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GI anatomy > The Liver, Gallbladder, Duodenum And Pancreas > Flashcards

The Liver, Gallbladder, Duodenum And Pancreas Flashcards

1
Q

Where does the liver lie in abdominal regions

A

Right upper quadrant and epigastrium of abdomen

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2
Q

Position of liver

A

Right side of body under diaphragm
Protected by the ribs
Moves inferiority with inspiration

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3
Q

What transports products of digestion , except lipids, to liver from the gut

A

Hepatic portal vein

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4
Q

Which product of digestion doesn’t go to the liver

A

Lipids

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5
Q

Where is bile produced

A

Liver

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6
Q

Where is bile stored

A

Gallbladder

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7
Q

Function of bile

A

Emulsifies lipid in the chyme entering the duodenum from the stomach

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8
Q

2 surfaces of liver

A

Diaphragmatic surface- lies anterosuperiorly
Visceral surface- lies posteroinferiorly

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9
Q

What regions of the liver are not covered by visceral peritoneum

A

Bare area of the liver
Region where the gallbladder lies in contact with the liver
Region of porta hepatis

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10
Q

Bare area of the liver

A

Region on posterior surface that lies in contact with diaphragm
No visceral peritoneum

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11
Q

Region of porta hepatis

A

Where hepatic blood vessels and ducts of the biliary system enter and exit the liver
No visceral peritoneum

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12
Q

How many lobes does the liver have

A

2

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13
Q

2 lobes of liver

A

Large right lobe
Small left lobe

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14
Q

Falciform ligament

A

Separates 2 lobes of liver
Connects anterior surface of the liver to the internal aspect of the anterior abdominal wall

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15
Q

What separates the 2 anatomical lobes of the liver

A

Falciform ligament

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16
Q

2 accessory lobes of the liver

A

Caudate lobe
Quadrate lobe

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17
Q

Where are the accessory lobes located on the liver

A

Posteroinferior surface

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18
Q

How many functional segments of the liver are there

A

8

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19
Q

How is each segment of the liver functional

A

All served by own branch of hepatic artery, portal vein and hepatic duct

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20
Q

What connects the liver and diaphragm

A

Coronary and triangular ligaments

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21
Q

What connects the liver and anterior abdominal wall

A

Falciform ligament

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22
Q

What connects the liver to the stomach and duodenum

A

Lesser omentum

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23
Q

Portal triad

A

Hepatic artery, hepatic portal vein and bile duct run together in free edge of lesser omentum

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24
Q

Epiploic Foramen

A

Entrance of the lesser sac
Anterior boundary = portal triad and free edge of lesser omentum

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25
Q

What forms the anterior boundary of the epiploic foramen

A

Portal triad and free edge of lesser omentum

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26
Q

2 recesses related to the liver

A

Hepatorenal recess
Subphrenic recesses

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27
Q

Hepatorenal recess

A

Lies between the right kidney and posterior surface of the right side of the liver
Fluid flows into this space in supine position

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28
Q

Left and right subphrenic recesses

A

Lie either side of falciform ligament, between the anterosuperior surface of the liver and diaphragm

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29
Q

What does the liver develop from

A

Embryological foregut
Grows from a tissue bud that develops in ventral mesentery
As the liver grows and migrates to the right side of the abdomen, its peritoneal attachments are pulled with it. The remains of the ventral mesentery form the lesser omentum and the falciform ligament. The peritoneal attachments of the liver anchor it to surrounding structures, including the diaphragm superior to it.

