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GI > 7. Hepatic, Biliary, and Pancreatic Anatomy > Flashcards

7. Hepatic, Biliary, and Pancreatic Anatomy Flashcards

1
Q

The right lobe of the liver is __% of the mass, while the left lobe of the liver is __%

A

60-70%

20-30%

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2
Q

What structure divides the right and left lobes of the liver?

A

Falciform ligament

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3
Q

What do the right and left hepatic ducts combine to form?

A

Common hepatic duct

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4
Q

What does the cystic duct join the common hepatic duct to form?

A

Common bile duct

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5
Q

Where does the common bile duct enter the duodenum

A

2nd segment at the sphincter or oddi, near where the pancreas empties into the duodenum

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6
Q

The hepatic artery is a branch off:

A

The celiac trunk of the abdominal aorta

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7
Q

At the base of the falciform ligament is the __ __, which is the obliterated:

A

Round ligament

Umbilical vein

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8
Q

What are the anterior and posterior structures that are peritoneal reflections holding the liver to the diaphragm?

A

Anterior and posterior coronary ligaments

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9
Q

The anterior and posterior layers converge on the right and left sides of the liver to form the:

A

Right and left triangular ligaments

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10
Q

What is the small lobe of the live that is found adjacent to the gallbladder?

A

Quadrate lobe

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11
Q

What is the porta hepatis

A

Where the portal triad comes into the liver – hepatic artery, portal vein, bile duct

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12
Q

What is the small lobe of that is found more cranial and near the IVC?

A

Caudate

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13
Q

What is the area of the liver that is located at the top of the liver between the anterior and posterior coronary ligaments

A

Bare area–not covered by peritoneum

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14
Q

The left lobe is made up of segments:

A

II, III, IV

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15
Q

The right lobe is made up of segments:

A

V, VI, VII, VIII

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16
Q

What is segment 1 of the liver, which receive blood flow from the right and left sides?

A

Caudate

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17
Q

What drains the caudate lobe?

A

Had its oven hepatic vein draining directly into the IVC

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18
Q

What liver segments are donated to an adult patient? Pediatric?

A

Adult: V, VI, VII, VIII (right lobe)
Child: II, III (portion of the left lobe)

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19
Q

What vein drains the midgut? Hindgut? Ultimate drainage?

A

Superior mesenteric
Inferior mesenteric
(Hepatic vein which drains into the IVC and back into the heart)

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20
Q

Venous blood in the portal vein is high in ____ but low in ___

A

Nutrients

Oxygen

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21
Q

Central veins from each lobule join to form the ____

A

Hepatic vein

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22
Q

What cells in the sinusoids are responsible for filtering unwanted substances?

A

Kupffer cells

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23
Q

What is the space between the sinusoids and the liver cell plates called?

A

Space of Disse

24
Q

What cells are found in the Space of Disse?

A

Stellate cells

25
Q

What happens to substances that get stuck in the Space of Disse and cant return to the sinusoids?

A

Enter the lymphatics–drain the same direction as the bile–away form the central vein

26
Q

What is the endocrine subunit of the liver?

A

Hexagonal lobule

27
Q

What is the exocrine unit of the liver?

A

Triangle between three central veins, focus on the bile exiting the lobules

28
Q

What is the liver acinus?

A

Short axis between two triads at the hexagon corners

Long axis between two central veins

29
Q

What cell is responsible for the formation of scar tissue?

A

Stellate cells–lay down collagen and can eventually cause cirrhosis

30
Q

What is the mechanism for concentration of gallbladder contents?

A

Absorption of water, sodium, and chloride leads to the concentration of bile salts, cholesterol, lecithin, and bilirubin

31
Q

What are cholesterol and lecithin solubilized by in the gallbladder?

A

Bile salts

**prevents the bile salts from precipitating

32
Q

The gallbladder volume goes from 500 ml to __ with concentration

A

50 ml

33
Q

What is emulsification?

A

Decrease in surface tension and breaking of fat glubules into smaller size particles

34
Q

Formation of ____ after emulsification helps the absorption of fat breakdown products?

A

Micelles-incorporate fatty acids, monoglycerides, and cholesterol
**allow fats to remain soluble in an aquous solution

35
Q

What stimulates the release of cholecystokinin (CCK)?

A

Fatty foods in the duodenum

36
Q

What are the two main effects of CCK on bile movement?

A
  1. Gallbladder contraction and emptying in 1 hr

2. Relaxation of the sphincter or Oddi

37
Q

What substance has a similar effect to CCK on gallbladder contraction, but is a weaker stimulus?

A

Acetylcholine

38
Q

What is the effect of secretin on biliary epithelium?

A

Stimulates the epithelium to produce a solution rich in sodium bicarbonate to help neutralize acids and optimize pancreatic function

39
Q

What part of the GI tract absorbs bile acids?

A

Ileum

40
Q

What are the key enzymes secreted by the pancreas?

A

Trypsin (trypsinogen)
Chymotrypsin (chymotrypsinogen)
Carboxypolypeptidase (procarboxypeptidase)
**secreted in inactive forms

41
Q

What activates trypsinogen to trypsin?

A

Enterokinase (vili of the small intestine)

42
Q

What happens once trypsinogen is converted to trypsin?

A

Furtheractivates trypinogen as well as converting chymotrypsinogen to chymotrypsin and procarboxypeptidase to carboxypeptidase

43
Q

How are proteins converted to proteoses, peptones and polypeptides?

A

Pepsin

44
Q

How are proteoses, peptones, and polypeptides converted to polypeptides and amino acids?

A

Trypsin
Chymotrypsin
Carboxypolypeptidase
Proelastase

45
Q

How are polypeptides converted to amino acids for absorption?

A

Peptidases located in the vili of the small intestine

46
Q

What degrades starches to maltose and 3-9 glucose polymers

A

Ptyalin (saliva) 20-40%

Pancreatic amylase 50-80%

47
Q

What converts maltose and 3-9 glucose polymers to glucose?

A

Maltase and alpha dextrinase in the intestinal villi

48
Q

What enzyme of the intestinal villi converts lactose to galactose? Sucrose to fructose?

A

Lactase

Sucrase

49
Q

Majority of dietary fats are in the form of:

A

Triglycerides (TG)–glycerol backbone with 3 fatty acid side chains
**diet includes small amounts of phospholipids and cholesterol esters

50
Q

What digests all the TG that is can reach within 1 minute (into free fatty acids and 2 monoglycerides?

A

Pancreatic lipase (provided that the fats are esterified)

51
Q

What breaks down phosphlipids and cholesterol esters?

A

Phospholipase

Cholesterol esterase

52
Q

What prevents fat components that have been broken down by emulsification and pancreatic lipase from reassembling?

A

Formation of micelles and removal of monoglycerides and fatty acids, transport through the brush border for absorption

53
Q

How do the pancreatic ductule cells form bicarbonate?

A

CO2 diffuses in from the blood
Carbonic anhydrase converts it to carbonic acid
Dissociation to bicarbonate and H+; bicarbonate into the lumen and H+ active transport into the blood

54
Q

What is the effect of CCK and secretin on pancreatic secretion?

A

CCK: acts on ACINI to produce digestive enzymes
Secretin: acts on duct cells to produce bicarbonate rich solution

55
Q

Which molecule has the greatest effect on sphincter of oddi relaxation?

A

Cholecystokinin

56
Q

What hepatic acinus zone will have the greatest exposure to viral particles?

A

Zone 1 (greatest blood flow, most Kupffer cells)

57
Q

What hepatic acinus zone is at the greatest risk for ischemia?

A

Zone 3

GI (28 decks)

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