Liver, Pancreas, Spleen, Gallbladder, Appendix Flashcards
1
Q
In what regions is the liver found?
A
Right hypochondriac region, Epigastric region and Left Hypochondriac region
2
Q
What is the normal weight of the liver?
A
1500g
3
Q
What are the two surfaces of the liver?
A
Diaphragmatic and Visceral surfaces
4
Q
What is the name given to the shape of the diaphragmatic surface of the liver?
A
Convex
5
Q
What surfaces is the diaphragmatic surfaces subdivided into?
A
Anterior, superior, posterior and right lateral surfaces
6
Q
What are the different positions/ locations of the vermiform appendix?
A
Retrocecal location ( 12 o’clock)
Paracolic (11 o’clock)
Mid Inguinal/ Sub - caecal (6 o’ clock)
Pelvic - ( 4 o’ clock)
Promonteric - ( 3 o’ clock)
Splenic - (2 o’clock)
-Pre-ileal ( most dangerous)
-Post-ileal
7
Q
On the visceral surface of the liver, which area is not covered by Peritoneum ?
A
Fossa for gallbladder and the porta hepatis.
8
Q
What are the notable features on the diaphragmatic surface of the liver?
A
- Bare area of the liver
- Groove for inferior vena cava
- Fissure for ligamentum venosum
- Attachment of coronary, right, and left
triangular and falciform ligaments
9
Q
What are the notable features on Visceral surface?
A
- Fissure for ligamentum teres hepatis
- Porta hepatis
- Fossa for gallbladder
10
Q
Where is the cystic notch located?
A
It is located about 5 cm to the right of the median plane and often corresponds to the
fundus of the gallbladder.
11
Q
Which parts of the liver is NOT covered by peritoneum ?
A
- Bare area of the liver: It is a triangular area on the posterior aspect of the right lobe (details on p. 115).
- Fossa for gallbladder, on the inferior surface of the liver between right and quadrate lobes.
- Groove for IVC, on the posterior surface of the right lobe
of the liver. - Groove for ligamentum venosum.
- Porta hepatis.
12
Q
What is the name of the structure that divides the right lobe from the left lobe?
A
Cantlie’s plane/line
13
Q
On the postero-inferior surface of the liver, the Cantlie’s plane passes through what structures?
A
Fossa for gallbladder, to the groove for IVC.
14
Q
On the anterosuperior surface on the liver, the Cantlie’s line passes from?
A
This plane passes from the IVC to the cystic notch present a little to the right of the falciform ligament.
15
Q
Which part of the liver corresponds to segment 1?
A
The Caudate Lobe
16
Q
Which part of the liver corresponds to segment IV?
A
The Quadrate Lobe
17
Q
True or False? Segment I to IV of the left lobe of liver are supplied by the left branch of hepatic artery, left branch of portal vein and drained by left hepatic duct. The segments V to VIII of right lobe of liver are supplied by right hepatic artery, right branch of portal vein and drained by right hepatic duct.
A
TRUE!!
18
Q
How long will it take a liver to grow to its original size?
A
6-12 months
19
Q
True or False? False ligaments of the liver include Ligamentum teres hepatis & Ligamentum venosum.
A
FALSE!! These are true ligaments because they are actually the remnants of fetal structures.
20
Q
What are the false ligaments ( peritoneal folds) of the liver?
A
- Coronary ligament.
- Right triangular ligament.
- Left triangular ligament.
- Lesser omentum.
- Falciform ligament
21
Q
The Falciform ligament , Coronary ligament and Lesser omentum is a remnant of what embryological structure?
A
Ventral Mesogastrium
- Lesser omentum is from the dorsal part of the ventral mesogastum
22
Q
What structures is the falciform ligament connecting to the liver?
A
It connects the liver to the undersurface of the diaphragm and the anterior abdominal wall up to the umbilicus.
23
Q
The coronary ligament connects what structures to the liver?
A
It is a triangular fold of the peritoneum connecting the bare area of the liver to the diaphragm. It consists of two layers— upper and lower. The upper layer is reflected from the diaphragm to the liver whereas the lower layer is reflected from the liver to the upper end of the kidney.
24
Q
The ligament of Teres / Ligamentum Teres Hepatis / Round ligament is a remnant of ?
