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MRCEM Primary > Abdominal viscera anatomy > Flashcards

Abdominal viscera anatomy Flashcards

1
Q

What are the 2 surfaces of the liver?

A

Diaphragmatic and visceral

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2
Q

Which surface of the liver is the diaphragmatic surface?

A

Antero-superior surface

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3
Q

Which surface of the liver is the visceral surface?

A

Postero-inferior surface

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4
Q

Where does the diaphragmatic surface of the liver fit?

A

Beneath the curvature of the diaphragm

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5
Q

Which part of the diaphragmatic surface is not covered by visceral peritoneum?

A

Posterior aspect (also not in direct contact with the diaphragm)

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6
Q

Which parts of the visceral surface of the liver are not covered with peritoneum?

A

Fossa of the gall bladder
Porta hepatis

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7
Q

What is the visceral surface of the liver irregular and flat?

A

Because it is moulded by the shape of the surrounding organs.

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8
Q

Name the structures that the visceral surface of the liver is in contact with.

A

Right kidney
Right adrenal gland
Right colic flexure
Transverse colon
First part of duodenum
Gall bladder
Oesophagus
Stomach

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9
Q

Name the structures that the diaphragmatic surface of the liver is in contact with.

A

Diaphragm
Lungs
Pleura

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10
Q

How is the posterior surface of the liver secured to the IVC?

A

Hepatic veins
Fibrous tissue

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11
Q

Which ligament attaches there anterior surface of the liver to the anterior abdominal wall?

A

Falciform ligament

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12
Q

Which ligament attaches the superior surface of the liver to the diaphragm?

A

Coronary ligament (split into left and right triangular ligaments)

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13
Q

What is the liver covered by?

A

A fibrous layer (Glissonā€™s capsule)

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14
Q

What is the liver comprised of?

A

Right lobe
Left lobe (smaller)
Caudate lobe (middle inferior)
Quadrate lobe (middle superior)

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15
Q

What does the caudate lobe lie between?

A

IVC and a fossa produced by ligamentum venous.

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16
Q

What does the quadrate lobe lie between?

A

The gallbladder and a fossa produced by the ligamentum trees.

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17
Q

What separates the caudate and quadrate lobes?

A

A deep, transverse fissure (porta hepatis)

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18
Q

What does the porta hepatis transmit?

A

All the vessels, nerves and ducts entering and leaving the liver (but not the hepatic veins)

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19
Q

What are the hepatocytes of the liver arranges into?

A

Lobules.

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20
Q

What are the structural units of the liver?

A

Lobules.

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21
Q

What is each lobule drained by?

A

A central vein.

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22
Q

What is found at the periphery of the lobules?

A

Portal triad

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23
Q

What does each portal triad consist of?

A

Arteriole
Venule
Bile duct

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24
Q

Aside from the arteriole, vein and bile duct, which 2 other structures are also found within the portal triad?

A

Lymphatic vessels
Vagus nerve (parasympathetic fibres)

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25
Q

Which vessels supply the liver?

A

Hepatic artery proper (25%)
Hepatic portal vein (75%)

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26
Q

Which parts of the liver are supplied by the hepatic artery proper?

A

Non-parenchymal structures.

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27
Q

Where is the hepatic artery proper derived from?

A

Coeliac trunk.

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28
Q

Which parts of the liver are supplied by the hepatic portal vein?

A

Liver parenchyma

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29
Q

What does the hepatic portal vein carry in the blood to the liver parenchyma?

A

Nutrients from the small intestine (allows detoxification to occur)

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30
Q

What is venous drainage of the liver through?

A

Hepatic veins

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31
Q

Where do the hepatic veins open up into?

A

The IVC

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32
Q

What is the innervation to the parenchyma of the liver?

A

Hepatic plexus = coeliac plexus (sympathetic) + vagus nerve (parasympathetic)

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33
Q

Where do the hepatic plexus nerve fibres enter the liver?

A

Hepatic plexus

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34
Q

What is Glissonā€™s capsule of the lover innervated by?

A

Branches of the lower intercostal nerves

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35
Q

Which nodes drain the anterior aspect of the liver?

A

Hepatic lymph nodes

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36
Q

Which nodes drain the posterior aspect of the liver?

