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MD3002 - GI Anatomy > Liver, Gallbladder, Biliary System and Pancreas > Flashcards

Liver, Gallbladder, Biliary System and Pancreas Flashcards

1
Q

What is the liver

A

largest gland

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2
Q

Where is the liver located in the abdomen?

A

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

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3
Q

How does the liver move in inspiration?

A

Descends

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4
Q

What is the liver surrounded by?

A

Surrounded by peritoneum except for the bare area (related to diaphragm posteriorly)

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5
Q

Where should the liver not be palpable?

A

below the costal margin

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6
Q

What is the liver surrounded by deep it its peritoneum?

A

the liver is completely surrounded by the Glisson’s capsule that is a thin connective tissue layer sending extensions into the organ in-between the lobules

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7
Q

What two sources does the lvier receieve blood from?

A
  • Hepatic portal vein: Brings absorbed nutrients and drains venous blood of stomach, small intestine, part of large intestine, pancreas and spleen
  • Hepatic artery proper: Supplies the hepatocytes with oxygen
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8
Q

How is bile drained from the liver?

A

drained via canaliculi that lie between the hepatocytes into bile ductules & eventually into bile ducts

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9
Q

What is the venous drainage of the liver?

A

Venous drainage is by hepatic veins that enter the inferior vena cava

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10
Q

What are the four main functions of the liver?

A
  • Synthesis & secretion of bile
  • Storage of glucose, glycogen, proteins, vitamins and fats
  • Detoxification of metabolic waste
  • Synthesis of blood clotting & anticoagulant factors (fibrinogen & prothrombin)
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11
Q

Describe the processes involved in the synthesis and secretion of bile

A
  • Constituents of bile: bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water & electrolytes
  • Bile pigments are derived as the breakdown products of haemoglobin
  • Kupffer cells (fixed phagocytes) play a role in the formation of bile pigments
  • Bile salts are responsible for the detergent & emulsifying effect of bile on fats
  • Bile salts also increase the absorption of fats by the small intestine
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12
Q

What is a hepatic lobule?

A

smallesr functional unit of the liver

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13
Q

Where does blood from the hepatic artery proper and portal vein pass into?

A

sinusoids and flow into the central vein

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14
Q

Where do sinusoids lie?

A

between sheets of hepatocytes

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15
Q

What is the function of hepatocytes?

A

produce bile and detoxify blood

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16
Q

How does bile flow in the liver?

A

lows in the canaliculi between the hepatocytes towards biliary ducts

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17
Q

What are the 2 main surfaces of the liver

A

diaphragmatic and visceral surfaces

  • bare area on the diaphragmatic surface
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18
Q

What are the 4 lobes of the liver?

A
  • right
  • left
  • caudate
  • quadrate
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19
Q

What lobe are the quadrate and caudate lobes connected to?

A

From a functional/vascular distribution point of view the caudate & quadrate lobes are part of the left lobe

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20
Q
A

red = caudate

blue = quadrate

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21
Q

What are ligaments of the liver?

A

reflections of the peritoneum

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22
Q

What is the falciform ligament a remnant of?

A

ventral mesentery

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23
Q

What is the function of the falciform ligament?

A

anchors the liver to the anterior abdominal wall

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24
Q

Where does ligamentum teres lie?

A

in the free border of the falciform ligament (inferior border)

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25
Q

What happens the falciform ligament superiorly?

A

the two peritoneal layers are continuous with coronary (anterior and posterior) and triangular ligaments (left and right) on the undersurface of the diaphragm

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26
Q
A

red = falciform ligament

blue = ligamentum teres

27
Q
A

green = coronary ligaments

purple = triangular ligaments

28
Q

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

A

obliterated umbilical vein

29
Q

What is ligamentum venosum a remnant of?

A

oblierated ductus venosus

30
Q
A

blue = ligamentum teres

green = ligamentum venosum

31
Q

What is the liver divided into?

A

8 functionall independent segments

R = 4

L = 4

32
Q

What does each segment of the liver have?

A

its own vascular inflow, vascular outflow and biliary drainage

33
Q

Describe the arterial supply into the liver

A

The hepatic artery proper, a branch of the celiac trunk, divides into right & left hepatic arteries that enter the porta hepatis

34
Q

How and where does the portal vein divide?

A

divides into right & left branches that enter the porta hepatis behind the arteries

35
Q

Where do the hepatic veins emerge?