A
Remnant of the obliterated left umbilical vein
25
The ligamentum venosum is a remnant of ?
The obliterated ductus venosus which in fetal life connects the left branch of the portal vein with the IVC.
26
When taking a liver biopsy where should the needle be placed?
The needle is inserted in the midaxillary line in 9th or 10th intercostal space to avoid injury to the lung
27
The anterior surface of the liver is related to what structures?
It is related to the xiphoid process and anterior abdominal wall in the median plane and diaphragm on each side.
28
The right lateral surface of the diaphragm relates to what structure?
It is related to the diaphragm opposite 7th to 11th ribs in the midaxillary line.
1. Upper one-third of this surface is related to both the lung and the pleura (remember the lung extends up to the 8th rib).
2. Middle one-third of this surface is related to the costodiaphragmatic recess of pleura (remember the pleura extends up to the 10th rib).
3. Lower one-third of this surface is related to 10th and 11th ribs (i.e., it is related neither to the lung nor to the pleura).
29
The posterior left lobe of liver is related to what structures?
The abdominal part of the esophagus, just to the left of the upper part of fissure for ligamentum venosum and causes esophageal impression. The fundus of the stomach is related just to the left of the esophageal impression.
30
What is the blood supply to the liver?
Hepatic artery
Hepatic Portal Vein
31
Where does the liver gets its venous drainage from?
(a) left hepatic vein between medial and lateral segments of the left true lobe
(b) middle hepatic vein between true right and left true lobes
(c) right hepatic vein between anterior and posterior segments of the right true lobe.
32
What is the lymph drainage of the liver?
Superficial lymphatics
Posterior mediastinal lymph nodes.
Hepatic nodes
Deep lymphatics- form two trunks:
* Ascending enters the thorax through the vena caval opening and terminates in the nodes around the IVC.
* The descending trunk empties in hepatic nodes located in the porta hepatis)
33
What is the nerve supply of the Liver?
Sympathetic fibres - Coeliac plexus
Parasympathetic fibres- Derived from the hepatic branch of the anterior vagal trunk, which reaches the porta hepatis through the lesser omentum.
34
What is the name of the pouch-like dilation found in the neck of the gallbladder?
Hartmann’s pouch
35
What is the surface marking for the fundus of the gallbladder?
It lies beyond the sharp lower border of the liver and touches the parietal peritoneum of the anterior abdominal wall at the tip of the ninth costal cartilage, where the transpyloric plane crosses the right costal margin, at the lateral border of the right rectus sheath
36
What are the factors that keep the liver in position?
1. Hepatic veins connecting the liver to the IVC.
2. Intra-abdominal pressure maintained by the tone of
abdominal muscles.
3. Peritoneal ligaments connecting the liver to the abdominal walls.
37
True or False? The posterior border for the fissure of ligament venosum will form the anterior boundary of the caudate lobe?
TRUE!!
38
From what structures is the liver developed?
Hepatic bud from the distal end of the foregut.
39
What structures do these hepatic buds give rise to and what structures do they later form?
* Small accessory bud on its right side called pars cystica which forms cystic duct and gallbladder.
* The main bud called pars hepatica gives rise to right and left hepatic ducts and liver parenchyma.
40
What is the name given to the acute angle between the cystic duct and the common hepatic duct ?
Cystohepatic angle.
41
What is the width and length of the gallbladder?
Length: 10cm.
Width: 3 cm (at its widest part).
42
What are the layers of the gallbladder?
1. Serous layer
2. Subserous layer
3. Fibromuscular layer of the fibrous tissue mixed with smooth muscle fibres, which are arranged in loose bundles disposed in longitudinal, circular, and oblique directions.
4. Mucous membrane
43
True or False? The Serous layer of the gallbladder is made of loose areolar tissue while the subserous layer of the gallbladder is made of peritoneum.
FALSE!! Serous layers made of PERITONEUM while Subserous layer is made of LOOSE AEROLAR TISSUE.
44
What is the blood supply to the gallbladder?
Cystic Artery ( a branch of right hepatic artery)
It may arise from the main trunk of the hepatic artery, from the left hepatic artery, or from the gastroduodenal artery.
45
What is the Venous drainage of the gallbladder?
