pages 74-80 Flashcards
What is the hepatic artery proper a branch of?
common hepatic artery
Hepatic artery proper supplies ____ % of blood to liver
25
What does the hepatic artery proper deliver?
highly oxygenated arterial blood to liver
Where is the hepatic artery proper located?
left of the common bile duct and anterior to the HPV
What is the hepatic portal vein formed from?
superior mesenteric and splenic vein , sometimes the inferior mesenteric
What does the hepatic portal vein supply?
about 75% of blood to liver that is rich in bilirubin and nutrients but is poorly oxygenated
How many hepatic veins are there?
right, middle and left. which all drain into the IVC, inferior to the thoracic diaphram
Liver vasculature compartmentalizes liver into how many segments?
8
Do these arteries anastamose?
no,
How are liver lobectomies and segmentectomies possible?
since the hepatic veins and its branches run between the segments
What are the primary and secondary lymphatic nodes in the liver?
primary: hepatic nodes hear porta hepatis and secondary: celiac nodes
Liver produces about ___ of the lymph passing through the thoracic duct
half
where does the lymph drain into?
cisterna chyli and then thoracic duct
What is the liver innervated by?
celiac plexus,
What is the parasympathetic innervation of the liver?
vagal trunks, synapse in the liver, and lead to dilation of the bile duct diamater.
What does vagotomy lead to?
gall bladder enlargement and slows emptying
What is the sympathetic innervation of the liver?
via greater splanchnic. stimulates vasoconstriction in the hepatic artery and HPV. doesn’t affect bile formation.
How do visceral afferents in the liver travel?
splanchnic nerves go back to T6-9 cord levels and reffered pain is between ribs 6-9
What is cirrohsis of the liver?
loss of hepatocytes and replacement with fibrous CT. surface can appear fatty/nodular. common in alcoholics, anorexic/bulimics and in hepatitis patients. Associated with hepatomegaly and portal hypertension.
What is the treatment for liver cirrohsis?
portocaval anastomses, and or liver transplant
What produces bile?
liver
What stores bile?
gall bladder
What is bile?
green/yellow secretion that emulsifys fat
What is bile canaliculi?
microscopic channgels present between rows of hepatocytes
What are bile ducts
microscopic components of intrahepatic portal triads
What are right and left hepatic ducts?
form at the convergence of intrahepatic bile ducts
What is cystic duct?
transfers bile to and from gall bladder
What is the common bile duct?
joining of the common hepatic and cystic ducts
Where does the CBD pass?
through the hepatoduodenal ligament and descends posteriorly, joins the main pancreatic duct to form the hepatopancreatic ampulla
What controls the flow of contents into the major duodenal papilla?
hepatopancreatic sphincter
What is the sphincter of the CBD?
present at the distal end of the CBD, when open it releases bile into the hepatopancreatic ampulla and when closed bile backs up into the gall bladder and is stored there
Where is the gall bladder located? how much fluid can it hold?
located in the gall bladder fossa on the visceral surface of the liver, which is at the junction of the right and left functional lobes of the liver, and sits on the superior part of the duodenum. it holds 50 mil of fluid.
What are the parts of the gall bladder?
fundus, body, neck
what is the fundus of the gall bladder
wide, blunt end projectiong from AI border of the liver, contacts the anterior body wall just below tip of the right 9th costal cartilage
where is the body of the gall baladder?
adjacent to visceral surface of the liver, transverse colon and duodenum
where is the neck of the gall bladder?
it is a narrow tapered region near the porta hepatis,
what is the spiral valve?
it is spiralled mucosa in the neck of the gall bladder that allows bile to enter gall bladder when sphincter of common bile duct constricts distal end of CBD
what is the cystic duct?
connects gall bladder to common hepatic duct
What arteries/veins drain the gall bladder?
arteries: cystic artery (from the right hepatic) and veins: drains into HPV or into liver
What are the primary and secondary lymph nodes of the gall bladder and where do they drain?
primary nodes are cystic and hepatic, secondary are celiac nodes and they drain into the cisterna chyli then thoracic duct
How is the gall bladder innervated?
via the celiac plexus
How does the parasympathetic system affect the gall bladder?
stimulates contraction of the GB and relaxation of the hepatopancreatic sphincter
What does CCK do
hormone produced by the duodenum in response to a fatty meal, that stimulates release of bile
What does the sympathetic system do to the gall bladder?
T6-9, synapses in the celiac ganglion, and relaxes the gall bladder, and contracts the hepatopancreatic sphincter
What levels do visceral afferent fibers pass and where is the pain reffered to?
T6-9, in the greater splanchnic nerve and pain is reffered to area between ribs 6-9. right side
What are gall stones
cholesterol based concertions in gall bladder or biliary duct system. cause sluggish bile flow,
What stones are the most problematic
small stones are MOST problematic (jaundice/pancreatitis may occur). stones lodging in the cystic duct cause biliary colic leading to cholecytitis and GB enlargement
Why are large stones not that problematic
only cause issues if they block bile flow, 50% adults asymptomatic
What is a cholecystetomy
gall bladder is removed laparscopically. surgical difficulties arise with variation in the duct pattern and blood supply. post surgical complications: bile duct injury.
