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Anatomy MD1 > Liver, pancreas and gallbladd > Flashcards

Liver, pancreas and gallbladd Flashcards

1
Q

What is the largest visceral organ and gland in the body?

A

liver

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2
Q

What is the approximate weight of the liver

A

1500g

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3
Q

Describe the correct anatomical location of the liver

A

-almost all the right hypochondrium and epigastrium - extends into the left hypochondrium - inferior to the diaphragm

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4
Q

What is the liver covered with?

A

denses fibrous capsule

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5
Q

Describe 10 functions of the liver

A
  1. Production and secretion of bile (emulsification of fats)
  2. Production of bile pigments (bilirubin and biliverdin) from the breakdown of hemoglobin
  3. Detoxification (by filtering the blood to remove bacteria and foreign particles that have gained entrance from the intestine)
  4. Storage of carbohydrate as glycogen (later breakdown to glucose)
  5. Production and storage of lipids as triglycerides Plasma protein synthesis (albumin and globulin)
  6. Production of blood coagulants (coagulation factors I, II, V, VII, IX, X and XI
  7. Production of Anticoagulants (heparin, protein C, protein S and antithrombin )
  8. Reservoir for blood and platelets
  9. Storage of certain vitamins (B12), iron, and copper
  10. In the fetus – production of red blood cells
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6
Q

Describe the anatomical lobes of the liver?

A
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7
Q

How are the two superficial lobes of the liver created?

A

The Caudate and Quadrate lobes are reflections of peritoneum from the livers surface, the fissures formed in relation to the reflections and the vessels serving the liver and gall bladder.

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8
Q

Based on Hepatic drainage and blood supply how many real lobes are in the liver?

A

Two lobes: right and left

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9
Q

What is the right lobe divided into?

A

anterior and posterior segments which are than subdivided into superior and inferior segments

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10
Q

What is the left lobe of the lung divided into?

A

Medial and lateral segments which are further divided into superior and inferior segments

Medial superior segment is Caudate lobe

Medial inferior segment is Quadrate lobe

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11
Q

Why could the caudate lobe be considered a third liver?

A

-it has vasculation independent of the bifurcation of the portal triad

  • revieves vessels from both bundles
    • drained by one or two small hepatic viens (enter directly into IVC)
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12
Q

Which lobes hepatic viens enter directly into the IVC?

A

Caudate lobe

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13
Q

What ducts combine to form the common bile duct?

A
  • from the liver the right and left hepatic duct form the common hepatic duct
  • cystic duct
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14
Q

Where does bile accumulate between meals?

A

Gallbladder

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15
Q

Describe the surfaces of the liver

A
  • diaphragmatic surface (convex shaped)
  • visceral surface (concave)
  • inferior border
  • subphrenic recesses (seperated by falciform ligament)
    • subhepatic space
  • hepatorenal recess
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16
Q

What is the subphrenic recesses?

A
  • superior extension of the peritoneal cavity (greater sac) exist between the diaphragm and the anterior and superior aspects of the diaphragmatic surface of the liver
  • subdivided by the falciform ligament which extends between the liver and the anterior abdominal wall.
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17
Q

What is the Falciform ligament

A

A ligament that seperates the right and left recesses of the subphrenic recess.

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18
Q

What is the subhepatic space?

A

portion of the supracolic compartment of the peritoneal cavity immediately inferior to the liver

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19
Q

What is the Hepatorenal recess or Morison pounch?

A

Posteriorsuperior extension of the subhepatic space

lies between right part of the visceral surface of the liver and kidney and suprerenal gland.

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20
Q

What is the lowest gravity dependent part of the peritoneal cavity?

A

hepatorenal recess or Morison pouch

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21
Q

What drains into the hepatorenal recess?

A

Fluid from the omental bursa

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22
Q

What does the hepatorenal recess communicate anteriorly with?

A

right subphrenic recess

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23
Q

What is peritonitis? and what are some common sites for it to occue

A

Peritonitis is inflammation of the peritoneal cavity

  • localized abscesses in various parts of the peritoneal cavity
    • subphrenic recess common on right side
      • because site of ruptured appendix and perforated duodenal ulcers
    • pus from subphrenic recess may drain into hepatorenal recesses in bedridden patients
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24
Q

What happens to bedridden patients with an abscess to the subphrenic recess?

A

fluid drains into the hepatorenal recess

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25
Q

What is the site of drainage of a subphrenic abscess?

A
  • incision inferior to bed of 12th rib
  • subcostal incision inferior and parallel to right costal margin
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26
Q

What is the bare area of the liver?

A

an area of demarcation by the reflection of peritoneum from the diaphragm to it as the anterior (upper) and posterior (lower) layers of the coronary ligament

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27
Q

Which area of the liver is not covered with peritoneum?

A
  • fossa for the gallbladder
  • porta hepatis
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28
Q

What are the five fissures of the liver?

A
  1. Fissure for the round ligament (ligamentum teres hepatis)
  2. Fissure for the ligamentum venosum
  3. Fossa for gallbladder
  4. Fissure for the IVC
  5. Porta hepatic
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29
Q

Where is the fissure for the round ligament located?

