location of liver
RUQ, right hypochondriac, epigastric and left hypochondriac
enclosed by tight fibrous capsule of CT
Glisson’s capsule
Fxn of liver
Glycogen storage
Bile secretion
all nutrients absrobed from the digestive tract are conveyed to the liver via the
portal venous system
accumulates between meals and is stored in the gall bladder
bile
Extends from the umbilical notch on the inferior surface of the porta hepatis
Falciform ligament
Right leaflet of the falciform ligament becomes
the coronary ligament
Left leaflet of the falciform ligament becomes
Left triangular ligament
The right and left leaflets bear the
ligamentum teres or round ligament
Coronary ligament layers and where they are attached
Superior layer: superior surface on to the inferior surface of diaphragm
Inferior: psoterior surface of the R. lobe of liver to the R. kidney, R. suprarenal gland and IVC, aka Hepatorenal ligament
Where the upper and lower layers of the coronary ligament fuse
R. Triangular ligament
Left lobe of the liver connected to the undersurface of the diaphragm
Left Triangular Ligament, joins the lesser omentum
The obliterated umbilical vein
Ligamentum teres hepatis or round ligament
Forms the free border of the falciform ligament
Ligamentum teres hepatis or round ligament
round ligament becomes continuous with
ligamentum venosum, remnant of the fetal ductus venosus
remnant of fetal ductus venosus
Ligamentum venosum
shunts blood from the umbilis vein to the IVC
ductus venosus/ligamentum venosum
Gastrohelpatic ligament and hepatoduodenal ligament
porta hepatis
Fissures of the Liver
H - must know them
Porta hepatis contains the ff:
Anterior: common hepatic duct
Middle - hepatic artery
Posterior - portal vein
T/F Right and Left lobes do not communicate
True, they have their own arterial supply, venous and biliary drainage
Connects the caudate and the right lobe
caudate process
The subphrenic space is found in what surfaceof the liver
Anterosuperior
Bare are of the liver and the suprarenal impression is found in what surface?
Posterosuperior
extension of the subhepatic space, lying between the rifht part of the visceral surface of the liver, the right kidney and the suprarenal gland
Hepatorenal Recess/pouch, or Morrison’s Pouch
The groove for IVC passes towards
central tendon of the diaphragm
Vascular supply of the liver
Hepatic artery - carries O2 rich blood
Hepatid portal vein - carries venous blood
Renal, Phrenic, Lumbar and Intercostal veins
The liver has a double blood supply
Hepatic artery - 20-25%
Hepatic portal vein - 70-80%
The Hepatic Artery is a branch of
the celiac trunk
Formed by the union o fthe superior mesenteric and splenic veins
Hepatic portal vein
Carries virtually all of the nutrients absorbed into and bypass the liver via the lymphatic system
Hepatic portal vein
3 Main Hepatic Veins
Right, Central, Peripheral
Venous drainage of the liver
Central vein -> Collecting veins -> Hepatic veins -> IVC
Areas veins tend to be dilated and tortuous
Anal - hemorrhoid
Gastoesophageal - esophageal varices
Paraumbilical - caput medusae (liver cirrhosis or obstruction)
What connects intestinal veins with IVC and its retroperitoneal branches
Veins of Retzius
T/F between 2/4 to 3/4 of the lymph entering the thoracic duct comes from the liver
False. 1/4 to 1/2 comes from the liver
Subperitoneal fibrous capsule of the liver
Glisson’s capsule
Most lymph is formed in the
perisinusoidal spaces of Disse
Lymphatic system of the liver (anterior)
Superficial lymphatics from the anterior aspects of the deep diaphragmatic and visceral surfaces of the liver and deep lymphatic vessesl acompanying the portal triads -> Porta hepatis -> Hepatic LN -> Celiac LN -> Chyle cistern -> Thoracic Duct
Lymphatic system of the liver (posterior)
towards the bare area of the liver ->
Phrenic LN or
deep lyumpahtics -> posterior mediastinal lymph
Posterior surface of the left lobe (lymphatics)
esophagial hiatus -> Left gastric LN
Anterior central diaphragmatic surface (along falciform ligament)
parasternal LN
Along round ligament of the liver
umbilicus -> lymphatics of the AAW
Nerve supply of the liver
contains both sympathetic (celiac plexus) and parasympathetic (vagus) via the hepatic plexus
Receives filament from the.. (nerves)
R and L vagus and R. phrenic nerve
Largest derivative of the celiac plexus
Hepatic plexus
Perihepatic spaces
suprahepatic
infrahepatic
subphrenic
Peritoneum completely surrounds what part of the gallbladder
fundus
is the angle formed by the lateral border of the rectus abdominis and the 9th costal cartilage
tip of the fundus
The infundibulum is attached to the first part of the duodenum by the
cholecystoduodenal ligament (avascular, from the right part of the hepatoduodenal lig)
the bulging inferior surface of the infundibulum
Hartman’s pouch
connects the gallbladder to the common hepatid duct
Cystic duct
helps keep the cystic duct open
spiral valve of heister
T/F biliary stones can pass directly to the large bowel
True
Vascular supply of the gallbladder
Cystic Artery, the cystohepatic triangle of Calot
Lymphatics of the GB
Hepatic LN, cystic LN, Celiac LN
Nerve supply of gallbladder
celiac plexus (sympa and visceral afferent)
Vagus R, L (parasym)
R. Phrenic (sensory)
Referred pain: irritation in the liver
will manifest as pain the neck, and shoulder region
Shoulder pain also means biliary stones
Referred pain: irritation in the gallbladder
pain in T7 and T9 and infrascapular area
if the phrenic nerve is irritated
will cause ipsilateral pain in the shoulder and neck
gallbladdewr inflammation
cholecystitis
epigastric, umbilical and left hypochondriac region
stomach
The dilated superior part that is related tot he left dome of the diaphragm (part of stomach)
Fundus
Between the esophagus and the fundus
Cardiac notch
Stomach reaches which ICS
5th ICS
The pyloric canal and sphincter lie in what plane?
Transpyloric plane
Is a marked thickening of the circular layer of smooth muscle
Pylorus
Opening into the duodenum
pyloric orifice
Arteries that anastomose in the lesser curavature
R and L gastric arteries
Arteries that anastomose in the greater curvature
R and L gastroepiploic A.
Temporary longituinal folds formed when gastric mucosa is contracted
Rugae
temporarily formed during swallowing between longitudical gastric folds along the lesser curvature
gastric canal
Arterial supply of the stomach
R and L gastric
R and L gastroepiploic
Short and posterior gastric arteries
3 primary branches of the celiac artery
Left Gastric
Splenic Artery
Common Hepatic A.
Venous drainage of the stomach
Portal vein (main) *prepyloric vein - identifying the pylorus
Lymphatics drainage of the stomach
See picture
Nerve supply of the stomach
parasympatheic (ant L and post R vagus)
sympathetic (t6-T9 which passes to the celiac plexus thru the greater splanchnic nerve)