The venous drainage of the gallbladder is twofold (a) by the cystic vein, which drains into the portal vein and (b) by a number of small veins, which pass from the superior surface of the gallbladder to the liver through the gallbladder bed to drain into the hepatic veins
46
What is the lymph drainage of the gallbladder?
(a)Cystic lymph node of Lund
(b) the node alongside the upper part of the bile duct (node at the anterior border of epiploic foramen), which finally drains into the coeliac group of lymph nodes.
47
Where is the Cystic Lymph node of Lund located?
Calot’s triangle
48
What is the innervation of the gall badder?
* Cystic plexus formed by the sympathetic fibres (T7–T9),
* Parasympathetic fibres (right and left vagus nerve),
* Fibres of the right phrenic nerve.
49
Where is Gallbladder pain always reffered to?
(i) the inferior angle of the right scapula by sympathetic fibres
(ii) the tip of the right shoulder via the right phrenic nerve
(iii) the stomach by vagus.
50
How long is the cystic duct
3-5 cm
51
What is the name given to the structure found in the mucous membrane of the cystic duct?
Crescentic folds (5–10 in number) project into the lumen in a spiral fashion forming a spiral fold called “spiral valve (of Heister)"
52
What is the function for the Valves of Heister?
It keeps the duct open so that bile can pass through it both in and out of the gallbladder.
53
What is the name of the hormone that influences the relaxation and contraction mechanism of the gallbladder?
Cholecystokinin
54
Where is cholecystokinin released from?
Duodenal mucosa
55
What are the 4 parts of the Common Bile duct ?
1. Supraduodenal part.
2. Retroduodenal part.
3. Infraduodenal (or pancreatic) part.
4. Intraduodenal part.
56
How long is the common bile duct?
7.5 cm ( 3 inches long)
57
Which part of the common bile duct descends behind the first part of the duodenum with the gastroduodenal artery on its left and IVC on its posterior aspect?
Retroduodenal Part
58
Which part of the common bile duct is about 2.5 cm long and descends in the right free margin of the lesser omentum to the right of the hepatic artery proper and anterior to the portal vein?
Supraduodenal part
59
True or False? The part of the common bile duct that enters the posteromedial surface of the descending (second) part of the duodenum a little below to its middle is the Intramural part.
TRUE!! ( Intraduodenal or intramural part )
60
How long is the major duodenal papilla from the pylorus?
8–10 cm distal to the pylorus.
61
What is the name of the sphincter that surrounds the bile duct?
Sphincter choledochus (of Boyden)
62
What is the name of the sphincter that surrounds the pancreatic ducts?
Sphincter pancreaticus
63
What is the name of the sphincter surrounding the Ampulla of Vater?
Sphincter ampullae (of Oddi)
64
What is the blood supply to the Upper part of the bile duct?
Twig from the descending branch of cystic artery
65
What is the blood supply to the lower part of the bile duct?
Ascending branch of the superior pancreaticoduodenal artery.
66
What is cirrhosis of the liver?
Following injury and death of hepatocytes (caused by alcohol, toxins, etc.), the liver parenchyma undergoes fatty degeneration and is replaced by fibrous tissue called hepatic fibrosis/cirrhosis of liver.
67
Why is Hematemesis a symptom of cirrhosis of the liver?
Rupture of esophageal varices formed due to portal hypertension.
68
What is Portal Hypertension ?
Normal portal pressure is about 5–15 mmHg. The portal pressure of about 40 mmHg is called portal hypertension. It occurs because the fibrosed liver cannot handle as much blood flow through the portal circulation, leading to complications such as varices and ascites.
69
True or False? On the right side of the fissure for ligamentum venosum, this surface presents a slight elevation that comes in contact with the lesser omentum. Hence, it is called tuber omentale/omental tuberosity.
FALSE!! It is on the left side
70
Where does the Quadrate Lobe lie?
Between the fossa for gallbladder and
the fissure for ligamentum teres below the porta
hepatis.
71
Where does the Caudate lobe lie?
Between the inferior vena cava and the fissure for the ligamentum venosum
72
What is the surface marking of the liver?
* The upper margin of the liver is approximately level with the xiphisternal joint, arching slightly upwards on each side.
* On the left it reaches the fifth intercostal space 7–8 cm from the midline, and on the right to the fifth rib, curving down to the right border which extends from ribs 7 to 11 in the midaxillary line.
