Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD3002 > Liver, Gall Bladder, Biliary System, and Pancreas > Flashcards

Liver, Gall Bladder, Biliary System, and Pancreas Flashcards

1
Q

What is the largest gland of the body ?

A

The liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where, in relation to the 9 abdominal regions, is the liver located ?

A

Lies across the upper abdomen under the diaphragm; in the right hyponchondrium and most of the epigastric region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the movement of the liver upon inspiration ?

A

The liver descends upon inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

To what extent is the liver surrounded by peritoneum ?

A

The liver IS surrounded by peritoneum, except for the bare area (related to the diaphragm posteriorly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which parts of the diaphragm are palpable ?

A

All but those below the costal margin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the largest organ in the body ? How much does it weight ? What percentage of total body weight is that ?

A

The liver
1200-1500 g
2-2.5% of total body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the coverings of the liver. What happens to those if surgery of the liver is performed ?

A
  • Covered by peritoneum
  • Below its peritoneal covering, the liver is completely surrounded by the Glisson’s capsule that is a thin CT layer sending extensions into the organ in between the lobules

Glisson’s capsule is NOT strong enough to hold sutures that may be required following trauma/surgery to the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Identify the main vessels of the liver.

A
  • Hepatic portal vein: formed by the superior mesenteric and splenic veins (latter receives inferior mesenteric vein), divides into R and L branches that enter the porta hepatis behind the arteries. Brings absorbed nutrients and drains veinous blood of stomach, small intestine, part of large intestine, pancreas, and spleen.
  • Hepatic artery proper: branch of celiac trunk, divides into R and L hepatic arteries that enter the porta hepatis. Supplies the hepatocytes with oxygen
  • Hepatic veins (three or more) emerge from the posterior surface of the liver and drain into the IVC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where is the bile produced ? How is it drained from this place ?

A

Bile is produced in the liver

Bile is drained through canaliculi that lie between the hepatocytes into bile ductules and eventually into bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Identify the veinous drainage of the liver.

A

Veinous drainage is by hepatic veins that enter the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main functions of the liver ?

A
  • Detoxification of metabolic waste
  • Synthesis and secretion of bile
  • Storage of glucose, glycogen, proteins, vitamins and fats
  • Synthesis of blood clotting and anticoagulant factors (firbinogen and prothrombin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Identify the main constituents of bile.

A

BILE

-Constituents: Bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), FAs, water, electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are bile pigments formed ?

A
  • Bile pigments are derived from the breakdown product of haemoglobin.
  • Kupffer cells (fixed phagocytes) play a role in the formation of bile pigments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the function of bile salts in bile ?

A
  • Bile salts are responsible for the detergent and emulsifying effect of bile on fats
  • Bile salts also increase the absorption of fats by the small intestine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define hepatic lobule.

A

“Group of hepatocytes radiating outward from a central vein in the center and the portal triads (portal vein, hepatic artery and bile duct)”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the direction of veinous blood and bile from the liver in hepatic lobules.

A

Blood from the hepatic portal vein and from the hepatic artery proper pass into the sinusoids and flow into the central vein.

Sinusoids lie between sheets of hepatocytes. Those hepatocytes produce bile, and this bile flows in the canaliculi between the hepatocytes towards biliary ducts (opposite direction from blood from artery proper and hepatic portal vein).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Identify the main surfaces and lobes of the liver.

A

SURFACES

  • Diaphragmatic (bare area is on the diaphragmatic surface)
  • Visceral
LOBES
Left
Right
Caudate
Quadrate
(From a functional/vascular distribution POV, caudate and quadrate lobes are part of L lobe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Identify the main ligaments associated with the liver, stating the location of each.

A
  • Falciform ligament (remnant of ventral mesentery), attaches the liver to the anterior abdominal wall and separates right and left liver lobes.
  • Ligamentum teres (lies in free border of falciform ligament)
  • Coronary ligament (anterior and posterior folds) – attaches the superior surface of the liver to the inferior surface of the diaphragm and demarcates the bare area of the liver. The anterior and posterior folds unite to form the triangular ligaments on the right and left lobes of the liver.

