Liver, gallbladder, pancreas, spleen

Question 1

ligaments of the liver

Answer 1

-gastrohepatic and open hepato-duodenal ligament makeup the lesser omentum
-foramen of winslow- epiploic foramen -> hole in the open hepato-duodenal ligament
-the portal triad is found here
-if you put your finger through you would enter the lesser sac

Question 2

liver

Answer 2

-large right lobe and small left
-lobes are separated by falciform ligament-> connect liver to anterior abdominal wall
-round ligament contains ligamentum teres (remnant of umbilical vein -> ligamentum vanosum)
-ligamentum vanosum- remnant of ductus vanusus that shunted oxygenated blood from placenta (even though coming from a vein) liver during development
-convex upper surface-
-right lobe divided into quadrate lobe and caudate lobe by GB, ligamentum teres, IVC, and ligamentum venosum
-bare area- no peritoneum-> infections spread from abdomen into thorax

Question 3

porta hepatis

Answer 3

-posteroinferior surface lies between the caudate and quadrate lobes
-contains:
-R/L hepatic ducts
-R/L branches of the hepatic artery
-portal vein
-sympathetic and parasympathetic nerve fibers
-Lymph nodes
-portal triad- in the lesser omentum and hepatoduodenal ligament (common hepatic duct, portal vein, proper hepatic artery

Question 4

portal vein

Answer 4

-ascends right, behind 1st pair of duodenum, enters lesser omentum
-runs upwards ANTERIOR to epiploic foramen to porta hepatis, and divides into right and left terminal branches
-enters liver and breaks up into sinusoids -> central veins -> hepatic veins -> IVC
-function:
-brains blood from the lower third of esophagus to halfway down to anal canal
-drain blood from spleen, pancreas, and gallbladder

Question 5

arterial and venous supply to liver

Answer 5

-artery- R/L hepatic artery (branched from proper hepatic)
-veins- central veins in liver lobule -> hepatic veins -> IVC
-lymph drainage- produces 1/3-1/2 of body lymph
-enters porta hepatis -> celiac nodse and posterior mediastinal lymph node
-nerve- sympathetic and parasympathetic from celiac plexus -> vagus

Question 6

bile ducts

Answer 6

-right and left hepatic ducts emerge from porta hepatis
-ducts unite to form common hepatic duct
-cystic duct and common hepatic duct form -> bile duct
-common bile duct pierces medial wall of 2nd part of duodenum -> joined by main pancreatic duct
-opens into small ampulla in duodenal wall -> hepatopancreatic ampulla (ampulla of Vater)
-sphincter of oddi controls release of enzymes and bile into duodenum

Question 7

galbladder

Answer 7

-divided into fundus, body, neck
-capacity to store 30-50 ml of bile
-concentrates by absorbing water
-under surface of liver
-artery- cystic artery and vein
-lymph- cystic node -> hepatic nodes -> celiac nodes
-nerve- sympathetic (T5-T9) - inhibits contraction
-parasympathetic vagus- stimulation contraction
-somatic- dorsal route ganglion (C3-5)

Question 8

pancreas

Answer 8

-exo and endocrine
-elongated structure
-epigastrium and LUQ
-crosses the transpyloric plane
-retroperitoneal
-divided into head, neck, body, tail
-main duct and accessory duct
-duct runs all the way down to tail
-enzymes enter duodenum to support digestion
-become fatty and lobule as you age

Question 9

head of pancreas

Answer 9

-disc shaped
-lies within concavity of duodenum
-part of head extends left behind the superior mesenteric vessels (uncinate process)

Question 10

neck of pancreas

Answer 10

-constricted
-connects head to body
-lies anterior to beginning of portal vein and origin of SMA

Question 11

body of pancreas

Answer 11

-runs upward and left across midline
-splenic artery runs along length of the body and enters the spleen

Question 12

tail of pancreas

Answer 12

-passes forward in splenicorneal ligament and in contact with hilum of spleen

Question 13

blood supply to pancreas

Answer 13

-splenic and superior and inferior pancreaticoduodenal arteries/veins
-lymph- nodes situated along arteries that supply gland -> celiac and superior mesenteric lymph nodes
-nerve- parasympathetic (vagal) nerve -> stimulate secretion of enzymes into duodenum via ducts
-sympathetic T5-T9- inhibit secretion

Question 14

spleen

Answer 14

-reddish
-largest single mass of lymphoid tissue in body
-oval shaped with notched anterior border
-lies just beneath left half of diaphragm close 9-11 ribs
-long axis lies along shaft of 10th rib and its lower pole extends forward as far as the midaxillary line
-should not be able to palpate spleen -> if you can -> enlarged
-deep breathe- move anteriorly
-surrounded by peritoneum at hilum forms -> gastrosplenic omentum (ligament) and splenicorenal ligament
-splenic artery and vein
-lymph- celiac nodes
-innervation- celiac plexus

Question 15

greater omentum =

Answer 15

gastrohepatic ligament

Question 16

triangle of calot (cystohepatic triangle)

Answer 16

-stones obstruct cystic duct
-stone can pass into small bowel
-cystic or common bile duct or in gal bladder
-where the hepatic ducts and neurovascular structures enter/exit the liver
-located at the porta hepatis of the liver
-accessory ducts etc. here that need be to removed first
-where gal bladder is removed

Question 17

pancreatic cancer

Answer 17

-retroperitoneal
-caught late
-back pain
-painless jaundice
-bile duct obstruction
-symptoms free often bc retroperitoneal

Question 18

liver 2 blood supplies

Answer 18

-two blood supplies
-hepatic portal vein- from digestion delivering deoxygenated blood from the small intestine containing nutrients
-hepatic arteries - supply the liver itself

Question 19

gal stone pancreatitis

Answer 19

-ERCP- removal of gal stones

Question 20

spleen percussion

Answer 20

tympanic percussion of abdomen in hollow parts normally
-anterolateral line- should be tympanic
-deep breathe- spleen forward - still tympanic -> fine
-if sound becomes dull -> enlarged
-if you can palpate -> large

Question 21

large intestine flexures

Answer 21

-ascending and descending- retroperitoneal
-transverse colon- intraperitoneal
-those “corners” or flexures gas trapping occurs
-splenic flexure syndrome
-ascending posterior, transverse across anteriorly, descend posteriorly