73
What are the structures that a have a postero-infero relation to the Quadrate lobe of liver?
1. Pyloric region of stomach
2. First part of duodenum
3. Right free end of Lesser omentum.
4. Portion of Transverse colon.
74
Which vein is known to become dilated during portal hypertension and produce caput medusa and why?
Para-umbilical vein found in ( falciform ligament & round ligament ) , this is because its a site of portal- systemic anastomoses.
75
In which regions of the anterior abdominal wall is the pancreas located?
Epigastric and left hypochondriac regions.
76
Fill in the blanks. " The _______ part of the pancreas secretes the pancreatic juice and the _______ part secretes the hormones, viz., insulin, etc.
The exocrine part produces pancreatic juices
The endocrine part produces hormones.
77
Where does the pancreas cross the posterior abdominal wall?
Obliquely from concavity of the duodenum to the hilum of spleen opposite the level of T12–L3 vertebrae
78
What is the normal weight & length of the pancreas?
80-90 grams
12-15 cm
79
Where does the tail of the pancreas lie?
In the iliorenal ligament with splenic vessels
80
The head of the pancreas is found at what vertebral level?
L2
81
What are the parts of the pancreas?
Head
Neck
Body
Tail
82
What are the three borders of the pancreas?
Superior
Inferior
Right lateral
83
What are the relations to the superior border of the pancreas?
First part of the duodenum
Superior pancreaticoduodenal artery.
84
True or False? The left lobe of the liver is higher than the right lobe of liver.
FALSE!! The right lobe of liver is HIGHER than left lobe .
85
What structures are found in Calot's triangle?
Right Hepatic Artery
Cystic artery
Cystic lymph node of Lund
86
What is the epithelium of the mucosa of the gallbladder?
Simple columnar with no goblet cells , short microvilli
87
What are the layers of the gallbladder?
Mucosa, muscularis and serosa on inferior surface
88
What layer is found in the gallbladder bed?
Adventitia
89
At what vertebral level is the head of the Pancreas?
L2
90
At what vertebral level is the body & neck of the pancreas located?
L1 - anterior to IVC and aorta
91
At what vertebral level is the tail of the Pancreas located?
T 12
92
Fill in the blanks. "The tail of the Pancreas lies in the _________ along with _______. "
Lienorenal ( Splenorenal) ligament along with splenic vessels - therefore it is intra- periotneal
93
What is the blood supply to the head and uncinate process of the pancreas ?
- Anterior and posterior arcades of pancreatico-duodenal arteries.
- Anterior & Superior pancreaticoduodenal artery coming from GDA
- Inferior pancreaticodudodenal artery coming from SMA
94
What is the blood supply to the body and tail of he pancreas?
Splenic artery by 3 main branches :
- Dorsal pancreatic
- greater pancreatic (arteria pancreatica magna)
- caudal pancreatic (arteria caudae pancreatica)
95
Which branch of the splenic artery is the largest one and what is it's alternative name?
Greater Pancreatic branch ( aka greater pancreatic artery of von Haller and arteria pancreatica Magna)
96
Where does the arteria pancreatic magna come off the Splenic artery?
At the junction of body and tail of pancreas.
97
What is lymph drainage of the head of the Pancreas ?
* Pancreaticoduodenal nodes and prepyloric and post pyloric nodes to celiac and can spread into hepatoduodenal ligament
* Pancreaticoduodenal to superior mesenteric lymph node
98
The lymph drainage of the body and tail of the pancreas drains into which lymph nodes?
They drain to nodes along splenic vessels and mesocolic nodes.
Pancreatico-splenic to celiac lymph nodes
99
Fill in the blank. "When the mesenteries of an organ also fuse to the parietal peritoneum on the posterior abdominal wall, creating a relatively avascular plane. This is called __________.
Fusion fascia ( Francis quiz)
100
What is the name of the procedure used to mobilise the Duodenum and the Pancreas?
Kocher's manouvre
101
Which branch of the Vagus nerve provides parasympathetic innervation to the Pancreas?
Coeliac branch of posterior vagal nerve
102
What provides sympathetic innervation to the Pancreas?