A

between the lateral portion of the left love and the quadrate lobe (used to be umbilical vien)

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30
Q

Where is the fissure for the ligamentum venosum located?

A

between the caudate lobe and the lateral portion of the left lobe (used to be the ductus venosus)

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31
Q

Where is the fossa for the gallbladder?

A

located between the quadrate lobe and the major part of the right lobe

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32
Q

Where is the fissure for the IVC located?

A

between the caudate lobe and the major part of the right lobe

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33
Q

Where is the porta hepatis located?

A

Transverse fissure on the visceral side of the liver between the quadrate and caudate lobes

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34
Q

What does the porta hepatis contain?

A

hepatic ducts, hepatic arteries and branches of the portal vien

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35
Q

What ligament used to be the umbilical vien

A

ligament teres hepatis (round ligament)

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36
Q

What are the four major ligament of the liver?

A
  • coronary ligament
  • right and left triangle ligaments
  • falciform ligaments
  • round ligaments
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37
Q

What forms the coronary ligament?

A

reflection of the peritoneum

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38
Q

What do the right and left triangular ligaments enclose?

A

bare area

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39
Q

Where is the falciform ligament?

A

anterior layer of the coronary ligament

40
Q

What is the round ligament a remnant of?

A

fibrous remnant of the umbilical vein

41
Q

What are the two components of the lesser omentum

A
  • hepatogastric ligament
  • hepatoduodenal ligament (enclosing portal traid)
  • passes from the liver to the lesser curvature of the stomach and the first 2cm of the superior part of the duedenum
42
Q

What are the five areas of impressions on the visceral surface of the liver and their relationship?

A
  1. Gastric and pyloric area -
  2. duodenal area
  3. fossa for gallbladder
  4. colic area
  5. renal and suprarenal areas
43
Q

What does the gastric and pyloric area of the liver reflects?

A

right side of the anterior aspect of the stomach

44
Q

What does the duodenal area touch?

A

superior part of duodenum

45
Q

What does the colic area come in contact with?

A

right colic flexure and right transverse colon

46
Q

What does the renal and suprarenal area of the liver reflect in?

A

right kidney and suprerenal gland

47
Q

What does it mean that the liver is a dual blood supply?

A

It has a dominant venous source ( portal vien) and lesser arterial one.

48
Q

What does the portal vien distribute?

A
  • 70-80% of oxygen to the liver
  • all nutrients absorbed by alimentary tract (except lipids)
49
Q

What forms the portal vien?

A

superior mesenteric and splenic viens ascend anterior to IVC

They are part of the portal triad

50
Q

What are the main branches that lead into the portal vien

A
  • left and right gastric vien of stomach
  • splenic vien from spleen
  • inferior mesenteric vien from large intestine
  • superior mesenteric from large intestine
  • pancreaticduodenal from pancreas and stomach
51
Q

Describe the arterial blood flow to the liver from the aorta?

A

Celiac trunk -> common hepatic artery-> hepatic artery proper-> right, middle, left hepatic arteries and their subsequent branches

52
Q

What is it possible to resect segments of the liver that have sustained sever injury?

A

the right and left hepatic arteries, and the right and left portal viens do not communicate with each other so with cauterization it is possible to perform hepatic segmentectomies without excessive bleeding.

53
Q

Why is the liver easily injured?

A

large structure and its in a fixed position, can cause severe hemorrhage and RUQ

54
Q

What happens in liver cirrhosis?

A

liver tissue is destroyed and replaced by fatty and fibrous tissue that surrounds the intrahepatic blood vessels thus impeding circulation of blood.

This causes portal hypertension - increased blood pressure in portal vien >10mmHG

55
Q

What are the four portal systemic anastomoses?

RIPE

A
  1. esophageal (submucusal) viens/azygos vein
  2. inferior and middle rectal veins (hemorrhoids)
  3. Paraumbilical veins/small epigastric veins “caput medusae”
  4. Retroperitoneal viscera
56
Q

What are two ways to preform a liver biopsy?

A
  1. percutaneously right 8-9th intercostal space right midaxillary line via US guided. Need someone to hold breath to reduce costodiaphragmatic recess to prevent lung dammage
  2. trans jugular liver biopsy - cather in the right internal judgular vien guided into SCV out IVC and right hepatic vien
57
Q

What is the purpose of the bile ducts?

A

convey bile from the liver to the duedenum

58
Q

Where is bile produced and stored?

A

produced in the liver and stored and concentrated in the gallbladder

59
Q

What is the purpose of bile?

A

emulsifies the fat, so it can be absorbed by the intestine

60
Q

What is the pathway of ducts and their combinations to convey bile to the liver?

A

right and left hepatic ducts unite to form common hepatic duct which joins with cystic duct to form the common bile duct

61
Q

Where is the bile duct found?

A

free edge of lesser omentum by the union of the cystic duct and the common hepatic duct.

62
Q

what is the length of the bile duct?

A

5-15cm

63
Q

What are the two ligaments in the lesser omentum and which one surrounds the portal triad?