-Triangular ligaments (left and right):
The left triangular ligament is formed by the union of the anterior and posterior layers of the coronary ligament at the apex of the liver and attaches the left lobe of the liver to the diaphragm.
The right triangular ligament is formed in a similar fashion adjacent to the bare area and attaches the right lobe of the liver to the diaphragm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the ligaments of the liver made of ?

A

Those ligaments are reflections of peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the embryological origin of the following:

  • falciform ligament
  • ligamentum teres
  • ligamentum venosum
A
  • Falciform ligament is a remnant of the ventral mesentery
  • Ligamentum teres is the obliterated umbilical vein
  • Ligamentum venosum is the obliterated ductus venosus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is another name of ligamentum teres ?

A

Round ligament of the liver

22
Q

What is a liver segment ? How many are there ? What is the clinical significance of these segments ?

A
  • Liver is divided into 8 functionally independent segments
  • Each segment has own vascular inflow, outflow, and biliary drainage
  • This means that each segment can be surgically excised without affecting the others
23
Q

Describe the lymph drainage of the liver.

A
  • Lymph vessels leave the liver and enter several lymph nodes in the porta hepatis
  • Efferent vessels pass into celiac nodes
  • A few vessels pass from the bare area of the liver through the diaphragm to the posterior mediastinal lymph nodes
24
Q

How much lymph does the liver produce ?

A

1/3 to 1/2 of all body lymph

25
Q

What is the possible consequence of a retrograde tumour spread from the celiac nodes on the liver ?

A

Retrograde tumor spread from the celiac nodes may involve the hepatic nodes in the porta hepatis and obstruct the bile ducts causing jaundice

26
Q

Describe the nerve supply of the liver.

A

SYMPATHETIC: Sympathetic nerves from the celiac plexus (from foregut therefore greater splanchnic nerve, T5 to T9)
PARASYMPATHETIC: Anterior vagal trunk gives rise to a large parasympathetic hepatic branch that passes directly to liver

27
Q

What is the gall bladder ? Where is it located ?

A
  • Muscular sac in a shallow depression on the visceral surface of the right love of the liver
  • Concentrates and stores bile produced by the liver
28
Q

What are the main anatomical parts of the gall bladder ?

A

Fundus
Body
Neck

29
Q

Identify the main surface projections of the gall bladder.

A

Fundus of the gall bladder, at Murphy’s point, where right mid-clavicular line crosses the costal margin (at tip of right 9th CC, and where right linea semilunaris crosses the right costal margin)

30
Q

What is a positive Murphy’s sign indicative of ?

A

A positive Murphy’s point suggests acute cholecystitis (5F/6F disease)

31
Q

Describe the arterial supply, veinous drainage, and lymphatic drainage of the gallbladder.

A

GALL BLADDER

  • Arterial: Cystic artery (branch of right hepatic artery)- high variation
  • Veinous: Cystic vein drains into the portal vein
  • Lymphatic: Cystic lymph node located near the gallbladder neck. Lymph passes to the hepatic nodes along the course of the hepatic artery proper and then into the celiac nodes.
32
Q

Describe the nerve supply of the gall bladder.

A

Sympathetic: Sympathetic nerves from the celiac plexus (from foregut therefore greater splanchnic nerve, T5 to T9)
Parasympathetic: Vagal fibers from celiac plexus

33
Q

How long is the cystic duct ? What is its function ?

A

The cystic duct is 4 cm long

It joins the gall bladder to the common bile duct

34
Q

Describe the path of the cystic duct.

A
  • Cystic duct starts at gall bladder. Joins with the common hepatic duct (formed from R and L hepatic ducts) to form common bile duct (ductus choledochus), which runs in the hepatoduodenal ligament
  • The common bile duct then joins with the main pancreatic duct at the hepatopancratic ampulla (of Vater) before entering into the second (descending) part of the duodenum at major duodenal papilla.
  • Sphincter of Oddi present at around the final part of the common bile duct
35
Q

What is the diameter of the common bile duct ?

A

4-6 mm

36
Q

Define spiral valves of Heister.

