The Foregut 2 Flashcards
Where is the liver situiated?
RUQ of the abdominal cavity
Name the four lobes of the liver:
Left
Right
Caudate
Quadrate
Which lobes cannot be seen from the front?
Caudate
Quadrate
What is the liver encapsulated with?
Fibrous layer that is known as a capsule
What can happen if the liver expands?
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.
What is meant by the term ‘bare area’ of the liver?
Area not covered by peritoneum
Round ligament of liver (also called as ligamentum teres) is the remnant of which embryological structure?
Umbilical vein
What is the porta hepatis?
The area at which structures enter and leave the liver
Name structures present in the porta hepatis:
Hepatic nervous plexus
Hepatic ducts
Hepatic artery
Lymphatic vessels
Portal vein
What structures are in the portal triad?
Hepatic artery
Hepatic portal vein
Bile ducts
Where does the central vein drain to?
Hepatic veins then IVC
The extrahepatic biliary (Stuff not in liver) apparatus consists of:
Right hepatic ducts
Left hepatic ducts
Common hepatic duct
Gall bladder and cystic duct
Common bile duct
Where is bile produced?
Liver
Where is bile stored?
Gallbladder
Where does bile enter the gut tube?
Hepatopancreatic ampulla out via the major duodenal papilla
What is the function of bile?
To emulsify fat to aid digestion
What is Calot’s triangle?
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.
What does the biliary system link with the pancreatic duct to form?
The ampulla of Vater
When does biliary obstruction arise?
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).
What does pancreatic cancer do?
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.
What is the pancreas?
A gland that partly exocrine and partly endocrine. The exocrine part secretes the digestive pancreatic juice; the endocrine part secretes hormones.
How is it related to the duodenum?
Head of the pancreas lies in the C shaped curve of the duodenum
How is the pancreas peritonised?
Retroperitonised
Which vein is formed posterior to the neck of the pancreas?
Hepatic protal vein
Into which part of the duodenum does the pancreatic duct open?
Descending part
What is the arterial sypply of the pancreas?
Similar to the duodenum, the pancreas has a dual blood supply from the coeliac trunk and the superior mesenteric artery.
What is the venous drainage of the pancreas?
Drain into the splenic or superior mesenteric veins (into the portal system)
What is the nerve supply of the pancreas?
Both the coeliac plexus and the superior mesenteric plexus.
What is the lymph drainage of the pancreas?
Both to pre-aortic nodes at T12 and to Pre-aortic nodes at L1.
What does a coeliac plexus block do?
A coeliac plexus block can be done for conservative management of these symptoms.
What is the spleen?
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
How is spleen peritonised?
Intraperiotoneal
In which region of the abdominal cavity is the spleen located?
Left hypochodnrium region
Does spleen move with respiration?
Mobile with respiration
Name the structures in the hilum of spleen:
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)
The tail of which organ is closely related to hilum of the spleen?
Why must surgeons take care whn removing the spleen?
The spleen is prone to injury due to its location. Removal of the spleen (splenectomy) can save the patient’s life after injury.
What is the functions of the spleen?
Storage of RBC’s
Controls level of blood cells
Filters the blood and removes any old or damaged blood cells
Phagocytosis
