Topography and Histology of the Pancreas, Liver and Biliary System

Question 1

Give a brief overview of the development of the liver.

Answer 1

1. Hepatic diverticulum develops as an outgrowth from the caudal part of the foregut. This enlarges and is divided into 2 parts as it grows between two layers of ventral mesentery.
2. The foetal liver is bright red due to hepatopoesis
3. Bile formation begins the 12th week. The stalk connecting the cystic and hepatic ducts to the duodenum rotates with the duodenum
4. The left umbilical vein becomes continuous with the ductus venosus, blood from placenta bypasses liver. This closes after birth to become the ligamentum venosum

Question 2

Give a brief overview of the development of the pancreas

Answer 2

develops as an offshoot of the caudal part of the foregut

Question 3

1. What is the arterial supply of the liver?
2. What is the venous drainage of the liver?
3. Where else does it receive blood from?

Answer 3

1. hepatic artery arising from the coeliac trunk
2. hepatic veins which drain into IVC
3. receives venous blood from the hepatic portal vein

Question 4

What is portal hypertension?
What is it caused by?
What structures does this result in? What is their purpose?

Answer 4

If liver becomes fibrosed due to repeated inflammatory episodes, venous pressure can be raised. Anastamoses occur between the portal and system venous systems, allowing some of the blood that would otherwise collect in the portal system to escape

Question 5

What is the surface markings of the liver?

Answer 5

It exists in the right hypochondriac and epigastric regions and can extend into the left hypochondriac region
It superior border can be as high as the 5th rib
The right border extend between the 7th and 11th rib

Question 6

in a high power view of the submandibular salivary gland, there are darker and lighter staining cells. What is the produced by each?

Answer 6

1. pale = mucous

2. dark = protein

Question 7

What structure is present in salivary glands to drain each lobule?

Answer 7

intralobular ducts

Question 8

Draw a diagram of the biliary tree and the ducts present.

Answer 8

include:

• right/left hepatic ducts
• common hepatic duct
• cystic duct
• common bile duct
• pancreatic duct
• duodenum
• sphincter of oddi

Question 9

What is the arterial supply of the pancreas?

Answer 9

AA –> common hepatic –> gasproduodenal –> superior pacreatico-duodenal = head
AA –> splenic = body/tail posterior
AA –> SMA –> inferior pancreatico-duodenal = head inferior

Question 10

What is the venous drainage of the pancreas?

Answer 10

pancreatic veins –> splenic vein –> portal (tail)

superior mesenteric vein –> portal (head)

Question 11

Is the pancreas visible on ultrasound? Why/why not?

What is the best imaging available for the pancreas?

Answer 11

No
retroperitoneal
covered by bowel which contains air
CT

Question 12

What is secreted by the dark staining cells of the pancreas?

What is secreted by the pale staining cells of the pancreas?

Answer 12

acinar cells, zymogens

islets of langerhans, alpha, beta, delta, insulin, glucagon, somatostatin

Question 13

A low power view is taken through the liver of a pig.

1. identify the basic structural functional unit of the liver
2. What is the vessel in the middle, what does it contain?
3. What kind of tissue makes up the septa between the functional units?

Answer 13

1. lobule
2. central venule, venous blood –> IVC
3. connective tissue

Question 14

Breifly describe the histology of the salivary glands and how this differs between the 3 salivary glands

Answer 14

Organised into units called acini. These can contain mucous (mucin) or serous acini (isotonic, watery fluid), or both
These drain into intercalated ducts which drain into striated ducts.
Striated ducts are folded and contain many mitochondria for modirication of saliva making it hypotonic

Question 15

How does the surface of a cirrhotic liver differ from that of a normal liver? Why has this occurred?

Answer 15

not smooth due to the formation of fibrous tissue as a result of repeated inflammatory episodes

Question 16

What are the two types of gallstones? What are their causes?

What can they result in?

Answer 16

choleserol stones due to high cholesterol
pigment stones - haemolytic problems
obstructive jaundice

Question 17

The lesser omentum extends between the stomach and the liver. Which three vessels run along the free edge of the lesser omentum extending from the porta hepatis. What is this region also called?

Answer 17

common bile duct
hepatic artery
hepatic portal vein
epiploic foramen

Question 18

What is the name of the sign that can be elicited from palpation of the gallbladder? What is the sign?

Answer 18

Murphy’s sign

Deep palpation of right upper quadrant, patient will stop breathing in or wince in pain

Question 19

What is the bare area of the liver?

Answer 19

Part of the superior surface which is not covered by peritoneum