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GI Week 2 > Liver, Pancreas and Spleen > Flashcards

Liver, Pancreas and Spleen Flashcards

1
Q

The liver wins the prize for what?

A

largest gland in the body

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2
Q

the liver lies under what?

A

ribs 5-10 and the diaphragm - on the RUQ

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3
Q

HOw does the liver help with fat digestion?

A

secretes bile for emulsification

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4
Q

Where is bile concentrated and stored?

A

in the gallbladder

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5
Q

What are the two surface of the liver?

A

diaphragmatic and visceral

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6
Q

Descrie the diaphragmatic surface. Shape? Covering/

A

It’s smooth and dome-shaped - conforms to concavity of the diaphragm

most of the surface is covered with peritoneum except the “bare area” where no peritonem intervenes between the liver and the diaphragm

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7
Q

Describe the vsceral surface.

A

contacts the abdominal viscera
covered by peritoneum
porta hepatis is the entry and exit for blood vessel and bile ducts

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8
Q

An H-shaped group of fisusres divides the liver into what?

A

four anatomic lobes

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9
Q

What divides the liver into right and left anatomical lboes?

A

falciform ligament

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10
Q

What two lobes are anatomically part of th right lobe?

A

caudate and quadrate

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11
Q

Which lobe are the caudate an quadrate functionally part of?

A

the left lobe - according to the distribution of the hepatic artery, bile duct and portal vein

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12
Q

Why is this distinction important?

A

If part of the liver becomes cirrhotic, we can isolate where we resect based on blood supply, reducing blood less

liver an lose up ot 75% of cells before it stops functioning! And it can “regenerate” itself

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13
Q

What makes the right sagital limb of the H=shaped group of fissures?

A

sulcus for the inferior vena cava

fosa for the gall bladder

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14
Q

What makes the left sagittal linb of the H?

A

fissure for the ligamentum venosus (ductus vnosus in fetus)

fissure for the ligamentum teres hepatis (obliterated umbilicla vein)

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15
Q

What makes the portal or cross limb of the H?

A

door to the liver = porta hepatis

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16
Q

What’s in the porta hepatis?

A

the portal triad: bile duct, hepatic artery, portal vein

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17
Q

What is the portal triad (hepatic pedicle) enclosed in?

A

the free edge of the hepatoduodenal ligament

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18
Q

What is the pringle maneuver?

A

clamping the portal triad (pedicle) to minimize blood loss following traumatic injury to the liver or during hepatic surgery

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19
Q

What does the hepatic artery branch off ot?

A

the common hepatic off the celiac trunk

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20
Q

What percentage of blood does the hepatic artery deliver to the liver?

A

20-30% - it’s oxygenated

rest comes from the portal vein

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21
Q

What veins unite to form the portal vein?

A

superior mesenteric, inferior mesenteric and splenic

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22
Q

True or false: once inside hte liver, the contents of the portal triad travel independently of each other.

A

false - they go together

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23
Q

What vein drains th eliver?

A

the hepatic vein to the IVC

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24
Q

The lieft and right hepatic ducts join at the porta hepatis forming what?

A

the common hepatic duct

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25
Q

What does the common hepatic duct join to form the common bile duct?

A

the cystic duct

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26
Q

What common bile duct travels in the free edge of what structure?

A

the lesser opentum with the hepatic artery and portal vein anteiror to the omental foramen

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27
Q

The common bile duct passes behind the duidenum to join and pancreatic duct which forms what?

A

the hepatopancreatic ampulla of Water

28
Q

What does the hepatopancreatic ampulla of vater dump into?

A

the 2nd part of the duodenum at the major duodenal papilla

29
Q

What sphincter surrounds the hepatopancreatic ampulla and controls the flow of bile and pancreatic juices into the duodenum?

A

the sphincter of the hepatopancreatic ampulla or the sphincter of Oddi

30
Q

What sphincter controls the flow of bile in the common bile duct into the hepatopancreatic ampulla?

A

the choledochal sphincter

31
Q

The narroewst part of the biliary passage is the terminus of the hepatopancreatic ampulla. Why is this clinically sigifnicant?

A

it’s a common site for gallstones to lodge - will cause pain and jaundice

32
Q

The hepatic vein is formed by the union of what veins?

A

the central veins of the lobules in the liver

33
Q

What will provide an alrternate route for venous return if there’s an obstruction of the portal vein?

A

the portal-systemic or caval anatomoses

34
Q

What caval anatomosis will enlarge to form esopahgeal varices?

A

left gastric vein and axygos system of beins in the gastroesophageal reigon

35
Q

What caval anatomosis will enlarge to form caput medusae?

