Liver, Gallbladder, Pancreas, Spleen

Question 1

Diaphragmic surface of liver

Answer 1

• Subphrenic recess
• Falciform ligament
• Subhepatic recess + hepatorenal recess(Morrison’s pouch)
• covered by peritoneum expect Bare area
• fibrous capsule pf Glisson (under peritoneum)

Question 2

Visceral surface of liver

Answer 2

• covered by peritoneum except gall bladder fossa + port hepatica
  1. Right saggital fissure:
• gallbladder fossa
• IVC groove
  2. Left saggital fissure:
• fissure of ligamentum teres hepatis
• fissure of ligament venosum

Question 3

Lesser omentum

Answer 3

Composed of:

• Hepatoduodenal ligament (+ porta heptaica strucutres)
• Hepatogastric ligament (+ right and left gastric a.)

Question 4

Impressions on liver visceral surface

Answer 4

• Duodenal impression
• Gastric impression
• Gallbladder impression
• Colic impression
• Renal and adrenal impression

Question 5

8 surgical segments of liver

Answer 5

1. Posterior Caudate segment
2. Left posterior Lateral segment
3. Left anterior Lateral segment
4. Left medial segment
5. Right anterior Medial segment
6. Right anterior Lateral segment
7. Right posterior Lateral segment
8. Right posterior Medial segment

Question 6

Blood supply of liver

Answer 6

ARTERY:
Portal vein
Proper hepatic artery⇒ right and left middle branch ⇒ medial and lateral secondary branches ⇒ tertiary branches
VEIN:
collecting vein ⇒ central vein ⇒ sublobar vein ⇒ hepatic vein ⇒ IVC

Question 7

Innervation of Liver

Answer 7

HEPATIC PLEXUS

sympathetic: celiac plexus
parasympathetic: vagus nerve

Question 8

Pathway of Bile

Answer 8

hepatocytes ⇒ bile canaliculi ⇒ Herring’s duct ⇒ Interlobular biliary duct ⇒ collecting bile duct ⇒ right and left hepatic duct ⇒ common hepatic duct ⇒ common bile duct

Question 9

Blood supply of Common bile duct

Answer 9

ARTERY:
- cystic artery (proper hepatic artery)
- right hepatic artery
- posterior superior Pancreaticoduodenal artery + Gastroduodenal artery
VEIN:
- Posteior superior Pancraticoduodenal vein

Question 10

Blood supply Gallbladder

Answer 10

• Cystic artery (proper hepatic artery)
• Cystic vein (⇒PV)
• hepatic lymph nodes ⇒ cystic lymph nodes

Question 11

Innervation of Gallbladder

Answer 11

sympathetic: CELIAC NERVE PLEXUS
parasympathetic: VAGUS NERVE + RIGHT PHRENIC NERVE

Question 12

Porto-caval anastomosis

Answer 12

1. Gastro-esophageal region: left gastric + esophageal veins
2. Paraumbilical region: paraumbilical vein + esuperficial epigastric vein and lateral thoracic vein
3. Anorectal region: superior rectal vein + middle and inferior rectal veins
4. Retroperitoneal region

Question 13

Ducts of pancreas

Answer 13

• Main pancreatic duct of Wirsung

- Accessory pancreatic duct of Santorini

Question 14

Blood supply of pancreas

Answer 14

ARTERY:
- superior pancreaticoduodenal a. (gastroduodenal)
- inferior pancreaticoduodenal a (SMA)
 ⇒ together 1st Riolan anastomosis
- dorsal pancreatic a (Splenic a)
- Pancreatic branches (splenic a)
- Great pancreatic a (splenic a)
- Artery of tail of pancreas (splenic a)

VEIN:

• pancreatic veins (⇒ splenic vein)
• pancreaticoduodenal vein (⇒ SMV)

LYMPH:
pancreatico-splenic lymph nodes ⇒ SMLN

Question 15

Innervation of Pancreas

Answer 15

sympathetic: ABDOMINOPELVIC SPLANCHNIC NERVES
parasympathetic: VAGUS NERVE

Question 16

Surfaces of Spleen

Answer 16

• Diaphragmatic surface
• Visceral surface:
  
  • Gastric surface: antero-superior
  • Renal surface: postero-superior
  • Colic surface: inferior

Question 17

Ligaments of Spleen

Answer 17

• Gastrosplenic ligament (left gastroepiploic vessels + short gastric vessels)
• Splenorenal ligament (splenic a/v + tail of pancreas)
• Phrenic-splenic ligament
• Phrenicocolic ligament

Question 18

Splenic nest (Nidus linealis)

Answer 18

• fossa in which spleen is laying

- most important keeping spleen fixed: Phrenicocolic ligament- Sustentaculum lienis

Question 19

Blood supply of Spleen

Answer 19

• Splenic artery (celiac trunk)
• Splenic vein (short gastric vein, pancreatic vein, left gastroomental vein) (⇒ IMV)
• Pancreatic-splenic and celiac lymph nodes

Question 20

Innervation of Spleen

Answer 20

Celiac nerve plexus