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30
Q

Ligamentum teres

A

Round ligament of the liver in free edge of falciform ligament
Remnant of umbilical vein

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31
Q

Umbilical vein

A

In the fetus, carries oxygenated blood from placenta to fetus

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32
Q

Ligamentum venosum

A

Lies on posterior surface of liver in groove between caudate lobe and left lobe of liver
Remains of ductus venosus

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33
Q

Ductus venosus

A

In fetal life diverts blood from umbilical vein to the IVC, shunting oxygen-rich blood to heart and bypassing the liver

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34
Q

Arterial supply of liver

A

Right and left hepatic arteries(branches of coeliac trunk)

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35
Q

Coeliac trunk —> left and right hepatic arteries

A

Coeliac trunk:
1. Left gastric
2. Splenic
3, common hepatic arteries
Common hepatic artery—> gastroduodenal artery and hepatic artery proper
Hepatic artery proper —> left and right hepatic arteries

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36
Q

3 branches of coeliac trunk

A

Left gastric artery
Splenic artery
Common hepatic artery

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37
Q

Which artery bifurcates to form the left and right hepatic arteries

A

Hepatic artery proper

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38
Q

What branch comes off the common hepatic artery to form the hepatic artery proper

A

Gastroduodenal artery

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39
Q

Venous drainage of liver

A

Venous blood exits via 2/3 large hepatic veins that lie within the liver
Unite with inferior vena cava as it passes posterior to the liver

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40
Q

Hepatic portal vein

A

Nutrient-rich venous blood that leaves the gut is transported to the liver via the hepatic portal vein
Receives blood from the superior and inferior mesenteric veins and the splenic veins

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41
Q

Which veins feed into the hepatic portal vein

A

Superior mesenteric vein
Inferior mesenteric vein
Splenic vein

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42
Q

Hepatic plexus

A

Parasympathetic fibres from the vagus nerve
Sympathetic fibres
Follows paths of hepatic vessels and ducts of biliary tree

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43
Q

Parasympathetic fibres to liver stem from which nerve

A

Vagus nerve

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44
Q

Pain from the liver is felt in which region

A

Epigastric

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45
Q

Function of gallbladder

A

Stores and concentrates bile

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46
Q

Location of gallbladder

A

Lies on posteroinferior surface of liver
Lies close to duodenum

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47
Q

3 parts of gallbladder

A

Fundus
Body
Neck

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48
Q

Body of gallbladder

A

Forms main part which sits in gallbladder fossa on the visceral surface of the liver
It tapers towards the neck

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49
Q

Neck of gallbladder

A

Shape tapers
Communicates with the cystic duct

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50
Q

Fundus of gallbladder

A

Rounded end of the gallbladder
Typically extends to inferior border of liver

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51
Q

Surface marking of Fundus of gallbladder

A

Tip of 9th costal cartilage at the point where the right midclavicular line intersects the right costal margin

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52
Q

Which cells produce bile

A

Hepatocytes

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53
Q

Biliary tree

A

Bile first excreted into small channels called bile canaliculi which drain into ducts of increasing calibre that converge to form right and left hepatic ducts

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54
Q

Common hepatic duct

A

Left and right hepatic ducts converge
Receives the cystic duct from the gallbladder

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55
Q

Common bile duct

A

Distal to where cystic duct joins common hepatic duct
Runs in free edge of lesser omentum
Descends posterior to superior part of duodenum and head of pancreas
Enters the duodenum

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56
Q

Cystic duct

A

Bile leaving the liver not needed for digestion enters the gallbladder
Or bile flows from gallbladder to common bile duct and duodenum

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57
Q

Spiral fold/valve

A

Lies at junction between the gallbladder neck and cystic duct

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58
Q

When does common hepatic duct —-> common bile duct

A

When cystic duct joins

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59
Q

Arterial supply to gallbladder

A

Cystic artery (branch of right hepatic artery)

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60
Q

Venous drainage of gallbladder

A

Cystic veins that pass directly into liver or join hepatic portal vein

61
Q

Which artery does the cystic artery branch from usually

A

Right hepatic artery

62
Q

Referred pain and the gallbladder

A

may also be referred to the right shoulder if gallbladder pathology (e.g. inflammation) irritates the diaphragm. The diaphragm is innervated by the phrenic nerve (C3-5). Spinal cord segments C3-5 also receive somatic sensory information from the skin over the shoulder. Therefore gallbladder pathology involving the diaphragm may be felt in the right shoulder.

63
Q

Visceral afferents to gallbladder

A

return to the CNS with the sympathetic fibres. Visceral pain from the gallbladder enters spinal cord levels T5 – T9 and is therefore referred to (i.e. felt in) the epigastrium.

