Liver, Gallbladder, Pancreas, and Spleen Flashcards
Visceral motor neurons in the CNS are known as what?
preganglionic
Parasympathetic visceral motor neuron fibers only run to what?
internal organs
Parasympathetic visceral motor neurons are what types of fibers?
GVE
What do Parasympathetic visceral motor neurons allow for the internal organs?
rest and digest; energy saving
Preganglionic cell bodies of the parasympathetic (visceral motor) division are found where?
CNX, S2-S4 spinal cord
What muscles are mainly intramural autonomic ganglia?
- smooth muscle
- cardiac muscle
- glands
The parasympathetic division runs from what structures?
esophagus to proximal large intestine
What do GVE fibers of the parasympathetic division from the esophagus to proximal large intestine increase what?
peristalsis and secretion
What increases secretion and motility of the intestines, restoring digestive activity after a sympathetic reaction?
parasympathetic stimulation
What derives from the posterior vagal trunk?
parasympathetic fibers
What is insensitive to most pain stimuli, including cutting and burning; however, is sensitive to sudden distention (gas pains) and transient ischemia from abnormally long contractions that are perceived as colic (spasmodic abdominal pains)?
the intestines
What levels form the greater splanchnic nerves?
T5-T9/T10
What levels form the lesser splanchnic nerves?
T10-T11
What levels form the least splanchnic nerve?
T12
What levels form the lumbar thoracic splanchnic nerves?
L1-L2/L3
What do greater splanchnic fibers run to?
celiac gangle
What do lesser and least splanchnic fibers run to?
- superior mesenteric ganglia
- aorticorenal ganglia
What do thoracic lumbar splanchnic fibers run to?
inferior mesenteric ganglia
Postganglionics of the celiac ganglia distribute to what?
foregut
Postganglionics of the superior mesenteric and aorticorenal ganglia distribute to what?
midgut
Postganglionics of the inferior mesenteric ganglia distribute to what?
hindgut
The foregut and midgut receive parasympathetic stimulation via what?
vagus n
The hindgut receives parasympathetic stimulation via what?
pelvic splanchnics (S2-S4)
The intermesenteric plexus allows for communication between what?
celiac plexus, superior mesenteric plexus, aorticorenal plexus, inferior mesenteric plexus
What nerves are considered sympathetics?
- greater splanchnic
- lesser splanchnic
- least splanchnic
- lumbar splanchnic
What nerves are considered parasympathetics?
- vagus n
- pelvic splanchnics
- hypogastric nn (L and R)
What level is associated with the vagus n?
CN-X
What levels are associated with pelvic splanchnic nn?
S2-S4
The inferior hypogastric plexus is associated with what nerves?
Hypogastric nn
What is served by the same blood and lymphatic vasculature and the same somatic nerve supply as the region of the abdominopelvic wall it lines?
parietal peritoneum
What is the parietal peritoneum sensitive to?
- pressure
- pain
- heat
- cold
pain is generally well localized
What is served by the same blood and lymphatic vasculature and the same visceral nerve supply as the organs it covers?
visceral peritoneum
What is the visceral peritoneum insensitive to?
- touch
- heat
- cold
- laceration
stimulated primarily by stretching and chemical irritation
Pain from where is poorly localized and is referred to dermatomes of the spinal ganglia providing the sensory fibers?
visceral peritoneum
Pain from the foregut will usually be experienced where?
epigastric region
Pain from the midgut will usually be experienced where?
umbilical region
Pain from the hindgut will usually be experienced where?
pubic region
Esophagus and stomach pain is referred where?
epigastric
Small intestine, cecum, appendix, and ascending colon pain is referred where?
umbilical region
Descending and sigmoid colon pain is referred where?
pubic region
What is perceived as somatic pain and has GVA and GSA fibers?
visceral peritoneum pain
The greater splanchnic nerve is associated with what type of pain?
epigastric pain
What is the largest organ and gland in the body?
liver
What are the 4 lobes of the liver?
