100 - Abdominal Viscera 2

Question 1

Quadrant occupied by the liver

Answer 1

Fills RUQ, extends into LUQ

Question 2

*Anterior surface of the liver

Answer 2

Question 3

Features of diaphragmatic surface of liver 1 2 3 4

Answer 3

1) Dome-shaped 2) Divided into two lobes by falciform ligament 3) Shiny, covered with peritoneum 4) Coronary ligament is where peritoneum reflects off liver to undersurface of diaphragm

Question 4

Falciform ligament

Answer 4

Double layer of serous membrane that separates right and left lobes of liver. Attaches liver to anterior abdominal wall. Extends to ligamentum teres.

Question 5

*Visceral surface of the liver

Answer 5

Question 6

Landmarks of visceral surface of liver 1 2 3 4 5

Answer 6

1) Gastric impression on left lobe 2) Porta hepatis is the hilum where neurovascular bundle enters liver. 3) “H”-shaped fissure (porta hepatis, ligamentum teres, ligamentum venosum, gallbladder, IVC) 4) Kidney impression 5) Duodenal impression

Question 7

Arrangement of vessels entering porta hepatis

Answer 7

Portal vein is behind. Artery to left. Bile duct to the right. Nerves and lymphatics are present, but not visible.

Question 8

Lobes demarcated by ‘H’ shape on visceral liver

Answer 8

Caudate lobe is superior, quadrate lobe is inferior

Question 9

How does the neurovascular portal triad reach the porta hepatis?

Answer 9

Travels through the lesser omentum, attaching to the lesser curvature of the stomach

Question 10

Venous drainage of the liver

Answer 10

Drains into the IVC. Three hepatic veins drain into the IVC, which is intimately associated with the liver

Question 11

Role of portal vein to liver

Answer 11

Delivers venous blood from the GIT into the liver

Question 12

Biliary system structure 1 2 3

Answer 12

1) Hepatocytes produce bile, which enters duct system. 2) Ducts get progressively larger, right and left hepatic ducts join to form the common hepatic duct at the hilum 3) Common bile duct joins the pancreatic duct at ampulla.

Question 13

How do the pancreatic duct and bile duct enter the duodenum?

Answer 13

Very complex sphincter. Sphincter is normally closed.

Question 14

How does bile get stored in the gallbladder?

Answer 14

Sphincter into the duodenum is normally closed. Bile accumulates, backs up into the gallbladder where it is stored and concentrated.

Question 15

*Gallbladder picture

Answer 15

Question 16

Pancreas location 1 2 3 4

Answer 16

1) Head is in C-shaped curve of duodenum 2) Uncinate process is a wedge-shaped process coming off the head of the pancreas. Also within the C-shaped curve of the duodenum 3) Body is above the duodenaljejunal flexure 4) Tail of the pancreas points towards the hilum of the spleen

Question 17

Over what does the pancreas lie?

Answer 17

Superior mesenteric vessels

Question 18

Ducts within pancreas 1 2

Answer 18

1) One main duct that drains most of the pancreas. This drains into the major duodenal papilla. 2) An accessory duct that drains the head and uncinate process. This drains into the minor duodenal papilla

Question 19

Important possible injury of the spleen

Answer 19

Break of the left ribs 9, 10, 11 can puncture spleen. Spleen is very vascular, so this can result in fatal bleeding.

Question 20

Spleen

Answer 20

Oval mass of lymphoid tissue in the LUQ. Smooth diaphragmatic surface, visceral surface with hilum.