Liver, gallbladder, extra-hepatic bile ducts

Question 1

Describe the location of the liver.

Answer 1

• Located in the right hypochondrium, epigastrium, and part of left hypochondrium, 1.5kg average.

Question 2

What is the location of the hepatic dull area?

Answer 2

• Relative dull area: from 4th ICS or 5th rib to the 6th rib: lung + liver.
• Absolute dull area: from 6th ICS downwards:
  liver.

Question 3

Where is the bare area of the liver?

Answer 3

• Posterosuperior surface of the right lobe of the liver.
• Only part of the liver that has no peritoneal covering.

Question 4

What are the ligaments of the liver?

Answer 4

• Falciform (round and venosum),
• Coronary
• Triangular (left and right)
• Hepatogastric and hepatoduodenal (lesser omentum).

Question 5

What forms the common hepatic duct?

Answer 5

• Right and left hepatic ducts.

Question 6

What forms the common bile duct?

Answer 6

• Cystic duct and common hepatic duct.

Question 7

What are the 3 parts of common bile duct?

Answer 7

• Supraduodenal
• Retroduodenal
• Paraduodenal (in pancreas)

Question 8

Where does the common bile duct join the pancreatic duct?

Answer 8

• At the Ampulla of Vater.
• Drain into the major duodenal papillae and controlled by the sphincter of Oddi.

Question 9

Describe the anatomy of the portal venous system.

Answer 9

• Main blood supply of liver
• Located in free edge of lesser omentum (posterior in triad)
• Gives off right and left branches in liver.
• Formed at L1 behind the neck of the pancreas when the superior mesenteric and splenic veins unite.

Question 10

What are the main porto-systemic anastomoses?

Answer 10

• Lower oesophagus (left gastric).
• Umbilicus (paraumbilical).
• Secondarily retroperitoneal organs (asc. and desc. colon).
• Anal canal (superior rectal).

Question 11

What is the clinical relevance of porto-systemic complication involving the left gastric anastomosis?

Answer 11

• Oesophageal varices.

Question 12

What is the clinical complication of portal hypertension in paraumbilical vein?

Answer 12

• Caput medusae.
• Portal pressure may force this vein open, with blood running to the anterior abdominal wall.

Question 13

What does the hepatic veins drain into?

Answer 13

• 3 hepatic veins run from the liver into the IVC (enclosed by liver).
• Veins run between hepatic segments, apart from the triad of segmental hepatic arteries, intrahepatic portal veins and bile ducts.

Question 14

Describe the anatomy of the major duodenal papilla.

Answer 14

• Located in second part of duodenum, common bile duct and pancreatic duct empty into it.

Question 15

Discuss the control of the gall bladder.

Answer 15

• Mainly hormonal cholecystokinin (CCK) = bile release.
• Coeliac plexus sympathetics and visceral efferents (typically T7/T8).