- right lobe
- left lobe
- caudate lobe
- quadrate lobe
What is located in the upper right quadrant of the abdomen?
liver
What has essential metabolic functions?
liver
What does the liver occupy most of?
the right hypochondriac and epigastric regions and frequently extends into left hypochondriac region as far as left anterior axillary line
What makes clotting factors, enzymes, etc.?
liver
What is the liver hidden and protected by?
thoracic cage and diaphragm
What ribs does the liver lie deep to?
ribs 7 to 11 on the right side and cross midline toward left nipple
When a person is asked to inspire deeply, what may be felt and why?
the liver because of the inferior movement of the diaphragm pushing down on the liver
Where does the caudate lobe lie next to?
IVC
Where is the quadrate lobe located near?
round ligament and gallbladder
What does not cover the pare area of the liver?
peritoneum
The visceral surface of the liver is covered with visceral peritoneum expect in what areas?
fossa for the gallbladder and at the porta hepatis
What lies between the liver and kidney, and adrenal gland?
hepatorenal recess (morison’s pouch)
What communicates anteriorly with the right subphrenic recess?
hepatorenal recess (Morison’s pouch)
What organs are located in the inferoposterior region?
- gastric and duodenal area
- lesser omentum
- gallbladder
- colic area
- renal and suprarenal area
What are the accessory lobes of the liver?
quadrate and caudate lobe
Under the right lobe, what can you find?
Morison’s pouch
What is positioned to the right of the IVC and gallbladder
right lobe
What is positioned to the left of the ligamentum teres?
left lobe
What is positioned anterior to the portal triad between the falciform ligament and gallbladder?
quadrate lobe
What is positioned posterior to the portal triad between the falciform ligament and IVC?
caudate lobe
What is the remnant of the ductus venosus?
ligamentum venosum
What shunted blood to the umbilical vein to the IVC to bypass the lungs in fetal circulation?
ductus venosus
What attaches to the inferior portion of the falciform ligament?
round ligament of the liver (ligamentum teres)
What is the ligamentum teres a remnant of?
umbilical vein
What provided the fetus with oxygen and nutrient rich blood?
umbilical vein
What parts of the liver are considered to portal lobes?
right and left lobes
Each portal lobe has its own blood supply from what?
hepatic artery and hepatic portal vein
Other than blood supply, what else do the portal lobes have their own of?
venous and biliary drainage
The portal lobes of the liver are subdivided into what?
8 hepatic segments
What is segmentation of the portal lobes based on?
tertiary branches of the right and left hepatic arteries, hepatic portal veins, and hepatic ducts
Each segment of the portal lobes of the liver are supplied by and drained by what?
- supplied by tertiary branch of right or left hepatic artery
- drained by tertiary branch of right or left hepatic duct
What passes between segments and further demarcates portal segments on their way to the IVC?
intersegmental hepatic veins
What makes up the portal triad?
- portal vein
- hepatic artery
- common bile duct
What is most posterior in the portal triad?
portal vein
What are the 2 sources that the liver receives blood from?
- hepatic portal vein (75-80%)
- hepatic artery (20-25%)
What carries poorly oxygenated blood from the abdominopelvic portion of the GI tract to the liver?
hepatic portal vein
What carries well-oxygenated blood from the aorta to the liver?
hepatic artery
What carries nutrient rich blood directly from the small intestines to the liver?
hepatic portal vein
What is the hepatic portal vein formed by?
union of the superior mesenteric and splenic veins
What is the main channel of the portal venous system?
hepatic portal vein
What collects blood from the abdominal part of the GI tract, pancreas, spleen, and most of the gallbladder and carries it to the liver?
hepatic portal vein
What happens near the porta hepatis?
hepatic artery and hepatic portal vein terminate & divide into right and left branches, supplying the respective liver lobe
What helps hold the liver in position?
the attachment of the hepatic veins to the IVC
What can be found between the segments of the lobes of the liber and open into the IVC just inferior to the diaphragm?
hepatic veins
Portal vein carries what type of blood?
poorly oxygenates, but nutrient rich blood
What branches off the celiac trunk?
- common hepatic a
- left gastric a
- splenic a
What does the common hepatic continue as?