64
Q

If gallbladder pathology irritates parietal peritoneum

A

innervated by somatic nerves, so pain is well localised to the right hypochondrium.

65
Q

Hepatomegaly

A

Hepatomegaly is enlargement of the liver. Causes include hepatitis (inflammation of the liver from various causes), malignancy, and heart failure. When the liver is enlarged, its inferior border becomes palpable inferior to the right costal margin.

66
Q

Liver metastases

A

Although primary cancer of the liver does occur, most cancers of the liver are metastases from cancer elsewhere in the body. Because venous blood from the gut passes through the liver, bowel cancers often metastasize to the liver.

67
Q

Cirrhosis of the liver

A

Cirrhosis is sometimes referred to as ‘scarring’ of the liver. It is caused by chronic excess alcohol consumption, chronic infection with hepatitis B or C, or a build-up of fat in the liver. Hepatocytes are destroyed and replaced with fibrous tissue. The liver becomes shrunken, hard, and nodular. Loss of hepatocytes impairs the function of the liver and liver failure may ultimately result.

68
Q

Portal hypotension and portosystemic anastomoses

A

Portal hypertension is high blood pressure in the portal venous system. It results when blood flow through the liver and portal vein is obstructed (e.g. in cirrhosis of the liver). Portosystemic anastomoses are communications between veins draining to the systemic circulation and veins draining to the portal circulation. For example, in the distal oesophagus, venous blood drains into both the systemic veins (via the azygos) and into the portal system (via the gastric veins). If flow in the portal system is obstructed, pressure in the portal system increases and blood is diverted from the portal veins into the systemic veins. The systemic veins become distended and varicose (in the oesophagus these are called oesophageal varices) and prone to rupture, which can result in catastrophic bleeding.

69
Q

Portosystemic anastomoses

A

communications between veins draining to the systemic circulation and veins draining to the portal circulation

70
Q

Gallstones, biliary colic and cholecystitis

A

Gallstones are common in the UK population. They are mostly composed of cholesterol. They are often asymptomatic but cause symptoms when they migrate into the biliary tree and lodge there. When a gallstone lodges in the cystic duct, contraction of the gallbladder against it causes severe pain termed biliary colic. If the stone moves back into the gallbladder, the pain eases. If it does not, and the stone becomes stuck, it blocks the flow of bile into the cystic duct and the gallbladder becomes inflamed (cholecystitis). Cholecystectomy is removal of the gallbladder. It is usually performed laparoscopically.

71
Q

What are gallstones most commonly composed of

A

Cholesterol

72
Q

Cholecystectomy

A

Removal of the gallbladder
Usually performed laparoscopically

73
Q

At what level does the coeliac trunk leave the anterior aspect of he aorta

A

T12

74
Q

What does the left gastric artery supply

A

Distal oesophagus
Lesser curvature of stomach

75
Q

What does the common hepatic artery supply

A

Liver
Stomach
Duodenum

76
Q

What does the splenic artery supply

A

Stomach
Pancreas
Spleen

77
Q

Duodenum shape

A

C-shaped that cups the head of the pancreas
Continuous proximally with pylorus if stomach and distally with Jejunum

78
Q

Is the duodenum retroperitoneal or intraperitoneal

A

Retroperitoneal

79
Q

How many parts is the duodenum described in

A

4

80
Q

4 parts of duodenum

A
  1. Superior
  2. Descending
  3. Inferior
  4. Ascending
81
Q

What enters the first part (superior) of duodenum posteriorly

A

Common bile duct
Gastroduodenal artery
Hepatic portal vein

82
Q

Where does the superior mesenteric artery lie in the duodenum

A

Third part- inferior

83
Q

Duodenojejunal flexure

A

Where the fourth part (ascending) of the duodenum meets the Jejunum

84
Q

Major duodenal papilla

A

Halfway along the internal wall of duodenum
Small elevation that marks the point at which bile and digestive pancreatic secretions enter the duodenum

85
Q

Where do bile and digestive pancreatic secretions enter the duodenum

A

Major duodenal papilla

86
Q

Arterial supply to first half of duodenum

A

Gastroduodenal artery from the common hepatic artery and do from the Coeliac trunk

