Liver, Gall Bladder & Pancreas

Question 1

Liver introduction:

Answer 1

• large complex organ primarily located in the RUQ and partly in the LUQ which is separated from the thoracic cavity by the diaphragm
• shaped like an irregular hemisphere and is divided into 4 lobes including Lt, Rt, Quadrate, Caudate with two main surface including the diaphragmatic and visceral surfaces
• Liver has many functions including the filtering of blood (DIMES)
  Detoxification: breakdown of drugs and alcohol
  Immune functions
  Metabolism of fat, CHOs, AA;s
  Excretion of bilirubin
  Synthesis of bile, hormones and plasma proteins

Question 2

Define the porta hepatis

Answer 2

Transverse fissure separating the caudate and quadrate lobes of the liver on the visceral surface which allows the passage of the 
Portal vein
hepatic artery 
hepatic nerve plexus
hepatic ducts
lymphatic ducts

Question 3

Lesser omentum location and attachments?

Answer 3

the LO is a double fold of peritoneum which connects the lesser curvature of the stomach and the proximal duodenum to the liver

Question 4

What 2 ligaments are formed by the lesser omentum?

Answer 4

Hepatogastric: sheet aspect
Hepatoduodenal: thickened aspect on the free edge of the LO that encloses the portal triad

Question 5

Portal triad?

Answer 5

bile duct
hepatic artery
portal vein

Question 6

Falciform ligament

Answer 6

Connects liver to anterior abdominal wall & diaphragm

Question 7

Round ligament (Ligament teres)

Answer 7

Contained within the free inferior edge of the falciform ligament

Fibrous remnant of the umbilical vein (carried well-oxygenated, nutrient-rich blood from placenta to foetus)

Question 8

Ligamentum venosum:

Answer 8

fibrous remnant of the ductus venosus, which in the foetus connects the left umbilical vein to the IVC (which allows blood to bypass the liver in the foetus)

Question 9

Coronary ligament:

Answer 9

A peritoneal reflection connecting the superior aspect of the liver to the diaphragm, that outlines the bare area of the liver.
The anterior and posterior folds unite to form the the triangular ligaments of the liver

Question 10

Triangular ligaments:

Answer 10

peritoneal folds that connect the superior aspect of the liver to the diaphragm

Question 11

Difference between the left and right triangular ligaments?

Answer 11

Right: situated at the right extremity of the bare area
Left: is a continuation of the falciform and coronary ligament anteriorly

Question 12

What are the 2 blood supplies to the liver?

Answer 12

70% via the portal vein

30% via the hepatic artery

Question 13

Portal vein:

Answer 13

Formed by the SMV and splenic veins posterior to the neck of the pancreas which supplies nutrient rich blood from the small intestines and stomach to the liver

Question 14

Hepatic artery:

Answer 14

A branch of the celiac trunk which supplies oxygenated blood to or close to the porta hepatis, which divides into left and right branches and supplies the corresponding parts of the liver

Question 15

Bile duct?

Answer 15

travels to the GB in the other direction of the other vessels in the portal triad

Question 16

what structures make up the portal triad?

Answer 16

hepatic artery
portal vein
bile duct

Question 17

Venous drainage of the liver:

Answer 17

hepatic veins drain into the IVC just inferior to the diaphragm

Question 18

nerve supply to the liver:

Answer 18

hepatic plexus consisting of:

• sympathetic fibres from ( T5-9 via the celiac plexus/abdominopelvic splanchnic)
• parasympathetic fibres: vagus nerve