Coeliac plexus which receives preganglionic SNS fibres from greater splanchnic and these synapse on postganglionic neurons in coeliac ganglia which go on to pancreas.
103
What is the location of the Pancreas?
It lies in the Posterior abdominal wall in the Epigastric and Left hypochondric region
104
Where does D1, D2, D3 lie in relation to the head of the pancreas?
D1- lies antero-superior to upper part of head.
D2- firmly adherent to head ( pancreas may be embedded within its wall)
D3 - lies inferior to head.
105
What are the anterior surface relations of the HEAD of the pancreas?
Gastroduodenal artery
Transverse colon
Root of the transverse mesocolon
Jejunum
106
What is the posterior surface relations of the HEAD of the pancreas?
(a) IVC,
(b) left renal vein,
(c)bile duct (lying in a groove, and may be found embedded in the pancreatic tissue), and
(d) right crus of diaphragm.
107
The Uncinate process of the pancreas is related ANTERIORLY to?
Superior mesenteric vessels
108
Fill in the blanks. "The Uncinate process of the pancreas is related Posteriorly to the _______."
Abdominal aorta
109
How long is the neck of the pancreas?
1.5-2 m
110
The posterior surface of the NECK of the pancreas is related to what structures?
Superiorly - Portal vein
Posteriorly - Formation of the hepatic portal vein
Inferiorly - Superior mesenteric vein
110
What are the anterior surface relations for the neck of the pancreas?
* Pylorus of stomach
* Transverse mesocolon attached ( inferiorly)
110
Fill in the blanks. " On the anterior surface , the _________ and __________ descends in the region of the junction of the head & neck."
Gastroduodenal artery & Pancreaticoduodenal artery.
110
What are the three borders of the body of the Pancreas?
Anterior
Superior
Inferior
111
What are the three surfaces of the Body of the Pancreas?
Anteroposterior, Anteroinferior, Posterior
112
What is the name of the structure inn superior border of the body of the pancreas that projects above the lesser curvature of the stomach?
Omental tuberosisty
113
What are the relations to the Anterosuperior surface of the body of the pancreas?
Stomach
Lesser sac
114
What are the relations to the anteroinferior surface of the body of the pancreas?
DJ flexure
Coils of jejunum
Jejunal loops
115
What are the relations of the inferior border of the body of the pancreas?
Superior mesenteric artery ( medially)
Inferior mesenteric vein ( laterally )
116
What are the relations of the Posterior Surface of the Pancreas?
Aorta
Splenic Vein ( closely applied)
Origin of Superior Mesenteric Artery
Lower aspect of left supra-renal gland
Left kidney
Left renal vein
deep to renal vessels - Left psoas muscle & Left diaphragmatic crus
117
What is the relation of the anterior border for the body of the pancreas?
Transverse mesocolon
118
Which part of the Pancreas is the only mobile part?
Tail of the pancreas
119
Which part of the pancreas contains the largest number of islets of Langerhans per unit of tissue as compared to other parts of the gland?
The tail of the pancreas
120
What are the posterior relations to the tail of the pancreas?
1.Splenic vessels lying within the lienorenal ligament .
121
What is the anterior relation to the tail of the pancreas?
Splenic flexure of the colon
122
What is the Venous drainage for the Head and Neck of the Pancreas?
Superior pancreaticoduodenal into Portal vein
Inferior pancreatico duodenal into SMV
123
What is the venous drainage for the body and tail of the pancreas?
Other pancreatic veins into splenic vein
124
What is the sympathetic Innervation of the Pancreas?
Sympathetic preganglionic fibres transverse splanchnic nerves to celiac& superior mesenteric ganglia & plexuses.
Greater splanchnic ( T5-T9)
Lesser splanchnic (T10 - T11)
Least splanchnic ( T12)
125
What is the parasympathetic innervation to the pancreas?
Posterior vagus & celiac plexus
126
What is Visceral pain of the pancreas mediated by and where is it normally felt?
Mediated mainly by the sympathetic afferents
Pain is referred to the epigastrium
127
What is Somatic (parietal pain) mediated by and where is it normally felt?
Mediated by the lower intercostal nerves
Pain is referred to the lower thoracic and paravertebral areas
128
From which embryological layer is the pancreas formed from?
The pancreas is formed from the caudal part of the FOREGUT
129