87
Q

Arterial supply to the second half of the duodenum

A

Inferior pancreaticoduodenal arteries from superior mesenteric artery

88
Q

Venous drainage of duodenum

A

Tributaries of the hepatic portal vein

89
Q

At what level does the pancreas lie

A

Horizontally on the posterior abdominal wall at L1

90
Q

Is the pancreas Intraperitoneal or retroperitoneal

A

Retroperitoneal

91
Q

What does the pancreas develop from

A

Dorsal and ventral pancreatic buds which fuse

92
Q

How many parts of the pancreas are there

A

4

93
Q

4 parts of pancreas

A

Head
Neck
Body
Tail

94
Q

Uncinate process

A

Hook-like projection of the head of the pancreas

95
Q

Where does the pancreas lie

A

Head is cupped by C-shaped duodenum
Tail extends to hills of spleen
Forms part of posterior wall of lesser sac

96
Q

Splenic artery and pancreas

A

splenic artery runs towards the spleen embedded in the upper border of the pancreas

97
Q

Splenic vein and pancreas

A

Lies posterior to pancreas

98
Q

Where are the main pancreatic duct and accessory pancreatic duct

A

Within the substance of the pancreas

99
Q

Function of the pancreas

A

Endocrine and exocrine
Synthesis and secretes insulin and glucagon
Produces pancreatic juice that contains digestive enzymes

100
Q

How is pancreatic juice transported from pancreas to duodenum

A

Through main pancreatic duct and accessory pancreatic duct

101
Q

Hepatopancreatic ampulla

A

Where the common bile duct and main pancreatic duct merge
Opens into 2nd part of duodenum at major duodenal papilla
Surrounded by smooth muscle (hepatopancreatic sphincter)

102
Q

Hepatopancreatic sphincter/ sphincter of Oddi

A

Smooth muscle that surrounds the Hepatopancreatic ampulla

103
Q

Where does the Hepatopancreatic ampulla open into the duodenum

A

Major duodenal papilla

104
Q

Where does the accessory pancreatic duct empty pancreatic juice into the duodenum

A

Minor duodenal papilla
Proximal to major duodenal papilla

105
Q

Arterial supply to pancreas

A

Pancreatic arteries derived from the splenic artery
Superior pancreaticoduodenal artery derived from the Gastroduodenal artery
Inferior pancreaticoduodenal arteries derived from the superior mesenteric artery

106
Q

What are the pancreatic arteries derived from

A

Splenic artery (major branch of coeliac trunk)

107
Q

What are the superior pancreaticoduodenal arteries derived from

A

Gastroduodenal artery (from common hepatic artery so coeliac trunk)

108
Q

What are the inferior pancreaticoduodenal arteries derived from

A

Superior mesenteric artery

109
Q

Venous drainage of the pancreas

A

Splenic vein drains the pancreas and united with the superior mesenteric vein to form the hepatic portal vein posterior to neck of pancreas

110
Q

Duodenal ulcer

A

Duodenal (peptic) ulcers are most common in the first part of the duodenum. A duodenal ulcer here may erode the duodenal wall and the gastroduodenal artery, which lies posterior to the first part of the duodenum, resulting in severe intra-abdominal bleeding.

111
Q

Pancreatitis

A

Inflammation of the pancreas may be chronic or acute. Acute pancreatitis is a life-threatening condition. There are many causes, but in the UK, it is most commonly due to excess alcohol intake or impaction of a gallstone at the hepatopancreatic ampulla. In gallstone pancreatitis, impaction of the gallstone prevents pancreatic juice from leaving the pancreas and it starts to break down the pancreas (autolysis). It is extremely painful, typically causing pain that radiates to the back.

112
Q

Pancreatic cancer

A

Cancer can affect any part of the pancreas and typically causes pain that radiates to the back. When it affects the head of the pancreas, it can obstruct the flow of bile in the bile duct. This leads to an accumulation of bile pigments in the blood and results in jaundice (yellowing of the skin).

