Retroperitoneum and Liver Flashcards
Give approximation of the location of the liver
Which ribs?
Which mesentery?
what kind of peritoneum?
how is it connected?
Mainly right hypochondrium and epigastric areas. Extends to the left hypochrondrium
Deep to the ribs 7-11
Develops in the ventral mesentery of the foregut.
It’s intraperitoneal except for the bare area.
Connected to anterior abdominal wall by Falciform Ligament
Connected to stomach by Lesser Omentum
Direct contact with part of Diaphragm (Bare Area of Liver)
Describe the surfaces of the liver
Which areas are covered by the visceral peri and not?
How is the top area separated?
Diaphragmatic surface
- > The posterior aspect of it is bare area (no visceral peri) making direct contact with the diaphragm
- > Separation into the right and left lobe by the FALCIFORM ligament.
- > Smooth convex
VISCERAL SURFACE
-> covered in visceral peri (not porta hepatis and gallbladder fossa0
Which organs is the liver in contact with?
What are the sublobes coming from the right lobe?
Stomach, duodenum, right kidney an colon
Right lobe has:
- > Main right lobe
- > Caudate (superior. Between IVC and Ligamentum venosum)
- > Quadrate lob (inferior, between the gallbladder (towards the right lobe) and ligamentum teres)
What are the ligaments of the liver?
Falciform ligament - attaches to the anterior abd wall
Coronary ligament - On the “crown” i.e. top. Attaches the liver to the diaphragm
Right and left triangular - attach the right and left lobes to the diaphragm.
Ligamentum teres and venosum - Venosum is the remnant of the ductus venosu which goes through the posterior separating the caudate from the left and quadrate. Lgamental teres - is below the venosum
What are the functional divisions of the liver?
how is cut in half?
Divided by its vascular supply into eight segments
Separated in half btween the gallbladder and the IVC
- > Left functional lobe - segments 1-4
- > Right functional lobes - segments 5-8
what is the diff // the functional and the anatomical line separating th liver?
Fuctional - going from the IVC to the gallbladder. This reflects the historical observance in the diff in atrophy // either sides of the line.
Anatomical - this reflects the line going through the falciform.
What is teh porta hepatis?
this is where all the neurovasculature (inc the portal triad), except fr the hepatic vein, goes in.
What is the proportion of the blood supply to the Liver
Coeliac trunk (hepatic artery proper) - 25% (review otehr card for this)
Hepatic portal vein - (75%) - this is the blood from the splenic vein, inferior and superior mesenteric vein.
VENOUS blood from the liver drains directly into the IVC via the 3 short hepatic vein
what does the splenic artery supply?
left gastro-omental and pancreatic artery
what liver diseases are associated with the vasculature system to the liver?
Fibrotic livers have high vascular resistance
Porto-systemic anastomoses therefore dilates due to the volume overload
which can then lead to oesophageal varcises, rectal varices (haemorrhiods) and caput varices
VARICES = veins that are enlarged or swollen
Where is the gallbladder found?
Between the quadrate and the right lobe of the liver.
Intraperitoneal
What is the structure of the gallbladder (GB)?
what is particular about the neck?
How do the ducts form?
Fundus
Body
Neck - has a mucosal fold called the HARTMAN’S pouch, common place for gallstones
It forms a cystic fuct and then joins the hepatic duct to form the common bile duct.
What is teh function of the gallbladder?
Concentrate and store bile (made by liver). Bile goes to the GB via hepatic duct
Bile then goes into the duodenum via the CBD
describe the biliary tree
What guards the ampulla of vater?
Recall up until the common bile duct (CBD)
CBD then joins pancreatic duct to form the hepatopancreatic ampulla of vater to join in the duodenum at the MAJOR DUODENAL PAPILLA
Sphincter of Oddi guards the ampulla of vater
BUT there are SEPARATE ducts for the bile and pancreatic known as bile duct sphincter and pnacreatic duct sphincter respectively
What is BILIARY COLIC?
GB contracts against obstruction from the stone stuck in the Hartmann’s pouch/cystic duct. Then dislodges into the GB or CBD.
What is Cholecystits?
Gallstones remain in th cystic duct leading to inflammation and mucosal oedema
Where is the IVC in relation to the liver?
Between the caudate and the left. It’s in a fossa on the posterior liver
What kind of an organ is spleen?
peritoneal?
how do the blood vessels enter?
Intraperitoneal - formed within the dorsal mesentery
it recycles rbc
Connected to the left kidney ia splenic renal ligament
Connected to the stomach via the gastrosplenic
Blood vessels enter via ligaments.
Describe the relations of the spleen
Posteriorly, upper left quadrant (under ribs 9-11)
It’s has relatins to the stomach, the left kideny, the splenic flexure (area on the colon which touches or hosts the spleen) of the colon and the pancreatic tail
what is the spleen supplied by?
Splenic artery-> makes it vulnerbale to trauma -> can rupture and haemorrhage in trauma cases
How do the retroperitoneal organs develop?
When tubes or organs move posteriorly during development and escape the peritoneum.
They become secondary retroperitneal organs. Come in direct contact with the abd wall and lose their mesentery.
E.g. DUODENUM - 1st part = Intraperitoneal. 2-4th part = secondart retro.
Other secondary retro inc. = Pancreas (tail in INTRA); Ascending and decending colon
What are the primary retroperitoneal organs?
These develop posterior to the peritoneal cavity and hence never have a mesentery
Kidneys Ureters Suprarenalorgans Aorta/IVC Nerves: lumbar plexus, sympathetic trunk, sympathetic trunk, oesophagus and rectum
Mnemonic = SAD PUCKER
How many parts in the pancreas?
5 tail body neck head proper uncinate process
all secondary retro, only tail is intraperitoneal.
What are the relations of the pancreas?
L1 - L3
Duodenum curves aroun the head
spleen posteriorly and laterally
stomach, anteriorly
What is pancreatitis and biliary stone disease?
When gallblader stones interfere with the flow of the pancreatic fluid into the SI -> inflammation of the pancreas.
Prolonged blockage will cause severe damage to the gallbladder, liver or pancreas which can be fatal.
Describe the parts of the duodenum with other organs
Superior part - Has a mesentery. Anterior to the bile duct and HPV
Descending - Bile duct opens into it (where the Mj duodenum papilla is)
Inferior - Crossed by superior mesenteric artery and vein
Ascending - Leads to Jejunum.
Which vertebrae locate the kidneys?
T11-L3
Right kidney is around the 11th intercostal space and the left is 11th rib. (hilum is around L1
what kind of an organ are kidneys?
Primary retroperitoneal
where does the superior mesenteric artery cross over?
over the left renal vein of the IVC
describe proximal relationship of other organs around the kidneys
look at diagram in the surgical soc slide 46
Left:-
ANT: Suprarenal land, panc, spleen, stomach, left colic flexure, jejunum
POST: diaphragm, 11th 12th ribs, psoas mj, quadratus lumborum, tranversus abdominis, subcostal, iliohypogastric, ilioinguinal nerve
RIGHT
ANT: Suprarenal gland, Liver, Duodenum, right colic flexure
POST: Diaphragm, 12th rib, psoas mj, quadratus lumborum, tranversus abdominis, subcostal, iliohypogastric, ilioinguinal nerve