what is steatorrhea
lack of bile acids due to bile duct injury, presence of excess fat in feces
What is the spleen
large lymphatic organ in body
Where is the spleen located
LUQ, posteriorly at the levels of ribs 9-11 and is surrounded by visceral peritoneum in all areas except the hilum
Stomach is ______, thoracic diaphragm is __________ in relation to the spleen
anterior and posterosuperior
Left kidney and tail of pancreas is ____ to the spleen
medial
left colic flexure is ____ to the spleen
inferior
how big is the spleen, whats its shape
variable, about the size of a clenched fist. rounded convexly, anterior and superior borders are sharper and notched. posterior and inferior borders are rounded and smooth.
what is the primary function of the spleen?
to filter blood, and expand/ contract in response to blood flow . it is not a vital organ
what is the gastrosplenic ligament
ligament to the spleen and greater curvature of the stomach. short gastric artery and left gastroepipolic artery
what is the splenorenal ligament
spleen to posterior wall near left kidney. contains splenic artery and vein
What are the arteries of the spleen
splenic artery, which is the largest celiac trunk , tortous pass along superior border of pancreas, splits into 5 near hilum of spleen
what are the veins of the spleen?
splenic vein is formed by several tributaries near hilum of the spleen. it is joined by inferior mesenteric vein and passes posterior to pancreas. Joins with superior mesenteric vein form HPV.
What are the lymphatics of the spleen
primary nodes: pancreaticosplenic nodes and secondary nodes: celiac or superior mesenteric nodes. from there pass to cisterna chyle and thoracic duct
What is the innervation of the spleen
celiac plexus. sympathetic via greater splanchic nerve (T6-8), snypase in the celiac ganglion and vasomotor and stimulate splenic contraction.
NO PARASYMPATHETIC INNERVATION
What is the rupture of the spleen
spleen is generally well protected by ribs 9-11, but can be ruptured due to rib fracture and due to trauma. leads to profuse bleeding and shock
What is the splenectomy
surgical repair of spleen is difficult due to thin capsule. removal is done after a splenic rupture , it is partially removed and followed by some regenertation.
What happens when spleen is removed, what takes up the functions
splenic functions are assumed by liver and bone marrow
What is an accessory spleen?
it is another spleen present hear hilum in about 10% of the people. Can be embedded in the tail of the pancreas
What is splenomegaly?
enlarged spleen due to disease (granulocytic luekemia, hypertension and anemia). Can enlarge about 10X, but spleen is not usually palpable in the adult, if you can palpate it near the lower left costal margin it is already enlarged to 3x its normal size.
What is the pancreas and where is it located
pancreas is a retroperitoneal organ that is transversly orientated and located posterior to the stomach (L1/2) with the duodenum of the right and the spleen on the left. Its exocrine function is digestive enzyme secretion and delivery to the duodenum and endocrine function is insulin and glucagon secretion/delivery
Where is the head of the pancreas and what structures pass around it
craddled in the arms of the duodenum, located right of the SMA, anterior to the IVC, right renal artery/ vein and left renal vein. The uncinate process is interomedial extension of pancreatic head and posterior to SMA. the Common bile duct is posterior portion of the head
Where is the neck of the pancreas and what structures pass around it
short segment anterior to SMA, covered by the pylorus of the stomach. Superior mesenteric and splenic veins merge posterior to the neck forming the HPV
Where is the body of the pancreas and what structures pass around it
elongated on the left side of the pancreas located left of the SMA, orientated transversly anterior to abdnomical aorta and L2. It is covered anteriorly by parietal periotneum and posteriorly by adventia
Where is the tail of the pancreas located
anterior to the left kidney and close to the hilum of the spleen (tickles the spleen)
what is the main pancreatic duct
it goes from the tail to head of pancreas and regulates the flow of bile and pancreatic juice into duodenum and prevents duodenal reflux. (merges with CBD to form the dilated hepatopancreatic ampulla, with the posterior part of the MPD opening to the major duodenal papilla)
Where is the sphincter of the pancreatic duct
at the terminal pancreatic duct,
What is the accessory pancreatic duct
it drains the uncinate process and inferior part of the head of the pancreas. opens into the duodenum via the minor doudenal papilla (40%) or may unit with main pancreatic duct and opens at the major duodenal papilla
What are the arteries that supply the pancreas and where to they branch from
1) pancreatic artery (splenic artery branch) supplies the tail and body.
2) ant/post superior pancreaticoduodenal (gastroduodenal branch) supplies the superior head.
3) ant/post inferior pancreaticoduodenal (SMA branch) supplies the pancreas head inferiorly.
What is the venous drainage of the pancreas
pancreatic vein, drains to splenic vein and less so to SMV, indirectly flows into HPV
What the primary and secondary nodes of the pancreas
primary: pancreaticosplenic nodes along the splenic artery
secondary: celiac, superior mesenteric and hepatic nodes
drain into cisterna chyli and then thoracic duct
What is the innervation of the pancreas?
Sympathetic: greater and lesser splanchnic T6-10. synapse in the celiac/superior mesenteric ganglia. and vasoconstrict/inhibit the pancreatic secretions. pancreatic pain refers to T6-10 cord segments and their dermatomes. or back (t10-12)
Parasympathetic: vagal trunks through celiac and superior mesenteric plexuses–>stimulated by hormones and this increases the pancreatic secretions.
What is pancreatitis
inflammation of the pancreas, resulting from pancreatic duct blockage or hepatopancreatic ampulla blockage. can involve all of the pancreas (body and tail)
What is pancretectomy
performed in the cases of chronic pancreatitis, extensive relationships of blood supply/ CBD and duodenum make it difficult to completely remove the head of the pancreas though.
