5. Structure of the liver, gall bladder, biliary tree & pancreas.pptx

Question 1

Bile production vs storage location?

Answer 1

Bile production: Liver

Bile storage and concentration: Gall bladder

Question 2

What is Glisson’s capsule?

Answer 2

Deep to its peritoneal covering, the liver is completely surrounded by Glisson’s capsule, a thin connective tissue layer that sends extensions into the organ, in between the lobules

Question 3

Liver arterial supply?

Venous drainage?

Answer 3

The liver is supplied by the (hepatic) portal vein bringing absorbed nutrients from the stomach and intestine; and the hepatic artery which supplies the hepatocytes (liver cells) with oxygen.
Venous drainage is by hepatic veins that enter the inferior vena cava.

Question 4

Bile drainage from liver to gall bladder?

Answer 4

Bile is drained via canaliculi that lie between the hepatocytes into bile ductules and eventually into bile ducts.

Question 5

4 liver function?

Answer 5

• Synthesis and secretion of bile.
• Storage of glucose, glycogen, proteins, vitamins and fats.
• Detoxification of metabolic waste.
• Synthesis of blood clotting and anticoagulant factors (fibrinogen and prothrombin).

Question 6

Constituents of bile

Answer 6

Bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water and electrolytes.

Question 7

Where do bile pigments derive from?

What is the role of KUPFFER CELLS?

Answer 7

Bile pigments are derived as the breakdown products of haemoglobin.
Kupffer cells play a role in their formation. Bile salts
are responsible for the detergent and emulsifying effect of bile on fats, they also increase the absorption of fats by the small intestine.

Question 8

What is the name of the liver functional unit?

Answer 8

Liver lobule

Question 9

What is the structure of a liver lobule?

Answer 9

Sheets of cells (hepatocytes) radiate outwards from the central vein, which forms the central axis of the lobule.
Sinusoids lie between the sheets and carry blood from the hepatic artery and portal vein (now mixed oxygenated and de-oxygenated blood) to the central vein.
Bile flow is in the opposite direction, in the canaliculi between the hepatocytes.

Question 10

The bare area of the liver is between which two ligaments?

Answer 10

The coronary and triangular “ligaments” on posterior liver surface

Question 11

What/where are the 4 lobes of the liver?

Answer 11

Anterior: Left, right (separated by falciform ligament, quadrate
Posterior: Caudate *next to IVC)

Question 12

What structure make up the portal triad>

Answer 12

Portal vein
Hepatic artery
Hepatic (biliary) ducts

Question 13

Liver divisions
Anatomically?
Functionally?

Answer 13

Anatomically:
-Right lobe (larger)
(Divided by the falciform ligament and lesser omentum)
-Left lobe

Functionally by vascular distribution:

• Caudate and quadrate lobe are part of left
• Divided by the fossa for the gall bladder and iVC

Question 14

What are the couinaud segments of the liver related to/

Answer 14

The functions of the liver segments

Question 15

What are liver ligaments?

Answer 15

Reflections of peritoneum that surround the bare area.
On the left, the coronary ligaments form the left triangular ligament, while on the right, they form the right triangular ligament

Question 16

Liver lymph drainage?

Answer 16

The lymph vessels leave the liver and enter several lymph nodes in the porta hepatis
The efferent vessels pass to the coeliac nodes
A few vessels pass from the bare area of the liver through the diaphragm to the posterior mediastinal lymph nodes.

Question 17

How is jaundice cause from lymph drainage of liver

Answer 17

Retrograde tumour spread from the coeliac nodes may involve the hepatic nodes in the porta hepatis and obstruct the bile ducts to cause jaundice

Question 18

Liver nerve supply?

Answer 18

Sympathetic nerves form the coeliac plexus (foregut, therefore greater splanchnic nerve, T 5 to 9)
The anterior vagal trunk gives rise to a large parasympathetic hepatic branch, which passes directly to the liver

Question 19

Structure of gall bladder?