- proper hepatic a
- right and left hepatic arteries
Within the liver, branches of the hepatic portal vein are distributed in a segmental pattern and end in non-contractile capillaries called?
venous sinusoids of the liver
What are thought to be the primary site for blood flow regulation of the liver?
venous sinusoids
What are cells of the liver called?
hepatocytes
What allows for communication between the portal venous system and systemic venous system?
portosystemic anastomoses
Portosystemic anastomoses occur in what located?
- between esophageal veins (draining into azygos vein, systemic, or left gastric vein, portal)
- between rectal veins (inferior and middle veins drain into IVC, systemic, superior rectal vein continues as IMV, portal)
- para-umbilical veins of anterior abdominal wall, portal, anastomosing with peri-umbilical superficial epigastric veins, system
- twigs of colic veins, portal, anastomosing with retroperitoneal veins, systemic
Postosystemic anastomoses between the esophageal veins form what when dilated?
esophageal varices
Portosystemic anastomoses between the rectal veins from what when abnormally dilated?
hemorrhoids
Portosystemic anastomoses of the para-umbilical veins and peri-umbilical superficial epigastric veins produce what when dilated?
caput medusae
What are varicose veins radiating from the umbilicus and were named because of their resemblance to serpents on the head of a character in Greek mythology?
caput medusae
What are large swollen veins within the esophagus due to portal hypertension that causes backflow of blood into one of the portal-caval anastomoses?
esophageal varices
What are associated with a high risk of upper gastrointestinal hemorrhage and accompanying high mortality?
esophageal varices
The esophageal portal system anastomoses is between what?
- left gastric vein (portal)
- azygos vein (systemic)
Esophageal varices are associated with what?
esophageal portal-systemic anastomoses
The rectal portal-systemic anastomoses occurs between what?
- superior rectal to IMV (portal)
- inferior and middle rectal to IVC (systemic)
Hemorrhoids are associated with what?
rectal portal-systemic anastomoses
Paraumbilical portal-systemic anastomoses occur between what?
- paraumbilical v anterior abdominal wall (portal)
- peri-umbilical superficial epigastric v (systemic)
Caput medusae are associated with what?
paraumbilical portal-systemic anastomoses
The retroperitoneal portal-systemic anastomoses occurs between what?
- colic, splenic, or portal vv (portal)
- retroperitoneal vv, posterior abdominal wall or diaphragm (systemic)
What are retroperitoneal veins associated with?
retroperitoneal portal-systemic anastomoses
What are caput medusae a result of?
portal hypertension
What provides collateral circulation in cases of obstruction in the liver or hepatic portal vein?
portosystemic anastomoses
What anastomoses is the most life threatening?
esophageal
All venous drainage from the GI system is filtrated through what before returning to the heart?
live
What is a deep recess of the peritoneal cavity where the right side is inferior to the liver and anterior to the kidney and suprarenal gland?
Morison Pouch
What is a gravity dependent peritoneal cavity present in the supine position and allows fluid draining omental bursa to the recess?
Morison Pouch
What communicated with the right subphrenic space?
morison pouch
What is produced continuously in the liver and stored in the gallbladder?
bile
What concentrates bile by absorbing water and salts?
gallbladder
When fat enters duodenum, where does the gallbladder send concentrated bile?
through the cystic and bile ducts to the duodenum
What emulsifies fat so it can be absorbed in the distal intestine?
bile
Without concentrated bile, what will their be an inefficient breakdown of?
fat
What secretes bile into the bile canaliculi formed between them?
hepatocytes
What do canaliculi drain into?
small interlobular biliary ducts and then into large collecting bile ducts of the intrahepatic portal triad
What do the large collecting bile ducts of intrahepatic portal triad merge to form?
right and left hepatic ducts
What do the right and left hepatic ducts drain?
right and left livers
After leaving the porta hepatis, the right and left hepatic ducts unite and form what?
common hepatic duct
What joins the common hepatic duct on the right side to form the common bile duct?
cystic duct
What does the union of the common hepatic duct and cystic duct form?
common bile duct
What supplies the gallbladder?
cystic artery
What is the cystic artery usually a branch of?
right hepatic artery, a branch of the proper hepatic artery (celiac trunk distribution)
What lies in Calot’s cystohepatic triangle?
the cystic artery
What is Calot’s cystohepatic triangle formed from?