A

paraumbilical veins with subcutaneous veins in the anterior abdominal wall

36
Q

What caval anastomosis will enlarge to form rectal hemorrhoids?

A

superior rectal vein (portal) with the middle and inferior rectal veins (caval)

37
Q

Where does the gallbladder lie?

A

along the right edge of the quadrate lobe of the liver in a shallow fossa on its visceral surface

38
Q

What are the 4 parts of the gall bladder?

A

fundus
body
neck
cystic duct

39
Q

Where is the fundus located?

A

at the tip of the 9th costal cartilage in the midclavicular line

40
Q

Where is the body located?

A

contacts hthe visceral surface of the liver

41
Q

What muscle is contained by the cystic duct? WHat does it do?

A

the spiral fold of smooth muscle which acts to keep it constantly open so that bile can always flow depending on where the cholecdochal sphincter is open

42
Q

What will store bile after a cholecystectomy?

A

the bile duct and the hepatic ducts often dilate to store bile

43
Q

What imaging is best for visualizing the gall bladder?

A

US

but magnetic resonance cholangio-pancreatography lets one visualize the entire biliary tree and surrounding structures

44
Q

What artery supplies the gall bladder? Arising form what?

A

the cystic artery arising from the right hepatic artery in the angle of the common hepatic and the cystic ducts (the triangle of calot)

45
Q

Is the pancreas and endocrine or exocrine gland?

A

both
exocrine with pancreatic enzymes
endocrine with insulin and glucagon

46
Q

Where is the pancreas located?

A

it extends tranversely across the posterior abdominal wall posteiror to the stomach - extends form the duodenum to the spleen

47
Q

The pancreas is retropeirtoneal except for what?

A

for the tail that lies within the hilus of the spleen

48
Q

What process off of the head of the pancreas projects medially, posterior to the superior mesnteric vessels?

A

the uncinate process

49
Q

THe splenic vein joins the superior mesenteric vein posterior to this part of the pancreas to form the portal vein?

A

the neck of the pancreas

50
Q

What part of the pancreas extends superiorlya and to the left across the aorta?

A

the body of the pancreas

51
Q

The body’s anterior surface provides attachment for what mesentery?

A

the transverse mesocolong

52
Q

The tail of the pancreas passes between the two layers of what with the splenic vessels?

A

the splenorenal ligament

53
Q

Where in the pancreas does the main pancreatic duct begin?

A

tail of the pancreas and then runs all the way through until it joins the common bile duct to form the hepatopancreatic duct

54
Q

Sometimes there’s an accessory pancreatic duct that drains what? Does it join the main pancreatic?

A

drains the head of the pancreas

usually joins the main pancreatic duct, but sometimes opens independently in the duodenum at the minor duodenal papill

55
Q

Cancer of the pancreas usually involves what part?

A

the head

56
Q

Where does blood supply to the pancreas come from?

A

Lots of places…

  1. branches of the splenic artery
  2. gastroduodenal artery branches (anterior superior pancreaticoduodenal and posterior superior pancreaticoduodenal arteries)
  3. Superior mesenteric branches (anterior inferior and posterior inferior pancreaticoduodenal arteries)
57
Q

Where is the spleen located?

A

LUQ under rigs 9-11

58
Q

What is the spleen in general terms?

A

the largest mass of lymphoid tissue in the body

59
Q

THe spleen is completely surrounded by peritoneum except where?

A

the hilus

60
Q

What is the function of the spleen?

A

produce antibodies from plasma cells

filteres blood to dispose of defective blood cells

store concentrate blood cells and platelets

61
Q

What are the two parts of the spleen?

A

the hilus (medial aspect) and diaphragmatic surface

62
Q

What structures lie in the hilus of the spleen?

A

the splenic artery and splenic vein

also gastrolienal ligament and splenorenal ligament

63
Q

Where does the gastrolienal ligament extent from?

A

passes from the hilus to the greater curvature of the stomach

64
Q

What does the gastrolienal ligament carry?

A

the left gastroomental and short gastric arteries

65
Q

Where does the splenorenal ligament extent?

A

left kidney to the hilus of the spleen

66
Q

WHat does the splenorenal ligament containt?

A

the splenic vessels and tail of the pancreas

67
Q

THe spleen is the most frequently injured organ in the abdominal cavity. WHat’s the fix?

A

Just take it out - it’s hard to repair and bleeds like hell

you don’t need it becase other reticuloendothelial organs (bone marrow and liver) assume the spleen’s function

GI Week 2 (11 decks)

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