Answer 19

Rounded fundus

Body that is its major part Neck that narrows towards the cystic duct

Question 20

How does bile reach GIT from gall bladder

Answer 20

`the cystic duct combines with the common hepatic duct to form the bile duct and enter the 2nd part of the duodenum with the pancreatic duct at the ampulla of Vater

Question 21

How is the cystic duct lumen held up?

Answer 21

The mucous membrane of the 
cystic duct is raised to form a 
spiral fold that is continuous 
with a similar fold in the neck of 
the gallbladder
The fold is commonly known as the “spiral valve (of Heister)”, the function of which is to keep the lumen constantly open.

Question 22

Blood supply of gall bladder?

Answer 22

Arterial: Cystic artery, a branch of the right hepatic artery
Venous: Drains directly into the portal vein

Question 23

Lymph drainage of gall bladder?

Answer 23

To a cystic lymph node neck GB neck.

• -> Hepatic nodes
• -> Coeliac nodes

Question 24

Nerve supply of gallbladder?

Answer 24

Sympathetic:
-Foregut (T5-9)

Parasympathetic:
-Vagal fibres from the coeliac plexus.

Question 25

What is used to surgically locate the cystic artery?

Bounded by?

Answer 25

The Calot's hystohepatic triangle
Bounded by:
-The edge of the right lobe of the liver
-The common hepatic duct
-The cystic duct

Question 26

Referred pain from gall bladder?

Answer 26

Referred pain from the gallbladder is usually to the epigastrium (T7 to 9), but irritation of adjacent peritoneum may involve the phrenic nerve (C3, 4, 5) giving referred pain to the right shoulder tip, via C3, 4 in the supraclavicular nerves

Question 27

Cause for painless, continues jaundice?

Answer 27

Carcinoma of the head of the pancreas may obstruct the bile duct causing painless, continuous jaundice

Question 28

Where does common bile duct enter duodenum?

Answer 28

At the major duodenal papilla

Question 29

What does the ERCP test stand for and identify?

Answer 29

Endoscopic, retrograde, cholangio pancreaticogram (ERCP) with stones in the gall bladder

Question 30

Where does the transpyloric place lie?

What structures lie on it?

Answer 30

The Transpyloric Plane at L1 is midway between the jugular notch and the pubic symphysis, and through the tips of the 9th costal cartilages

List of structures that lie on it:

• Fundus of gall bladder
• Pylorus
• Neck of pancreas
• Formation of portal vein
• Hilum of kidney (right lower than left)
• Spinal cord ends at L1/2
• Aorta and origin of SMA
• IVC
• 2nd part of duodenum

Question 31

Functions of the pancreas?

Answer 31

Exocrine and endocrine functions: digestive pro-enzymes secreted via pancreatic duct to 2nd part of duodenum; insulin and glucagon from the islets of Langerhans

Question 32

Journey of pancreatic duct?

Answer 32

The pancreatic duct begins in the tail of the pancreas and joins the bile duct at the hepatopancreatic ampulla (of Vater), that opens as the major duodenal papilla

Question 33

What are the 3 sphincters that make up the sphincter of Oddi?

Answer 33

1 around the end of the pancreatic duct (to control flow but prevent bile entering the pancreas)
1 around the end of the bile duct
1 around the combined ducts

Question 34

Blood supply of the pancreas?

Answer 34

1. Coeliac trunk FOREGUT
   - Gastroduodenal (direct to pancreas)
   - Superior pancreaticoduodenal (to Ant and Post branches)
   - Splenic –> Greater and Dorsal Pancreatic branches
2. Superior mesenteric artery MIDGUT
   - Inferior pancreaticoduodenal (to Ant and Post branches)

Mirrored by veins. Draining to portal vein although the portal vein is the mirror of the gasproduodenal artery.

Question 35

Affect on gallbladder of cholecystokinin?

Answer 35

Contraction which is produced but he mucous membrane of the duodenum on arrival of fatty food from stomach.

Question 36

Lymph drainage of the pancreas?

Answer 36

Along arteries

Efferent vessels drain into the coeliac and superior mesenteric lymph nodes

Question 37

Nerve supply of the pancreas?

Answer 37

Comes with arteries and is vagus (PS) + T7-9 and T10-11