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MD3002 Anatomy > Liver, gall bladder, biliary tree and pancreas > Flashcards

Liver, gall bladder, biliary tree and pancreas Flashcards

1
Q

What is the largest gland in the human body?

A

The liver

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2
Q

What areas does the liver occupy?

A
  • Lies across upper abdomen under the diaphragm; in the right hypochondrium and most of epigastric region
  • Surrounded by peritoneum except the bare area (related to diaphragm posteriorly)
  • Should not be palpable below costal margin at mid-clavic plane
  • Descends with inspiration
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3
Q

Where does the liver develop?

A
  • Ventral mesentary

- Anterior to stomach / gut tube

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4
Q

What is the smallest functional unit of the liver?

A

Hepatic lobule

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5
Q

What do sinusoids lie between?

A

Sheets of hepatocytes

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6
Q

What do hepatocytes do?

A
  • Produce bile

- Detoxify blood

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7
Q

What are the 2 surfaces of the liver?

A
  • Diaphragmatic (bare area on this surface)

- Visceral (related to organs)

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8
Q

What are the 4 lobes of the liver?

A
  • Left
  • Right
  • Caudate (belong to left)
  • Quadrate (belong to left)
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9
Q

How are the caudate and quadrate lobes deemed distinct?

A

Functional / vascular distribution point of view

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10
Q

What structures lie on the visceral side of the liver?

A
  • Stomach
  • Duodenum
  • Kidney
  • Colon
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11
Q

What ligament seperates the left from the right lobes anteriorly?

A

Falciform ligament

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12
Q

What seperates the left lobe from right functionally?

A
  • Line from vena cava to gall bladder
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13
Q

What is the falciform ligament a remnant of?

A

Ventral mesentary

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14
Q

What lies in the free border of the falciform ligament?

A

Ligamentum teres

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15
Q

What are the 2 peritoneal layers continous with?

A
  • Coronary (ant + post)

- Triangular ligaments (L + R) on the undersurface of the diaphragm

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16
Q

What does the falciform ligament anchor the liver to?

A

Anterior abdominal wall

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17
Q

What part of the liver does the peritoneum cover?

A

The anterior aspect of the diaphragmatic surface

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18
Q

What is the lesser omentum a remnant of?

A

The ventral mesentary

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19
Q

What is the ligamentum teres (round ligament of liver) a remnant of?

A

The obliterated umbilical vein

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20
Q

What does the falciform ligament divide into?

A

Coronary ligaments which then form triangular ligaments

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21
Q

What is the ligamentum venosum a remnant of?

A

The ductus venosus

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22
Q

How many segements are there in the liver?

A
  • 8 (4 on each lobe)
  • ## Caudate and quadrate considered Left
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23
Q

What makes each segemnt distinct?

A
  • Own vascular (hepatic artery and portal vein) inflow
  • Vascular outflow (hepatic vein)
  • Biliary drainage - Each segment can be surgically removed
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24
Q

What is the hepatic artery proper a branch of?

A

Coeliac trunk

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25
Q

What does the hepatic artery proper divide into?

A

Right and left hepatic arteries that enter the porta hepatis

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26
Q

What does the portal vein divide into?

A

Right and left branches that enter the porta hepatis behind the arteries

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27
Q

Where do the hepatic veins (3 or more) wmerge from and where do they drain?

A
  • Emerge from posterior surface of the liver and drain into the inferior vena cava
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28
Q

What does porta hepatis mean?

A

The gate of the liver

29
Q

How much lymph does the liver produce?

A

~ 33 - 50 %

30
Q

How is the lymph spread from the liver?

A

LEave the liver and enter several lymph nodes in the porta hepatis. The efferent vessels pass to the hepatic -> coeliac nodes

31
Q

Where can lymph from the bare area go to?

A

The diaphragm and follow the drainage from the diaphragm

Cancer can spread this way into the thrax

32
Q

How can retrograde tumour spread cause jaundice?

A

Retrograde spread srom coeliac nodes may involve the hepatic nodes in the porta hepatis and obstruct the bile ducts causing jaundice

33
Q

What is the sympathetic supply of the liver?

A
  • Coeliac plexus (from foregut therefore greater splanchnic nerve, T5-9)
34
Q

What is the parasympathetic nerve supply to the liver?

A

Anterior vagal trunk gives rise to a large parasympathetic hepatic branch that passes directly to the liver

35
Q

What is the gallbladder?

A
  • Muscular sac in a shallow depression on the visceral surface of the right lobe of the liver
  • Stores and concentrates bile produced by the liver
36
Q

What are the 3 parts of the gall bladder?

A

Fundus, body and neck

37
Q

Where is the fundus of the gallbladder located?

A
  • Murphy’s point
  • Right mid-clavic line crosses costal margin
  • Tip of right 9th costal cartilage
  • Linea semilunaris crosses the right costal margin
38
Q

What does a positive murphy’s sign indicate?

