Liver, Gallbladder, Biliary Tree and Pancreas Flashcards
What are the functions of the liver?
- receive nutrients absorbed from the GI tract
- glycogen, glucose, proteins, vitamins and fat storage
- bile secretion and synthesis
- detoxification of metabolic waste
- synthesis of blood clotting and anti-coagulation factors
Describe the anatomical relations of the liver
- sits inferior to the right hemi-diaphragm
- gallbladder if posterior and inferior
- hepatic flexure is inferior
- right kidney, adrenal gland, IVC and abdo aorta is posterior
- stomach is posterior at mid/left side
What are the ligaments of the liver?
Anterior attachments:
- falciform ligament (midline attachment)
- ligamentum teres (free border of falciform)
Superior attachments:
- coronary (anterior and posterior) ligaments
- triangular ligaments (left and right - formed from coronary ones coming together)
What is bare area?
- area of the liver not in contact with the peritoneum, is in contact directly with diaphragm
- adjacent to the IVC
What are the main anatomical features of the liver?
4 lobes:
- right
- left
- caudate (next to IVC)
- quadrate (next to gallbladder)
porta hepatis (between caudate and quadrate lobe) - site of entrance for portal triad:
- bile duct (more lateral)
- hepatic artery proper (more medial)
- hepatic portal vein (most posterior)
- deep to peritoneal cover surrounded by Glisson’s capsule (thin connective tissue that extends into organ between lobules) - not very strong
Describe the blood supply to the liver
dual blood supply:
- right and left hepatic arteries from the hepatic artery proper (from common hepatic artery from coeliac trunk)
- hepatic portal vein (75%)
Describe the lymphatic drainage of the liver
- liver produces a lot of lymph
- vessels leave liver and enter lymph nodes in porta hepatis
- efferent vessels pass from hepatic to coeliac nodes
- a few vessels go from bare area through diaphragm to posterior mediastinal nodes
Describe the nerve supply of the liver
- sympathetics form the coeliac plexus (from foregut) so greater splanchnic nerve T5-9
- anterior vagal trunk gives rise of large parasympathetic hepatic branch that goes directly to liver
Describe the segmental functional anatomy of the liver
- 8 functionally independent segments
- caoiunhaud’s classification
- each segment has own vascular inflow (hepatic artery and portal vein) and outflow (hepatic vein) and biliary drainage
- means that segments can be surgically removed without affecting the entire organ
What is the cantlie line?
imaginary line which splits the liver into 2 planes and marks where you will find the IVC and the gallbladder
Describe the hepatic lobule
- building block of the liver tissue
- consists of a portal triad, hepatocytes, a capillary network, and a central vein
- hepatic portal vein produces sinusoids that lie between sheets of hepatocytes (produce bile and detoxify blood)
- blood from hepatic artery proper and portal vein pass into sinusoids and flow into central vein
- bile flows in canaliculi between hepatocytes towards biliary ducts
What are the different parts of the gallbladder?
- fundus
- body
- neck
- cystic duct (where bile flows in and out)
What is Murphy’s point?
- where fundus of the gallbladder is found
- where right midclavicular line crosses costal margin
- tip of right 9th CC
- where linea semilunaris crosses right costal margin
What is the blood supply and drainage of the gallbladder?
- cystic artery (branch of right hepatic artery)
- numerous small veins from body and neck to segmental portal veins in liver
What is the lymph drainage of the gallbladder?
- cystic lymph node near neck of gallbladder
- lymph goes to hepatic nodes along course of hepatic artery proper then to coeliac nodes
What is the nerve supply of the gall bladder?
- coeliac plexus
- sympathetics from T5-9
- parasympathetics from vagus
How is the bile duct formed?
- right and left hepatic ducts form common hepatic duct
- common hepatic duct and cystic duct from bile duct
Where is gallbladder pain referred to?
- usually epigastrium (T7-9)
- if adjacent peritoneum involved pain can be referred to right shoulder (C3,4,5)
Describe the anatomy of the pancreas
- lies across epigastrium from duodenum to hilum of spleen
- has a head, neck, tail and uncinate process
- head is in duodenal arch
- uncinate process extends posterior to superior mesenteric vessels
What are the functions of the pancreas?
- exocrine: acinar cells release pancreatic digestive enzymes into main pancreatic duct
- endocrine: islets of langerhans release insulin and glucagon into bloodstream
Describe how the pancreas is involved in the biliary tree
- main pancreatic duct begins in tail of pancreas
- joins common bile duct at hepatopancreatic ampulla of Vater
- opens into duodenum at major and minor duodenal papilla
Describe the arterial supply of the pancreas and duodenum
- splenic artery from coeliac drunk (at tail of pancreas)
- branches: greater and dorsal pancreatic arteries
- gastroduodenal artery from common hepatic artery (towards head of pancreas)
- becomes superior pancreaticoduodenal artery which anastomoses with inferior pancreaticoduodenal artery ( from SMA)
What is the venous and lymphatic drainage of the pancreas?
- veins mirror arteries and eventually drain to hepatic portal vein
- lymph nodes situated along arteries that supply pancreas
- efferent lymph vessels drain to coeliac and superior mesenteric lymph nodes
What is the nerve supply of the pancreas
- sympathetics from T7-9
- parasympathetics from vagus
What can cause acute pancreatitis and what can occur from it?
- gallstone obstruction leading to reflux of bile and pancreatic juice into main pancreatic duct
- vascular haemorrhage can occur leading to blood/fluid accumulation in retroperitoneal space
Where is the trans-pyloric plane
- plane midway between xiphisternal joint and umbilicus
- intersects L1 vertebra and costal margin of 9th CC
What is found at the transpyloric plane?
- fundus of gallbladder
- pylorus of stomach
- neck of pancreas
- 1st part of duodenum
- hilum of kidney
- duodenojejunal flexure
- termination of spinal cord at L1/2
- origin of SMA
- formation of portal vein