A

The spiral valve of Heister are spiral folds present in the mucous membrane of the cystic duct and neck of the gall bladder.

37
Q

What are the components of the extrahepatic biliary tree ?

A

R and L hepatic ducts forming the common hepatic duct, which is joined by cystic duct to form common bile duct.

38
Q

What is a potential causes for common bile duct distention ?

A

Common bile duct may be slightly distended due to blockage by a stone at its distal end

39
Q

Define endoscopic retrograde cholangiopancreatogram (ERCP). What is this used for ?

A

“Use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems” (such as stones obstructing and dilating common bile duct)

40
Q

Where is pain from the gall bladder referred ?

A

Pain from the gall bladder is usually referred to the epigastrium (T7-T9). However, if the adjacent peritoneum is involved, pain may be referred to the right shoulder by the phrenic nerve (C3, 4, 5, supraclavicular nerve), or in between the scapulae.

41
Q

Describe the anatomical location of the pancreas.

A
  • Secondary retroperitoneal (except its tail)
  • Lies across the epigastrium close to major blood vessels
  • Extends from the duodenum to the hilum of the spleen
42
Q

What are the main anatomical parts of the pancreas ?

A 
Head
Neck
Body
Tail 
Uncinate process
43
Q

Where do the head and uncinate process of the pancreas lie anatomically ?

A

Head of the pancreas lies in duodenal arch

Uncinate process of the pancreas extends posterior to the superior mesenteric vessels

44
Q

Where does the main pancreatic duct begin ? Where does it open into the duodenum ?

A
  • The main pancreatic duct begins in the tail of the pancreas (joins the common bile duct at the hepatopancreatic ampulla (of Vater))
  • Main pancreatic duct opens in the duodenum at the major duodenal papilla
45
Q

What are the main components of the sphincter of Oddi ? Where is this sphincter located ?

A

I) Sphincter Ampullae (surrounds common channel at duodenal side of papilla).
2) Sphincter Choledochus (surrounds terminal bile duct).
3) Sphincter Choledochus (surrounds
terminal pancreatic duct).

Sphincter of Oddi is located at the junction between the duodenum, common bile duct, and common pancreatic duct.

46
Q

What is a clinical consequence of a carcinoma of the head of the pancreas ?

A

Carcinoma of the head of the pancreas may obstruct the common bile duct causing painless jaundice.

47
Q

Describe the arterials supply of the pancreas.

A

Pancreas has two major sources of arterial supply:
1) Celiac trunk → Common hepatic artery → Gastroduodenal artery → superior pancreatico-duodenal arteriy

Celiac trunk → Splenic artery → Dorsal and greater pancreatic arteries

2) Superior mesenteric artery → inferior pancreatico-duodenal artery

48
Q

Describe the veinous and lymphatic drainage of the pancreas.

A

PANCREAS

  • Veinous drainage: veins mirror the arteries and eventually drain into the hepatic portal vein
  • Lymphatic drainage: lymph nodes are situated along the arteries that supply the pancreas. Efferent lymph vessels drain into the celiac and superior mesenteric lymph nodes.
49
Q

Describe the nerve supply of the pancreas.

A

Sympathetics: come from T7-T11 along the arteries
Parasympathetics: from vagus

50
Q

Define the trans-pyloric plane.

A

Trans-pyloric plane is midway between the suprasternal/jugular notch and the superior border of the pubic symphysis (corresponds to a plane midway between the xiphisternal joint and umbilicus). It intersects with L1 vertebra and the costal margin of the 9th CC.

51
Q

Identify the main structures crossed by the transpyloric plane.

A
  • Fundus of the gall bladder
  • Pylorus of the stomach
  • Neck of the pancreas
  • First (superior) part of duodenum
  • Hilum of kidney (R lower than L)
  • Duodenojejunal flexure
  • Termination of spinal cord at L1/L2
  • Origin of the superior mesenteric artery
  • Formation of portal vein
52
Q

Define pyloric orifice.

A

Opening between the stomach and the superior part of the duodenum.

MD3002 (95 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions