The Liver, Gallbladder, Duodenum and Pancreas (GI) Flashcards
What are the two surfaces of the Liver?
Diaphragmatic surface and Visceral surface
What positions do the Diaphragmatic and Visceral surfaces lay?
Diaphragmatic- Anterosuperior
Visceral- Posteroinferior
Which three regions of the liver are not covered by peritoneum?
Base area of liver
Area where gallbladder lies in contact with liver
Region of Porta hepatis
What is the base area of the liver?
Region of posterior surface that lies in contact with diaphragm
What is the porta hepatis?
Where hepatic blood vessels and ducts of biliary system enter and exit the liver. The hepatic vein is not one of them
What is the liver split into?
What separates them from one another?
Large right lobe and small left lobe
Separated by falciform ligament
What does Falciform ligament connect?
Anterior surface of liver to anterior abdominal wall
Two accessory lobes oft the liver and where they are located?
Caudate and quadrate
Located on the Posteroinferior surface
How many segments is the liver split into internally? What does each segment have its own of?
8
Each segments has its own hepatic artery, portal vein and hepatic duct
What connects the Liver to the Diaphragm?
Coronary and triangular ligaments
What does the portal triad consist of and where do they run together?
Hepatic artery, Hepatic portal vein and bile duct
Free edge of the lesser omentum
What do the Portal triad and the free edge of the lesser omentum form? What is this the entrance to?
Form the anterior boundary of the epiploic foramen
Entrance to lesser sac
What are the three recesses related to the liver?
Hepatorenal recess
Right and left Sub phrenic recesses
Where does the hepatorenal recess lie?
Between the right kidney and the posterior surface of the right side of the liver
Where do the subphrenic recesses lie?
Each side of the falciform ligament, between the anterosuperior surface of the liver and diaphragm
Where does the Liver develop from? Where does it develop?
Foregut
Ventral mesentry
What is the Ventral mesentry?
Peritoneal fold in upper abdomen that connects the stomach to the anterior abdominal wall in Embryos
What does the Ventral mesentery develop into as the Liver is pulled to the right?
Lesser omentum and falciform ligament
What does the free edge of the falciform ligament contain? What is it a remnant of?
Round ligament of liver
Remnant of the umbilical vein
What is the Ligamentum Venosum a remnant of? Where does it lie?
Remnant of ductus venosus
Lies on posterior surface of liver, groove between caudate lobe and left lobe of liver
What is the function of the Ductus venous in a foetus?
Diverts blood from the umbilical vein to the IVC, bypassing the liver
What branch of the coeliac trunk supplies the liver? What does this branch further branch into? Where do these arteries enter the liver?
Common Hepatic
Becomes the Hepatic artery proper then branches into the left and right hepatic arteries
Enters the liver at the porta hepatis
What veins does Blood exit the liver from? What do they unite with? and what position to the liver do they unite with this vein?
Two or three hepatic veins (Not externally visible)
Unite with the Inferior Vena Cava as it passes posterior to liver
Where does the hepatic portal vein receives blood from?
From superior and inferior mesentric veins and splenic vein
What nervous system supplies the liver? Where do the parasympathetic fibers arise from?
Hepatic plexus
Vagus nerve
Where is pain from the liver referred to? Why?
Epigastric region
It is a foregut derivative
What is the
Function of the Gallbladder?
Stores and contracts bile
Where does the Gallbladder lie?
Visceral surface of the liver and close to the duodenum
What are the three parts of the Gallbladder?
Fundus, body and neck
Where does the body of the gallbladder sit?
Gallbladder fossa of the visceral surface of the liver
What does the neck of the gallbladder communicate with?
The cystic duct
Where is the surface marking of the fundus of the gallbladder at?
9th costal cartilage
Where the midclavicular line intersects the right costal margin
Which cells produce Bile and where is it first excreted into?
Produced by Hepatocytes (In the liver)
First excreted into small channels called bile canaliculi
Where do the Bile canaliculi drain bile into? and where do these bile ducts leave the liver?
Right and left hepatic ducts
Leave the liver at the porta hepatis
What do the left and right hepatic ducts converge into? Which duct is received to this duct from the Gallbladder?
Common Hepatic duct
Which receives the cystic duct from the gallbladder
What is the duct called after the common hepatic duct receives from the cystic duct?
Common bile duct
Where does the bile duct run? and where does it descend
Free edge of the lesser omentum
Descends posterior to the superior part of duodenum and posterior to the head of the pancreas
What is the valve that lies at the junction between the gallbladder neck and cystic duct?
