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MD3002 GI/GU/Renal > Liver, Gallbladder, Biliary Tree and Pancreas > Flashcards

Liver, Gallbladder, Biliary Tree and Pancreas Flashcards

1
Q

What are the functions of the liver?

A
  • 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
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2
Q

Describe the anatomical relations of the liver

A
  • 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
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3
Q

What are the ligaments of the liver?

A

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)
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4
Q

What is bare area?

A
  • area of the liver not in contact with the peritoneum, is in contact directly with diaphragm
  • adjacent to the IVC
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5
Q

What are the main anatomical features of the liver?

A

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
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6
Q

Describe the blood supply to the liver

A

dual blood supply:

  • right and left hepatic arteries from the hepatic artery proper (from common hepatic artery from coeliac trunk)
  • hepatic portal vein (75%)
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7
Q

Describe the lymphatic drainage of the liver

A
  • 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
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8
Q

Describe the nerve supply of the liver

A
  • 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
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9
Q

Describe the segmental functional anatomy of the liver

A
  • 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
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10
Q

What is the cantlie line?

A

imaginary line which splits the liver into 2 planes and marks where you will find the IVC and the gallbladder

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11
Q

Describe the hepatic lobule

A
  • 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
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12
Q

What are the different parts of the gallbladder?

A
  • fundus
  • body
  • neck
  • cystic duct (where bile flows in and out)
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13
Q

What is Murphy’s point?

A
  • 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
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14
Q

What is the blood supply and drainage of the gallbladder?

A
  • cystic artery (branch of right hepatic artery)

- numerous small veins from body and neck to segmental portal veins in liver

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15
Q

What is the lymph drainage of the gallbladder?

A
  • cystic lymph node near neck of gallbladder

- lymph goes to hepatic nodes along course of hepatic artery proper then to coeliac nodes

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16
Q

What is the nerve supply of the gall bladder?

A
  • coeliac plexus
  • sympathetics from T5-9
  • parasympathetics from vagus
17
Q

How is the bile duct formed?

A
  • right and left hepatic ducts form common hepatic duct

- common hepatic duct and cystic duct from bile duct

18
Q

Where is gallbladder pain referred to?

A
  • usually epigastrium (T7-9)

- if adjacent peritoneum involved pain can be referred to right shoulder (C3,4,5)

19
Q

Describe the anatomy of the pancreas

A
  • 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
20
Q

What are the functions of the pancreas?

A
  • exocrine: acinar cells release pancreatic digestive enzymes into main pancreatic duct
  • endocrine: islets of langerhans release insulin and glucagon into bloodstream
21
Q

Describe how the pancreas is involved in the biliary tree

A
  • 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
22
Q

Describe the arterial supply of the pancreas and duodenum

A
  • 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)
23
Q

What is the venous and lymphatic drainage of the pancreas?

A
  • 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
24
Q

What is the nerve supply of the pancreas

A
  • sympathetics from T7-9

- parasympathetics from vagus

25
Q

What can cause acute pancreatitis and what can occur from it?

A
  • 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
26
Q

Where is the trans-pyloric plane

A
  • plane midway between xiphisternal joint and umbilicus

- intersects L1 vertebra and costal margin of 9th CC

27
Q

What is found at the transpyloric plane?

A
  • 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

MD3002 GI/GU/Renal (64 decks)

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