A

Acute cholecystitis (5F/6F disease)

39
Q

What is the blood supply of the gall bladder?

A
  • Cystic artery (branch of right hepatic artery) (high variation)
40
Q

What is the venous drainage of the gall bladder?

A

Cystic vein which drains directly into portal vein

41
Q

What is the lymph drainage of the gallbladder?

A
  • Cystic lymph node situated near the gallbladder neck

- Lymph passes to the hepatic nodes along the course of the hepatic artery proper and then into coeliac nodes

42
Q

What is the nerve supply of the gallbladder?

A
  • Sympathetic (T5-9) G splanchnic

- Parasympathetic vagal fibres from the coeliac plexus

43
Q

How long is the cystic duct?

A

~4cm long

44
Q

What are the spiral folds in the neck of gallbladder and cystic duct called?

A

Spiral valves (of Heister)

45
Q

What is the common bile duct (ductus choledochus) formed from?

A

Cystic duct and common hepatic duct (which is itself derived from the right and left hepatic ducts)

46
Q

What does the common bile duct run in?

A

Hepatoduodenal ligament (portal triad)

47
Q

How large is the common bile duct in diameter?

A

4-6 mm

48
Q

What does the common bile duct join with?

A

Main pancreatic duct at the hepatopancreatic ampulla (of Vater) before entering into the 2nd (descending) part of the duodenum at major duodenal papilla

49
Q

Where is the Sphincter of Oddi located?

A

Around the final part of the common bile duct

50
Q

Where is the major duodenal papilla?

A

2nd part of duodenum

51
Q

Where is pain from the gallbladder referred to?

A
  • Epigastrum (T7-9)
  • If adjacent peritoneum is involved, pain may be referred to the right shoulder by the phrenic nerve (C3, 4, 5, supraclavicular nevre)
52
Q

Where does the pancreas lie in relation to the peritoneum?

A
  • Secondarily retroperitoneal (except its tail)
53
Q

Where does the pancreas lie in relation to other organs?

A
  • Lies across the epigastrum close to major vessels

- Extends from the duodenum to the hilum of the spleen

54
Q

Name the areas of the pancreas

A
  • Head, neck, body, tail and uncinate process
  • Head lies in duodenal arch
  • Uncinate process extends posterior to the superior mesenteric vessels
55
Q

What can carcinoma of the head of pancreas obstruct?

A

Common bile duct (causing painless jaundice)

56
Q

Where does the main pancreatic duct begin?

A

Tail of pancreas

57
Q

Where does the main pancreatic duct join the common bile duct?

A

Hepatopancreatic ampulla (of Vater)

58
Q

Where does it open into the duodenum?

A

Major duodenal papilla

59
Q

How many components does the Sphincter of Oddi have around the ducts and what are they called?

A

3

  • Bile duct and sphincter
  • Hepatopancreatic ampulla and sphincter
  • Main pancreatic duct and sphincter
60
Q

What are the 2 major souces of arterial blood to the pancreas?

A
  • Coeliac runk

- Superior mesenteric artery

61
Q

How does blood from the coeliac trunk reach the pancreas?

A
  • Coeliac trunk ->
  • Splenic artery ->
  • Dorsal and greater pancreatic arteries
  • Coeliac trunk ->
  • Common hepatic artery ->
  • Gastroduodenal artery ->
  • Superior pancreatico-duodenal aa
62
Q

What artery derived from the superior mesenteric artery supplies blood to the pancreas?

A

Inferior pancreatico-duodenal aa.

63
Q

What part of the pancreas contains a rich anastomosis?

A

Head

64
Q

What do the veins of the pancreas eventually drain into?

A

Hepatic portal vein

65
Q

Describe the lymph drainage of the pancreas

A
  • Lymph nodes are situated along the arteries that supply the pancreas
  • Efferent lymph vessels drain into the coeliac and superior mesenteric lymph nodes
66
Q

What is the nerve supply of the pancreas?

A
  • Sympathetics come from T7-9 along the arteries

- Parasympathetics from vagus

67
Q

Where is the trans-pyloric plane located?

A
  • Midway between the suprasternal/jugular notch and the superior border of the pubic symphysis
  • Corresponds to a plane that is midway between the xiphisternal joint and the umbilicus
  • Intersects with the L1 vertebra and the costal margin of the 9th CC
68
Q

What structures lie at the trans-pyloric plane?

A
  • Fundus of gallbladder
  • Pylorus of stomach
  • Neck of pancreas
  • 1st superior part of duodenum
  • Hilum of kidney (right lower than left)
  • Duodenojejunal flexure
  • Termination of spinal cord at L1/2
  • Origin of superior mesenteric artery
  • Formation of portal vein

MD3002 Anatomy (14 decks)

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