- liver
- cystic duct
- common hepatic duct
What causes gallbladder contraction, along with CCK, for bile release?
vagal parasympathetics
What inhibits bile secretion of the gallbladder?
sympathetic preganglionic efferents from T6-T9/10 in the greater splanchnic nerve that synapse in the celiac ganglion and send postganglionic fibers to liver and gallbladder
What cartilage level is the fundus of the gallbladder usually found?
9th cartilage
What is the lymphatic drainage of the gallbladder?
Cystic -> Omental foramen -> Hepatic -> Celiac
What is formed in the free edge of the lesser omentum by the union of the cystic duct and common hepatic duct?
common bile duct
What descends posterior to the superior part of the duodenum and lies in a groove on the posterior surface of the head of the pancreas?
common bile duct
On the left side of the descending part of the duodenum, what does the common bile duct come into contact with?
main pancreatic duct
The common hepatic duct and the main pancreatic duct run through the wall of the duodenum and unite to form what?
hepatopancreatic ampulla (ampulla of Vater)
What does the distal end of the hepatopancreatic ampulla open into the duodenum through?
major duodenal papilla
What organ has both exocrine and endocrine functions?
pancreas
What lies posterior to the stomach in the posterior wall of the lesser sac?
pancreas
What part of the pancreas is not considered retroperitoneal?
the distal tail since it comes into contact with the spleen
What are the 4 anatomical parts of the pancreas?
- head
- neck
- body
- tail
What part of the pancreas is nestled within the C-shaped curve of the duodenum and overlying the abdominal aorta, the right renal vessels, the left renal veins, and the IVC?
the head
What is the uncinate process apart of?
the head of the pancreas
What lies posterior to the superior mesenteric vessels?
uncinate process
What part of the pancreas lies anterior to the superior mesenteric vessels, the aorta, and the IVC and deep to the pylorus of the stomach?
the neck
What part of the pancreas extends above the duodenojejunal flexure and across the superior part of the kidney?
the body
What artery courses just superior to the body of the pancreas and tail, and sometimes may be partially surrounded by the parenchyma of the pancreas, as is the splenic vein?
the splenic artery
What vessel courses just inferior to the splenic artery?
the splenic vein
What part of the pancreas extends from the left kidney, which it crosses, and terminates at the hilum of the spleen in the splenorenal ligament?
the tail
What percentage of the pancreas is comprised exocrine, or contains digestive cells?
90%
If enzymes become active in the pancreas where they are supposed to be inactive, what can occur?
pancreatitis
What secretes a number of enzymes necessary for digestion of proteins, starches, and fats?
the acinar cells of the exocrine pancreas
What secretes fluid with high bicarbonate content that serves to neutralize the acid entering the duodenum of the stomach?
pancreatic ductal cells
Pancreatic secretion is under neural (1) and hormonal (2) control
- vagus nerve
- secretic and CCK
What do exocrine secretions empty primarily into?
the main pancreatic duct
What joins the common bile duct at the hepatopancreatic ampulla (of Vater)?
main pancreatic duct
What is a smaller, and variable, duct that also empties into the second part of the duodenum above 2 cm above the major duodenal papilla?
accessory pancreatic duct (of Santorini)
Can you live without a pancreas?
no
Because the pancreas is near a lot of other organs, this allows cancer to what?
metastasize quicker
What crosses the posterosuperior surface of the head of the pancreas or is embedded in its substance?
the common bile duct
The pancreatic and bile ducts unite to form what?
hepatopancreatic ampulla
The hepatopancreatic ampulla opens into the descending part of the duodenum at the summit of what?
the major duodenal papilla
What drains the uncinate process and the inferior part of the head of the pancreas?
the accessory pancreatic duct
What does the accessory pancreatic duct open into the duodenum at?