A

hepatogastric ligament and hepatoduodenal ligament (portal triad)

64
Q

What two ducts unite to form the hepatopancreatic ampulla?

A

main pancreatic duct and the bile duct

65
Q

What is the hepatopancreatic ampulla?

A

the dilation within the major duedenal papilla ( papilla of Vater) which leads to the duodenum.

66
Q

What functions in regulating bile distribution into the duodenum?

A

the sphincter of pancreatic duct ( if contacts cannot enter ampula and backs up into the cystic duct into the gallbladder for concentration)

67
Q

How does the gallbladder get bile?

A

When the sphincter of pancreatic duct contract it prevents bile from going into the duodenum - this cause bile to back up into the cystic duct into the gallbladder for concentration

68
Q

What are the four arteries supplying the gall bladder and where do they supply?

A
  1. Cystic artery - supplies the proximal part of the duct
  2. Right hepatic artery - supplies the middle part of the duct
  3. posterior superior pancreaticoduodenal and gastrodueodenal artery - supplies retroduedenal part of duct
69
Q

What are the three lymph nodes supplying the bile duct?

A
  • cystic lymph nodes near neck of gallbladder
  • nodes of the omental foramen
  • hepatic lymph nodes
70
Q

What is the location of the gallbladder?

A

Right 9th costal cartilage and lateral border of the rectus abdominis (tender if inflammed gallbladder)

71
Q

Where on the liver does the gallbladder sit?

A

inferior surface between right lobe and quadrate lobe

72
Q

How much bile can the gallbladder hold?

A

30-50ml

73
Q

Four parts of a gallbladder.

A

fundus (tip of right 9th cost cartiliage, midclavicle line and contacts the transverse colon)

body - rest on the upper part of the duodenom and transverse colon

Infundibulum

neck - gives rise to the cystic duct with spiral valves (Heisters valves)

74
Q

What is the Heirsters valvues?

A

spiral valves along the cystic duct that have resistance to sudden dumping of bile when the spincters are closed

75
Q

What hormone cause contraction of the gallbladder?

A

cholecystokinin (produced by duodenal mucosa)

76
Q

What supplies blood to the gallbladder?

A

Cystic artery from the right hepatic artery

77
Q

What is the abnormal puch on the gallbladder?

A

Hartmanns pouch (ampulla of the gallbladder)

78
Q

Where do gallstones collect in the bladder?

A

infundibulum

79
Q

What happens if a peptic duodenal ulcer ruptures?

A

false passage forms between infundibulum and superior part of duedenum

80
Q

What happens if someon ehas a short mesentery surrounding the gallbladder?

A

the gallbladder moves around - vscular torsion and infaction

81
Q

What is important to watch for during a cholecystectomy?

A

aberant version of the cystic and hepatic ducts

82
Q

What are the three types of gallstones:

A
  1. Cholesterol stones (crystaline cholesterol monohydrate) developing countries
  2. Pigment sones (bilirubn calcium salts) other countries with malaria
  3. Brown stones - biliary infections (parasites or bacteria
83
Q

What happens if a gallston goes to duodenom via a cholecystenteric fistula?

A

may become trapped in ileocecal valcue causing an obstruction

84
Q

Where is the pancreas found?

A

floor of the lesser sac in the epigastric and left hypochondriac regions

85
Q

Is pancreas in retroperitoneal?

A

Everything but the tail of the pancreas is in the retroperitoneal, the tail is in the splenorenal ligament

86
Q

Four parts of the pancreas?

A

head, neck, body, and tail

87
Q

Where is the head of the pancrease embrased

A

c-chaped curve of the duodenom

88
Q

What are the two main functions of the pancreas

A
  • Exocrine secretion pancreatic juice from acinar cells
  • Endocrine secretions (insulin, glucagon, somatostatin,) from the pancreatic islets that enter the blood
89
Q

What arteries supply the pancreas and the spleen?

A
  • gastroduedenal artery
  • right gastro-omental artery
  • anterion and posterior superios pancreatic ducodenal arteries
  • inferior pancreaticoduedenal arteries
  • splenic arteries
90
Q

What is the venous drainage of the pancreas and spleen?

A

portal vien, inferior and superior mesenteric viens

91
Q

Lymphatic drainage of the pancreas

A
  • pancreaticosplenic nodes
  • celiac nodes
  • superior mesenteric nodes
  • pyloric nodes
  • hepatic nodes
92
Q

What regulates drainage of the pancreatic duct and the common bile duct

A

sphincter of hepatopancreatic ampulla

93
Q

What does a CT of the abdomen look like?

KNow this

A
94
Q

CT of abdomen

A
95
Q

What happens if the hepatopancreatic ampulla is backed up?

A

This cause pancreatis as the pancreatic duct bacts up, and the pancreatic juice cannot enter the duodenum

96
Q

What are some symptoms associated with pancreatic cancer?

A
  • usually in pancreatic head
  • compresses the bile duct causing obstruction leading to retention of bile pigments, gallbladder enlargement and jaundice
  • 90% of pancreatic cancers have ductal adenocarcionoma
  • may cause portal or IVC obstruction.

Anatomy MD1 (3 decks)

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