Topography of the Liver, Pancreas and Gallbladder (AP)

Question 1

What are absorbed nutrients conveyed to the liver via?

Answer 1

Hepatic portal venous system

Question 2

Passage of bile from the liver

Answer 2

• Biliary ducts (R+L hepatic ducts)
• Common hepatic duct
• Unites with cystic duct to form bile duct

Question 3

2 large and 2 smaller lobes of the liver

Answer 3

• Large:
  > Right
  > Left
• Smaller:
  > Caudate
  > Quadrate

Question 4

What is the liver covered in, and which area is the exception?

Answer 4

• Visceral peritoneum
• Bare area (in fossa of gallbladder)

Question 5

2 parts of lesser omentum

Answer 5

• Hepatogastric ligament
• Hepatoduodenal ligament

Question 6

What does the free edge of the hepatoduodenal ligament contain?

Answer 6

Structures that enter/leave at porta hepatis:
- Hepatic artery
- Hepatic portal vein
- Hepatic bile duct

Question 7

What provides communication between the greater and lesser sacs of peritoneum?

Answer 7

Epiploic foramen

Question 8

Blood supply to liver

Answer 8

• Portal vein
• Hepatic artery

Question 9

Tributaries of the hepatic portal vein

Answer 9

• Splenic vein
• Superior mesenteric vein
• Inferior mesenteric vein

Question 10

What is a portal-systemic shunt?

Answer 10

Blood that would ordinarily course through the liver finds a way back to the heart via a detour

Question 11

What causes portal-systemic shunts?

Answer 11

Blockage within vessels of the liver (most commonly portal hypertension)

Question 12

What do portal-systemic shunts occur through?

Answer 12

Minor collateral vessels

Question 13

Clinical presentation of portal-systemic shunt

Answer 13

• Oesophageal varices
• Caput medusae
• Haemorrhoids

Question 14

Causes of portal hypertension

Answer 14

• Alcohol abuse –> cirrhosis (main)
• Viral hepatitis
• Bile duct autoimmune disease
• Developmental problems

Question 15

Components of porta hepatis

Answer 15

• Proper hepatic artery
• Portal vein
• Common bile duct

Question 16

What is an abdominal ligament?

Answer 16

Double fold of peritoneum that connects combinations of viscera to the body wall

Question 17

Which ligament attaches the liver to the anterior body wall?

Answer 17

Falciform ligament

Question 18

4 portosystemic anastomotic sites (portal tributary + systemic tributary for each)

Answer 18

• Lower oesophagus
  > PT = left gastric veins
  > ST = lower branches of oesophageal veins
• Upper part of anal canal
  > PT = superior rectal veins
  > ST = inferior + middle rectal veins
• Umbilicus
  > PT = paraumbilical veins
  > ST = small epigastric veins
• Region of hepatic + splenic flexure
  > PT = omental + colonic veins
  > ST = retroperitoneal veins

Question 19

Why is the liver one of the commonest organs to harbour metastatic tumours?

Answer 19

Receives all blood returning from organs within the abdomen

Question 20

Why does cirrhosis cause difficulty for blood to flow through the liver?

Answer 20

Scar tissue blocks blood from flowing through

Question 21

What is Budd-Chiari syndrome?

Answer 21

• Hepatic veins blocked by narrow clot
• Blood backs up into liver, causing it to grow larger

Question 22

5 areas of the pancreas

Answer 22

• Uncinate process
• Head
• Neck
• Body
• Tail

Question 23

How can gallstones cause pancreatitis?

Answer 23

• Block pancreatic duct
• Force enzymes back up into pancreas
• Irritates cells + causes inflammation

Question 24

What is a positive Murphy sign?

Answer 24

Patient feels pain upon inspiration with doctor palpating gallbladder

Question 25

What is an endoscopic retrograde cholangiopancreatography (ERCP)?

Answer 25

Technique that combines use of endoscopy + fluoroscopy to treat problems of bile + pancreatic ducts

Question 26

What is the Whipple procedure?

Answer 26

Surgery to remove:
- Head of pancreas
- Most of duodenum
- Portion of bile duct
- Gallbladder
- Associated lymph nodes

Sometimes also removed:
- Body of pancreas
- Entire duodenum
- Portion of stomach