A

hepatic veins (three or more) emerge from the posterior surface of the liver & drain into the inferior vena cava

36
Q

Describe the lymphatic drainage of the liver

A

follows the arteries

  • The liver produces a large amount of lymph (about 1/3 to 1/2 of all body lymph)
  • The lymph vessels leave the liver & enter several lymph nodes in the porta hepatis
  • The efferent vessels pass to the celiac nodes from hepatic nodes
  • A few vessels pass from the bare area of the liver through the diaphragm to the posterior mediastinal lymph nodes
  • Retrograde tumour spread from the celiac nodes may involve the hepatic nodes in the porta hepatis & obstruct the bile ducts causing jaundice
37
Q

Describe the nerve supply of the liver

A
  • Sympathetic nerves form the celiac plexus (from foregut therefore greater splanchnic nerve, T5-T9)
  • The anterior vagal trunk gives rise to a large parasympathetic hepatic branch that passes directly to the liver
38
Q

What is the gallbladder?

A

Muscular sac in a shallow depression on the visceral surface of the right lobe of the liver

39
Q

What is the function of the gallbladder?

A

stores and concentrates bile produced by the liver (non-essential functions)

40
Q

What are the three components of the gallbladder?

A

Fundus, body and neck

41
Q

Where is the fundus of the gallbladder located?

A

Fundus of the gall bladder is located at Murphy’s point where the right midclavicular line crosses the costal margin

− Tip of the right 9th costal cartilage

− Linea semilunaris crosses the right costal margin

42
Q

What does positive Murphy’s sign suggest?

A

acute cholecystitis (5F/6F disease)

43
Q

What is the blood supply of the gallbladder

A
  • Cystic artery (branch of right hepatic artery) − High variation
  • Cystic vein drains directly into the portal vein
44
Q

What is the lymph drainage of the gallbladder?

A
  • a cystic lymph situated near the gallbladder neck
  • lymph passes to the hepatic nodes along the course of the hepatic artery proper and then into the coeliac nodes
45
Q

Describe the nerve supply of the gallbladder

A
  • sympathetics = T5-9
  • Parasympathetics = vagal fibres from coeliacl plexus
46
Q

How long is the cystic duct?

A

~4cm long

47
Q

What are the spiral folds of the mucous membrane of the cystic duct and neck of gall bladder known as ?

A

spiral valves (of Heister)

48
Q

What does the cystic duct join and form?

A

joins with the common hepatic duct (derived from right & left hepatic ducts) and forms the common bile duct (Ductus choledochus)

49
Q

Describe the common bile duct

A
  • 4-6 mm diameter
  • Runs in hepatoduodenal ligament (portal triad)
50
Q

What does the common bile duct join with?

A

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

51
Q

What sphincter is in the final part of the common bile duct?

A

Sphincter of Oddi

52
Q
A
53
Q

Where is pain from the gallbladder usually referred to?

A

referred to the epigastrium (T7-T9). But if the adjacent peritoneum is involved, pain may be referred to the right shoulder by the phrenic nerve (C3, 4, 5, supraclavicular nerve)

54
Q

Where is the pancreas located within the peritoneum?

A

secondarily retroperitoneal

55
Q

Where is the pancreas located?

A

Lies across the epigastrium close to major blood vessels

Extended from the duodenum to the hilum of the spleen

56
Q

What are the 4 main components of the pancreas and where is each located?

A

Head, neck, body, tail & uncinate process

  • The head lies in duodenal arch
  • Uncinate process extends posterior to the superior mesenteric vessels
57
Q

Where does the main pancreatic duct begin anf what does it join?

A
  • The main pancreatic duct begins in the tail of the pancreas
  • Joins the common bile duct at the hepatopancreatic ampulla (of Vater)
58
Q

What could occur as a result of carcinoma in the head of the pancreas?

A

may obstruct the common bile duct causing painless jaundice

59
Q

What is the main arterial supply of the pancreas?

A
  • Coeliac trunk ⇒ common hepatic artery ⇒ gastroduodenal artery ⇒ superior pancreatico-duodenal aa.
  • Coeliac trunk ⇒ Splenic artery ⇒ dorsal and greater pancreatic arteries
  • Superior mesenteric artery ⇒ inferior pancreatico-duodenal aa.
60
Q

What is the venous drainage of the pancreas?

A

Veins mirror the arteries and eventually drain into the hepatic portal vein

61
Q

What is the lymph drainage of the pancreas?

A
  • Lymph nodes are situated along the arteries that supply the pancreas
  • Efferent lymph vessels drain into the celiac & superior mesenteric lymph nodes
62
Q

What is the nerve supply of the pancreas?

A

Sympathetics comes from T7-9 along the arteries & parasympathetics from vagus

63
Q

Where is the transpyloric plane

A
  • Midway between the suprasternal/jugular notch & the superior border of the pubic symphysis
  • Corresponds to a plane that is midway between the xiphisternal joint & the umbilicus
  • Intersects with L1 vertebra and the costal margin of the 9th costal cartilage
64
Q

What is located at the cross-section called 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 - GI Anatomy (11 decks)

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