Spiral fold
Artery that supplies Gallbladder? Where does it arise from?
Cystic artery
Arises from the right hepatic artery
What vein drains the gallbladder and what does it join?
Drained by cystic veins
Either pass directly into the liver or join hepatic portal vein
What sympathetic fibers supply the Gallbladder?
T5-T9 Greater splanchnic nerves
Where can pain be felt in association with the gallbladder?
Epigastrium (Due to nerves t5-t9)
Right shoulder
Why can inflammation of the gallbladder cause pain in the right shoulder?
inflammation of gallbladder can irritate diaphragm which is innervated by nerves C3-C5
Nerves C3-C5 also receives somatic sensory information from skin over the shoulder
What level does the coeliac trunk leave the aorta? Which structures does each branch supply?
Leaves at T12
LGA- Distal Oesophagus and lesser curvature of the stomach
Common hepatic artery- Liver, Stomach and Duodenum
Splenic artery- Stomach, pancreas and spleen
Duodenum
What are Four regions of the duodenum in order?
- Supeiror
- Descending
- Inferior
- Ascending
Duodenum
What lies posterior to the superior part of the duodenum
- Common bile duct
- Gastroduodenal artery
- Hepatic portal vein
Duodenum
What artery lies anterior to the third part of the duodenum?
Superior Mesentric artery
Duodenum
Where does the ascending duodenum meet the Jejenum?
Duodenojejunal flexure
Duodenum
Where does bile and pancretaic secretions enter the Duodenum?
Major duodenal papilla
Duodenum blood supply
What arteries supply the First and second half of the duodenum respectively?
- First half- Gastroduodenal (from coeliac trunk)
- Second half- Inferior pancreaticoduodenal (from SMA)
Duodenum blood supply
What vein drains the duodenum?
First half- Gastroduodenal vein then
Second half-
Pancreas
What position does the Pancreas lie in? on what structure?
Lies Horizontally on the posterior abdominal wall
Pancreas
What level does the pancreas lie on?
Is it retro or intra peritoneal?
L1
Retroperitoneal
Pancreas
What are the four parts of the pancreas?
Head, neck, body and tail
Pancreas
What does the pancreas form from?
Dorsal and ventral pancreatic buds which fuse during development
Pancreas
What is the Hook-like projection of the head of the pancreas called?
Uncinate process
Pancreas
Where does the tail of the Pancreas extend to?
The hilum of the spleen
Pancreas
What does the Pancreas form part of?
Posterior wall of the lesser sac
Pancreas
What is the lesser sac?
Potential space between the stomach and the pancreas
Pancreas
What runs within the substance of the pancreas?
Main pancreatic duct and accessory pancreatic duct
Pancreas
Two functions of pancreas
Exocrine and Endocrine functions
Pancreas
What does the Pancreas synthesise and secrete?
Insulin and Glucagon
Pancreas
What does the pancreas produce that is released into the duodenum? How does it get there?
Pancreatic juice
Via main pancreatic duct and accessory pancreatic duct
Pancreas
Where do the Common bile duct and main pancreatic duct merge?
Hepatopancraeatic ampulla
Pancreatic duct
Where does the hepatopancreatic ampulla open up into? what does its wall contain to stop reflux of duodenal contents?
Major duodenal papilla
Hepatopancreatic sphincter
Pancreatic duct
Where does the accessory pancreatic duct open its contents into?
Minor Duodenal papilla
Blood supply of pancreas
What three arteries supply the Pancreas? What are they branches of?
- Pancreatic arteries- branches of splenic artery
- Superior pancreaticoduodenal arteries- Branch of the Gastroduodenal artery
- Inferior pancreaticoduodenal arteries- Branch of superior Mesentric artery
Blood supply of pancreas
Venous system of the Pancreas
Splenic vein drains pancreas unites with the superior mesentric vein to form the hepatic portal vein
Spleen
What type of organ is the spleen?
What protects it?
Haematopoietic and lymphoid organ
Ribs 9-11
Spleen
Is the spleen intra or retroperitoneal?
What quadrant does it lie in?
Intraperitoneal
Left upper quadrant
Spleen
Two surfaces of the spleen?
What do they come into contact with?
- Diaphragmatic surface- adjacent to diaphragm
- Visceral surface-contact with stomach, left kidney and colon
Spleen
Difference between anterior and superior borders and the posterior and inferior borders
Anterior and superior-notched
Posterior and inferior are smooth
Blood supply of spleen
What artery supplies the spleen?
Where does it enter the spleen?
How many branches does it split into?
- Splenic artery
- Hilum on visceral surface
- five branches