minor duodenal papilla
What usually communicated with the pain pancreatic duct, but sometimes acts as a separate duct?
accessory pancreatic duct
What do the pancreatic arteries derive mainly from?
branches of the splenic artery
What are the anterior and posterior superior pancreaticoduodenal arteries branches of?
the gastroduodenal artery
What are the anterior and posterior inferior pancreaticoduodenal arteries branches of?
the SMA
The anterior and posterior superior/inferior pancreaticoduodenal arteries supply what?
the head of the pancreas
What are tributaries of the splenic and superior mesenteric parts of the hepatic portal vein?
pancreatic veins
What do pancreatic veins empty into?
splenic vein
What do the pancreatic lymphatic vessels follow?
blood vessels of the pancreas
Most of the pancreatic lymphatics end in (1) that lie along the splenic artery, but some end in the (2)
- pancreaticosplenic nodes
- pyloric lymph nodes
Efferent vessels of the pancreaticosplenic and pyloric lymph nodes drain into what?
superior mesenteric lymph nodes or celiac lymph nodes via hepatic lymph nodes
What are the nerves of the pancreas derived from?
the vagus and abdominopelvic splanchnic nerves passing through the diaphragm
Pancreatic parasympathetic fibers function as what?
secretomotor
Also parasympathetic fibers of the pancreas function as secretomotor, pancreatic secretion is primarily mediated by what?
hormones, secretin and cholecystokinin formed in the duodenum and proximal intestine
Visceral afferent pain fibers of the pancreas accompany what?
sympathetic fibers
What organ is not heavily innervates so if it stretches, it most likely will not cause pain?
the pancreas
What is a mobile ovoid lymphatic organ that lies intraperitoneally in the left upper quadrant?
the spleen
What is the spleen entirely surrounded by except at the hilum?
peritoneum
What comes out of the hilum of the spleen?
branches of the splenic artery and vein
What lies posterior to the left 9th through 11th ribs and is separated from them by the diaphragm and the costodiaphragmatic recess?
the spleen
What is the cleft-like extension of the pleural cavity between the diaphragm and lower part of the thoracic cage?
costodiaphragmatic recess
The diaphragmatic surface of the spleen runs behind what ribs?
9-11
What are the 3 parts of the visceral surface of the spleen and what are they associated with?
- gastric: greater curvature of the stomach
- renal: ventral surface of left kidney
- colic: left (splenic) flexure
What is considered a lymphatic organ?
the spleen
What does the splenorenal ligament contain?
splenic vessels and tail of pancreas
What attaches the spleen to the greater curvature of the stomach?
gastrosplenic ligament
What attaches the spleen to the left kidney?
splenorenal ligament
What is often in contact with the tail of the pancreas and constitutes the left boundary of the omental bursa?
hilum of the spleen
What is the gastrosplenic ligament and splenorenal ligament apart of?
the greater omentum
What is the largest branch of the celiac trunk?
splenic artery
What follows a tortuous course posterior to the omental bursa, anterior to the left kidney, and along the superior border of the pancreas?
splenic artery
Behind the layers of the splenorenal ligament, how many branches does the splenic artery divide into that enter the hilum of the spleen?
5
After the 5 branches of the splenic artery enter the hilum of the spleen, How many vassular segments do they divide into?
2 to 3
What is formed by several tributaries that emerge from the hilum?
splenic vein
What is the splenic vein joined by as it runs posterior to the body and tail of the pancreas through most of its course?
IMV
What does the splenic vein unite with posterior to the neck of the pancreas to form the hepatic portal vein?
SMV
What do the nerves of the spleen derive from?
the celiac plexus
What are nerves of the spleen distributed along?
mainly along branches of the splenic artery
What do the nerves of the spleen function as?
vasomotor
What is the course of the splenic lymphatic vessels?
splenic nodes -> pancreaticosplenic nodes -> celiac nodes
Celiac nodes drain into what?
cisterna chyli
What does the cisterna chyli empty into?
thoracic duct
Is the spleen a digestive organ
no
The celiac plexus supplies what type of fibers to the spleen?
parasympathetic and sympathetic