A

Phrenic and posterior mediastinal lymph nodes

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37
Q

At which vertebral level does the upper border of the liver lie at?

A

T6

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38
Q

Where does the left lobe of the liver lie?

A

To the left of the midline

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39
Q

Where is the lower border of the liver normally found?

A

About 3cm below the diploid process

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40
Q

To where can the liver extend inferiorly to?

A

The right costal margin

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41
Q

What are sinusoids in liver lobules?

A

Enlarged capillaries

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42
Q

What is the function of sinusoids in the liver lobules?

A

Drain blood from the portal triad into the central vein

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43
Q

Which structures are transmitted by the aorta hepatis?

A

Hepatic portal vein
Hepatic artery
Common hepatic duct
Sympathetic nerves
Hepatic branch the vagus nerve
Lymphatics

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44
Q

What are the 2 superior relations of the liver?

A

Thoracic cavity
Diaphragm

45
Q

What are the 4 anterior relations of the liver?

A

Thoracic cage
Costal margins
Pleura and lungs
Anterior abdominal wall

46
Q

What are the 5 posterior relations of the liver

A

Oesophagus
Stomach
Gallbladder
1st part of duodenum
IVC

47
Q

The hepatic portal vein is formed by the union of which 2 vessels?

A

Superior mesenteric vein
Splenic vein

48
Q

How many hepatic veins are there normally draining the liver?

A

3

49
Q

The gallbladder is entirely surrounded by what?

A

Peritoneum

50
Q

What are the anterior + superior relations of the gallbladder?

A

Inferior border of the liver
Anterior abdominal wall

51
Q

What are the posterior relations of the gallbladder?

A

Transverse colon
Proximal duodenum

52
Q

What are the inferior relations of the gallbladder?

A

Biliary tree
Duodenum (not proximal)

53
Q

What is the storage capacity of the gallbladder?

A

30-50ml

54
Q

What structure is the gall bladder continuous with?

A

Cystic duct

55
Q

The left and right hepatic ducts join to form what?

A

Common hepatic duct

56
Q

The common hepatic duct and the cystic duct joint to form what?

A

Common bile duct

57
Q

What joins the common bile duct to form the hepatopancreatic ampulla (ampulla of water)?

A

Pancreatic duct

58
Q

Where does the ampulla of water empty into?

A

The duodenum via the major duodenal papilla.

59
Q

What is the major duodenal papilla regular by?

A

Sphincter of oddi (muscular valve)

60
Q

What is Hartmannā€™s pouch?

A

A mucosal fold in the neck of the gallbladder.

61
Q

Why is Hartmannā€™s pouch of clinical importance?

A

Because this is a common location for gallstones to get lodged.

62
Q

Where is parasympathetic supply of the gallbladder and biliary tree from?

A

Vagus nerve

63
Q

Where is sympathetic supply of the gallbladder and biliary tree from?

A

Coeliac plexus

64
Q

Where is sensory supply of the gallbladder and biliary tree from?

A

Phrenic nerve (C3-C5)

65
Q

What is responsible for the referred pain from the gallbladder to the right shoulder tip?

A

Stimulation of the phrenic nerve

66
Q

What are the main sites of portosystemic anastomoses?

A

Oesophageal veins
Para-umbilical veins
Retroperitoneal veins
Rectal veins

67
Q

Due to the portosystemic anastomoses, what clinical findings happens when there is a rise in portal venous pressure?

A

Oesophageal varices
Caput medusae
Haemorrhoids

68
Q

What does the spleen do?

A

Regulates the filtration fo red blood cells and the immune response.

69
Q

What is the spleen comprised of?

A

Red and white pulp

70
Q

What is the white pulp of the spleen composed of?

A

Nodules called Malpighian corpuscles

71
Q

What are Malpighian corpuscles in the spleen composed of?

A

Lymphoid follicles (rich in B lymphocytes)

AND

Periarteriolar lymphoid sheaths (rich in T lymphocytes)

72
Q

Which type of lymphocyte is most abundant in the white pulp?

A

B-lymphocytes

73
Q

What is the red pulp of the spleen comprised of?

