3.b) The liver, biliary apparatus and spleen

Question 1

What ligaments can the lesser omentum be divided into?

Answer 1

Hepatoduodenal Ligament

Gastrohepatic Ligament

Question 2

Which ligaments suspend the spleen?

Answer 2

Splenorenal ligament (posterior)
Gastrosplenic ligament (anterior)

Question 3

In which mesentery does the liver develop?

Answer 3

Ventral foregut mesentery

Question 4

What connects the liver to the anterior abdominal wall?

Answer 4

Falciform Ligament

Question 5

What connects the liver to the lesser curvature of the stomach?

Answer 5

Lesser Omentum

Question 6

What is the region of the liver that makes direct contact with the diaphragm called?

Answer 6

Bare area of the liver

Question 7

Which ribs are the liver deep to?

Answer 7

Deep to ribs 7-11

Question 8

Which abdominal regions do the liver extend across?

Answer 8

The top 3:
right hypochondriac
epigastric
left hypochondriac

Question 9

What is the structure at the end of the falciform ligament called and how did it originate?

Answer 9

Ligamentum Teres

It is a remnant of the umbilical vein

Question 10

What are the ligaments on the superior surface of the liver called?

Answer 10

Coronary Ligament (anterior and posterior) 
Left and Right Triangular Ligaments

Question 11

What defines the anatomical boundary (dividing the liver into anatomical lobes)?

Answer 11

The fissures of the foetal veins

Question 12

What are the 2 accessory lobes of the liver and where are they located?

Answer 12

Quadrate: located between the gallbladder and the fissure of the ligamentum teres
Caudate: located between the IVC and the fissure of the ligamentum venosum
Porta hepatis divides the caudate and quadrate lobes.

Question 13

What is the ligament on the posterior end of the inferior aspect of the liver?

Answer 13

Ligamentum venosum: remnant of the ductus venosum

Question 14

What divides the liver into right and left functional lobes?

Answer 14

A line between the gallbladder and the IVC

Question 15

What is special about the caudate lobe?

Answer 15

It is functionally separate from the right and left lobes.

It is supplied by right and left hepatic arteries

Question 16

What vessels make up porta hepatis?

Answer 16

Common bile duct and lymphatics
Hepatic artery
Hepatic portal vein

Question 17

What are the 2 parts of the coronary ligament?

Answer 17

Anterior and Posterior

Question 18

Describe the anatomical relations of the liver

Answer 18

Covered by costal margin except in upper epigastrium
Convex diaphragmatic surface
Complex visceral surface in contact with stomach, duodenum, right kidney and colon

Question 19

Where is the liver palpated?

Answer 19

right hypochondriac region

Question 20

Blood supply to functional right and left vascular lobes of the liver

Answer 20

Right hepatic artery: Right lobe

Left hepatic artery: Left lobe, Caudate lobe, Quadrate lobe

Question 21

How many segments is the liver comprised of?

Answer 21

8

Each has its own blood supply, drainage and bile duct

Question 22

How many divisions of the celiac trunk? What are they?

Answer 22

3
Splenic artery
Left gastric artery
Common hepatic artery

Question 23

What does the common hepatic artery split into?

Answer 23

Gastroduodenal artery
Right gastric artery
Hepatic artery proper

Question 24

What does the Hepatic artery proper divide into?

Answer 24

Right and left hepatic arteries

Question 25

What join to form the hepatic portal vein?

Answer 25

Splenic vein | Superior mesenteric vein

Question 26

What connects the venous drainage of the liver to the IVC?

Answer 26

3 short hepatic veins

Question 27

What are the 4 sites of portal-systemic anastomosis? (systemic : portal)

Answer 27

Oesophageal Veins : Left Gastric Vein Inferior Rectal Vein : Superior Rectal Vein Epigastric Veins : Paraumbilical Vein Retroperitoneal Veins : Visceral Veins

Question 28

What is the significance of these portal-systemic anastomosis?

Answer 28

If there is a blockage causing hepatic portal tension, these sites of porto-systemic anastomoses could dilate, rupture and bleed heavily

Question 29

At which of the portal-systemic anastomoses is haemorrhage common?

Answer 29

Oesophagus | Rectum

Question 30

Describe the structure of the biliary tree.

Answer 30

Cystic duct from the gallbladder joins the hepatic duct (from the right and left hepatic ducts) to form the common bile duct

Question 31

Where does the common bile duct and pancreatic duct join and where do they enter into the duodenum?

Answer 31

Join at Ampulla of Vater | Enter duodenum at Major Duodenal Papilla

Question 32

What sphincter guards the ampulla of vater?

Answer 32

Sphincter of oddi

Question 33

Presence of sphincters in pancreatic and bile duct

Answer 33

There are separate sphincters for the bile duct and pancreatic duct

Question 34

What do neoplasms of the head of the pancreas result in?

Answer 34

Obstruction of pancreatic and bile duct exits

Question 35

What forms the common hepatic duct?

Answer 35

Left and right hepatic ducts

Question 36

What forms the common bile duct?

Answer 36

``` Common hepatic duct Cystic duct (from gall bladder) ```

Question 37

What is the clinical significance of the proximity of the gallbladder to the first part of the duodenum?

Answer 37

Gallstones can press on the duodenum and ulcerate causing a cholecystoduodenal fistula (gall stone will enter duodenum)

Question 38

What is the largest lymphoid organ in the body?

Answer 38

Spleen

Question 39

The spleen lies on the underside of which ribs?

Answer 39

9-11 | left ribs

Question 40

What does traumatic rupture of the spleen cause?

Answer 40

Severe haemorrhage | Can't be repaired, must be removed

Question 41

Describe the appearance of the superior border of the spleen

Answer 41

Knuckled

Question 42

What lies in the splenorenal ligament?

Answer 42

Tail of pancreas and splenic artery

Question 43

What does the gastrosplenic ligament carry?

Answer 43

Blood vessels from splenic artery (short gastric vessels) to the left side of the stomach