113
Q

Diabetes mellitus

A

Diabetes mellitus results when the insulin-producing cells of the pancreas no longer produce insulin (or produce inadequate amounts). This leads to sustained high blood glucose levels which are detrimental to many tissues of the body and are ultimately fatal if not controlled. Some patients develop diabetes secondary to pancreatitis.

114
Q

Splenomegaly

A

Enlargement of the spleen is splenomegaly. Causes include infection (e.g. infectious mononucleosis, malaria), haematological malignancy (e.g. leukaemia) and portal hypertension. When the spleen enlarges, it does so towards the midline, in the direction of the right iliac fossa, because the phrenicocolic ligament prevents its direct descent towards the left iliac fossa.

115
Q

In which direction does the spleen enlarge

A

Towards the midline in the direction of the right iliac fossa

116
Q

Splenic rupture

A

The spleen is soft and highly vascular and is therefore vulnerable to blunt abdominal trauma or rib fractures that may puncture the spleen. Splenic haemorrhage is life-threatening and is managed by removing the spleen (splenectomy). The spleen is not essential for life, although patients are more prone to some bacterial infections after splenectomy.

117
Q

Arterial supply of the spleen

A

Splenic artery (branch of coeliac trunk)

118
Q

Venous drainage of the spleen

A

Splenic vein

119
Q

Which 2 veins form the hepatic portal vein

A

Splenic vein
Superior mesenteric vein

120
Q

Number of branches of splenic artery

A

5

121
Q

Where does the splenic artery branch

A

Hilum of spleen

122
Q

Where does the splenic artery lie

A

Runs along superior border of pancreas embedded within it

123
Q

Spleen

A

Haematopoetic and lymphoid organ

124
Q

Function of spleen

A

Breakdown of red blood cells
Storage of red blood cells and platelets
Various immune response, including production of IgG

125
Q

Which antibodies does the spleen produce

A

IgG

126
Q

Location of spleen

A

Left upper quadrant

127
Q

Which ribs protect the spleen

A

9-11

128
Q

Number of surfaces of spleen

A

2

129
Q

Number of borders of spleen

A

4

130
Q

2 surfaces of spleen

A

Diaphragmatic
Visceral

131
Q

Which viscera does the spleen lie in contact with

A

Stomach
Left kidney
Colon

132
Q

Where is the hilum on the spleen

A

Visceral surface

133
Q

4 borders of the spleen

A

Anterior
Superior
Posterior
Inferior

134
Q

Which borders of the spleen are typically notched

A

Anterior and superior

135
Q

Which borders of the spleen are smooth

A

Posterior and inferior

136
Q

Size of spleen

A

normal sized spleen is not palpable below the costal margin. If it is palpable, it is enlarged by at least three times its normal size.

137
Q

The duodenum receives:
• bile from the liver and gallbladder via the

A

Common bile duct

138
Q

The duodenum receives:
• pancreatic juice from the pancreas via the

A

Main and accessory pancreatic ducts

139
Q

What connects gall bladder to common bile duct

A

Cystic duct

140
Q

Which accessory lobe of the liver is superior

A

Caudate is superior to quadrate

141
Q

Effects of cholecystectomy (removal of gallbladder)

A

Commonly no effects as bile still produced by liver and enters duodenum via common bile duct
Just no bile storage

142
Q

Endoscopic retrograde cholangiopancreatography (ERCP)

A

Diagnose and treat gallstones

143
Q

2 main causes of pancreatitis

A

Gallstones- block Hepatopancreatic ampulla and so pancreatic duct
Alcohol

144
Q

What is the Ligamentum teres the remnant of

A

Umbilical vein

145
Q

What separates the left and right lobe of the liver anteriorly

A

Falciform ligament and liagmentum teres

146
Q

What structures are contained in calot’s triangle

A

Cystic artery
Cystic lymph node (of Lund)
Lymphatic
Right hepatic artery

147
Q

Which part of the pancreas is Intraperitoneal

A

Tail

148
Q

Which artery is found in the porta hepatis

A

Hepatic artery proper

149
Q

Functionally the liver can be split into how many segments

A

8

GI anatomy (5 decks)

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