A

Sinuses filled with RBCs, platelets, granulocytes and scenic cords (or reticular fibres)

74
Q

Where does the spleen usually lie?

A

Between the 9th and 11th ribs on the right hand side.

75
Q

What is the anterior relation of the spleen?

A

Fundus of the stomach.

76
Q

What are the 4 posterior relations of the spleen?

A

Left lung
9th to 11th ribs
Left diaphragm
Costodiaphargmatic recess

77
Q

What are the 2 medial relations of the spleen?

A

Tail of pancreas
Left kidney

78
Q

What is the inferior relation of the spleen?

A

Left colic flexure

79
Q

How can you differentiate between palpating a spleen or a retroperitoneal mass?

A

Spleen is not ballotable
Spleen enlarges diagonally towards RLQ (kidney enlarges inferiorly)
Spleen has a notch on anterior border
Spleen is dull to percussion
Upper edge of the spleen is not palpable (kidney is)

80
Q

What is the endocrine function of the pancreas?

A

Controls blood glucose levels via the secretion of insulin and glucagon

81
Q

What is the exocrine function of the pancreas?

A

Secretes digestive enzymes into the duodenum.

82
Q

Which lumbar vertebrae is the pancreas in line with?

A

L1-L2

83
Q

What is the exocrine part of the pancreas composed of?

A

Acini (clustered cells)

84
Q

What is the path of the pancreatic duct?

A

Starts at the tail of the pancreas.
Runs to the head.
Units with CBD to form ampulla of water.

85
Q

What are the 5 parts of the pancreas?

A

Head
Uncinate process
Neck
Body
Tail

86
Q

Where does the head of the pancreas lie?

A

Within the ā€˜Cā€™ shaped curve of the duodenum

87
Q

What is posterior to the head of the pancreas?

A

IVC
Right renal artery
Right renal vein
Left renal vein

88
Q

What lies in a groove on the posterior surface of the head of the pancreas?

A

Bile duct

89
Q

What is the uncinate process?

A

A prolongation of the pancreatic head.

90
Q

What vessel is anterior to the uncinate process?

A

Superior mesenteric vessels

91
Q

In what plane does the neck of the pancreas lie?

A

Transpyloric plane.

92
Q

What is the portal vein formed by?

A

Union of the superior mesenteric vein and splenic vein.

93
Q

What structures are posterior to the body of the pancreas?

A

Aorta
L2
Left adrenal gland
Left kidney

94
Q

The tail of the pancreas lies in close proximity to what?

A

The hilum of the spleen

95
Q

Which is the only part of the pancreas that is intraperitoneal?

A

Tail

96
Q

What are the 4 anterior relations of the pancreas?

A

Lesser sac
Stomach
1st part of duodenum
Transverse mesocolon

97
Q

What are the 7 posterior relations of the pancreas?

A

Left crus of diaphragm
IVC
Aorta
Right and left renal vein
Left kidney
Left adrenal
SMA (+ vein)

98
Q

What is the left lateral relation of the pancreas?

A

Hilum of spleen

99
Q

What are the 2 right lateral relations of the pancreas?

A

2nd part of the duodenum
Ampulla of vater

100
Q

What is the arterial supply of the pancreas?

A

Splenic artery

101
Q

Which arteries does the head of the pancreas receive receive additional blood supply from?

A

Superior and inferior pancreaticoduodenal arteries

102
Q

What is the venous drainage of the spleen?

A

Splenic vein

103
Q

Where does the splenic vein drain into?

A

Superior mesenteric vein

104
Q

What does the superior mesenteric vein drain into?

A

Hepatic portal vein

105
Q

Which lymph nodes drain the pancreas?

A

Pancraticosplenic nodes (majority)

AND

Pyloric lymph nodes

106
Q

What is the parasympathetic nerve supply to the pancreas?

A

Vagus nerve

107
Q

What is the sympathetic and sensory nerve supply to the pancreas?

A

Thoracic splanchnic nerves (T6-T10)

108
Q

What is responsible for the referred pain from the pancreas to the back?

A

Due to sensory innervation by the thoracic splanchnic nerves (T6-T10)

109
Q

The dual supply of blood to the liver means that what typeof event is very rare?

A

Liver infarction

MRCEM Primary (39 decks)

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