Liver, Portal Circulation, Billiary System and Spleen

Question 1

What ligaments can the lesser omentum be divided into?

Answer 1

Hepatoduodenal Ligament

Gastrohepatic Ligament

Question 2

Which ligaments suspend the spleen?

Answer 2

Splenorenal ligament and Gastrosplenic ligament

Question 3

In which mesentery does the liver develop?

Answer 3

Ventral mesentery

Question 4

What connects the liver to the anterior abdominal wall?

Answer 4

Falciform Ligament

Question 5

What connects the liver to the lesser curvature of the stomach?

Answer 5

Lesser Omentum

Question 6

What is the region of the liver that makes direct contact with the diaphragm called?

Answer 6

Bare area of the liver

Question 7

Which ribs are the liver deep to?

Answer 7

Deep to ribs 7-11

Question 8

Which abdominal regions do the liver extend across?

Answer 8

The top three: right hypogastric, epigastric and left hypogastric

Question 9

What is the structure at the end of the falciform ligament called and how did it originate?

Answer 9

Ligamentum Teres - it is a remnant of the umbilical vein

Question 10

What are the ligaments on the superior surface of the liver called?

Answer 10

Coronary Ligament (anterior and posterior) 
Left and Right Triangular Ligaments

Question 11

What defines the anatomical boundary (dividing the liver into anatomical lobes)?

Answer 11

The fissures of the foetal veins

Question 12

What are the two accessory lobes of the liver and where are they located?

Answer 12

Quadrate - located between the gallbladder and the fissure of the ligamentum teres
Caudate - located between the IVC and the fissure of the ligamentum venosum
The porta hepatis divides the caudate and quadrate lobes.

Question 13

What is the ligament on the posterior end of the inferior aspect of the liver?

Answer 13

Ligamentum venosum - remnant of the ductus venosum

Question 14

What divides the liver into right and left functional lobes?

Answer 14

A line between the gallbladder and the IVC

Question 15

What is special about the caudate lobe?

Answer 15

It is functionally independent - its blood supply is separate to the two main lobes

Question 16

What vessels make up porta hepatis?

Answer 16

Common bile duct
Hepatic artery
Hepatic portal vein

Question 17

What are the two parts of the coronary ligament?

Answer 17

Anterior and Posterior

Question 18

What is the space between the superior surface of the liver and the diaphragm called?

Answer 18

Subphrenic Space

Question 19

What are the branches of the coeliac trunk?

Answer 19

Left Gastric Artery
Splenic Artery
Common Hepatic Artery

Question 20

What are the branches of the common hepatic artery?

Answer 20

Right gastric artery
Gastoduodenal Artery (branches into the anterior and posterior superior pancreaticoduodenal arteries and the right gastro-omental artery)
Supraduodenal Artery
Cystic Artery
Hepatic Artery Proper
NOTE: Superior Pancreaticoduodenal Arteries anastomose with the inferior pancreaticoduodenal arteries (which come off the superior mesenteric artery)

Question 21

What connects the venous drainage of the liver to the IVC?

Answer 21

Three short hepatic veins

Question 22

What are the four sites of portal-systemic anastomosis?

Answer 22

Oesophageal Veins - Left Gastric Vein
Inferior Rectal Vein - Superior Rectal Vein
Epigastric Veins - Paraumbilical Vein
Retroperitoneal Veins - Visceral Veins

Question 23

What is the significance of these sites?

Answer 23

If there is a blockage causing hepatic portal tension, these sites of porto-systemic anastomoses could dilate and possibly bleed

Question 24

At which of these anastomoses is haemorrhage common?

Answer 24

Oesophagus

Rectum

Question 25

Describe the structure of the biliary tree.

Answer 25

The cystic duct from the gallbladder joins the hepatic duct (from the right and left hepatic ducts) to form the common bile duct

Question 26

Where does the common bile duct and pancreatic duct enter into the duodenum?

Answer 26

Major Duodenal Papilla | NOTE: the pancreatic duct joins the common bile duct at a dilation in the common bile duct called the Ampulla of Vater

Question 27

What is the clinical significance of the proximity of the gallbladder to the first part of the duodenum?

Answer 27

Gallstones can press on the duodenum and ulcerate causing a cholecystoduodenal fistula

Question 28

The spleen lies on the underside of which ribs?

Answer 28

9-11

Question 29

What are the two ligaments at the hilum of the spleen?

Answer 29

Splenorenal and Gastrosplenic