The Foregut 2

Question 1

Where is the liver situiated?

Answer 1

RUQ of the abdominal cavity

Question 2

Name the four lobes of the liver:

Answer 2

Left

Right

Caudate

Quadrate

Question 3

Which lobes cannot be seen from the front?

Answer 3

Caudate

Quadrate

Question 4

Answer 4

Question 5

What is the liver encapsulated with?

Answer 5

Fibrous layer that is known as a capsule

Question 6

What can happen if the liver expands?

Answer 6

Expands WIthin its fibrous layer

Fibrous layer is innervated by branches of the lower intercostal nerves. The stretching of the fibrous layer results in sharp and well localised pain. This is known as liver capsule pain.

An enlarged liver can also effect the diaphragm due to its close relation. This can cause referred pain to the shoulder tip.

Question 7

What is meant by the term ‘bare area’ of the liver?

Answer 7

Area not covered by peritoneum

Question 8

Round ligament of liver (also called as ligamentum teres) is the remnant of which embryological structure?

Answer 8

Umbilical vein

Question 9

What is the porta hepatis?

Answer 9

The area at which structures enter and leave the liver

Question 10

Name structures present in the porta hepatis:

Answer 10

Hepatic nervous plexus

Hepatic ducts

Hepatic artery

Lymphatic vessels

Portal vein

Question 11

What structures are in the portal triad?

Answer 11

Hepatic artery

Hepatic portal vein

Bile ducts

Question 12

Where does the central vein drain to?

Answer 12

Hepatic veins then IVC

Question 13

The extrahepatic biliary (Stuff not in liver) apparatus consists of:

Answer 13

Right hepatic ducts

Left hepatic ducts

Common hepatic duct

Gall bladder and cystic duct

Common bile duct

Question 14

Answer 14

Question 15

Where is bile produced?

Answer 15

Liver

Question 16

Where is bile stored?

Answer 16

Gallbladder

Question 17

Where does bile enter the gut tube?

Answer 17

Hepatopancreatic ampulla out via the major duodenal papilla

Question 18

What is the function of bile?

Answer 18

To emulsify fat to aid digestion

Question 19

What is Calot’s triangle?

Answer 19

Triangular space formed by cystic duct, common hepatic duct and inferior surface of liver.

The triangle contains cystic artery.

During the removal of the gall bladder (cholecystectomy) care should be taken not to damage the structures in and around the triangle.

Question 20

Answer 20

Question 21

What does the biliary system link with the pancreatic duct to form?

Answer 21

The ampulla of Vater

Question 22

Answer 22

Question 23

When does biliary obstruction arise?

Answer 23

Arises when passage of bile into the duodenum is blocked completely or partially. Obstruction may be intrahepatic or extrahepatic (causes: Gall stones, cancer of the head of pancreas).

Question 24

What does pancreatic cancer do?

Answer 24

Pancreatic cancer often presents late, if it starts at the head of the pancreas it will cause biliary obstruction sooner, making symptoms more obvious and allowing for a more timely diagnosis.

Question 25

What is the pancreas?

Answer 25

A gland that partly exocrine and partly endocrine. The exocrine part secretes the digestive pancreatic juice; the endocrine part secretes hormones.

Question 26

Answer 26

Question 27

How is it related to the duodenum?

Answer 27

Head of the pancreas lies in the C shaped curve of the duodenum

Question 28

How is the pancreas peritonised?

Answer 28

Retroperitonised

Question 29

Which vein is formed posterior to the neck of the pancreas?

Answer 29

Hepatic protal vein

Question 30

Into which part of the duodenum does the pancreatic duct open?

Answer 30

Descending part

Question 31

What is the arterial sypply of the pancreas?

Answer 31

Similar to the duodenum, the pancreas has a dual blood supply from the coeliac trunk and the superior mesenteric artery.

Question 32

What is the venous drainage of the pancreas?

Answer 32

Drain into the splenic or superior mesenteric veins (into the portal system)

Question 33

What is the nerve supply of the pancreas?

Answer 33

Both the coeliac plexus and the superior mesenteric plexus.

Question 34

What is the lymph drainage of the pancreas?

Answer 34

Both to pre-aortic nodes at T12 and to Pre-aortic nodes at L1.

Question 35

What does a coeliac plexus block do?

Answer 35

A coeliac plexus block can be done for conservative management of these symptoms.

Question 36

What is the spleen?

Answer 36

the largest single mass of lymphoid tissue in the body. It acts as a filter for blood and plays an important role in the immune responses of the body. It is highly vascularised and if perforated will bleed heavily

Question 37

How is spleen peritonised?

Answer 37

Intraperiotoneal

Question 38

In which region of the abdominal cavity is the spleen located?

Answer 38

Left hypochodnrium region

Question 39

Does spleen move with respiration?

Answer 39

Mobile with respiration

Question 40

Name the structures in the hilum of spleen:

Answer 40

Splenorenal ligament containing the splenic vessels (artery, vein and lymphatics)

Splenorenal ligament containing the tail of the pancreas

Vessels in the gastrosplenic ligament (short gastric arteries and left gastro-omental vessels)

Question 41

The tail of which organ is closely related to hilum of the spleen?

Question 42

Why must surgeons take care whn removing the spleen?

Answer 42

The spleen is prone to injury due to its location. Removal of the spleen (splenectomy) can save the patient’s life after injury.

Question 43

What is the functions of the spleen?

Answer 43

Storage of RBC’s

Controls level of blood cells

Filters the blood and removes any old or damaged blood cells

Phagocytosis