7. Hepatic, Biliary, and Pancreatic Anatomy

Question 1

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

Answer 1

60-70%

20-30%

Question 2

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

Answer 2

Falciform ligament

Question 3

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

Answer 3

Common hepatic duct

Question 4

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

Answer 4

Common bile duct

Question 5

Where does the common bile duct enter the duodenum

Answer 5

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

Question 6

The hepatic artery is a branch off:

Answer 6

The celiac trunk of the abdominal aorta

Question 7

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

Answer 7

Round ligament

Umbilical vein

Question 8

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

Answer 8

Anterior and posterior coronary ligaments

Question 9

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

Answer 9

Right and left triangular ligaments

Question 10

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

Answer 10

Quadrate lobe

Question 11

What is the porta hepatis

Answer 11

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

Question 12

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

Answer 12

Caudate

Question 13

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

Answer 13

Bare area–not covered by peritoneum

Question 14

The left lobe is made up of segments:

Answer 14

II, III, IV

Question 15

The right lobe is made up of segments:

Answer 15

V, VI, VII, VIII

Question 16

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

Answer 16

Caudate

Question 17

What drains the caudate lobe?

Answer 17

Had its oven hepatic vein draining directly into the IVC

Question 18

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

Answer 18

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

Question 19

What vein drains the midgut? Hindgut? Ultimate drainage?

Answer 19

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

Question 20

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

Answer 20

Nutrients

Oxygen

Question 21

Central veins from each lobule join to form the ____

Answer 21

Hepatic vein

Question 22

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

Answer 22

Kupffer cells

Question 23

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

Answer 23

Space of Disse

Question 24

What cells are found in the Space of Disse?

Answer 24

Stellate cells

Question 25

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

Answer 25

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

Question 26

What is the endocrine subunit of the liver?

Answer 26

Hexagonal lobule

Question 27

What is the exocrine unit of the liver?

Answer 27

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

Question 28

What is the liver acinus?

Answer 28

Short axis between two triads at the hexagon corners | Long axis between two central veins

Question 29

What cell is responsible for the formation of scar tissue?

Answer 29

Stellate cells--lay down collagen and can eventually cause cirrhosis

Question 30

What is the mechanism for concentration of gallbladder contents?

Answer 30

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

Question 31

What are cholesterol and lecithin solubilized by in the gallbladder?

Answer 31

Bile salts | **prevents the bile salts from precipitating

Question 32

The gallbladder volume goes from 500 ml to __ with concentration

Answer 32

50 ml

Question 33

What is emulsification?

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What stimulates the release of cholecystokinin (CCK)?

Answer 35

Fatty foods in the duodenum

Question 36

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

Answer 36

1. Gallbladder contraction and emptying in 1 hr | 2. Relaxation of the sphincter or Oddi

Question 37

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

Answer 37

Acetylcholine

Question 38

What is the effect of secretin on biliary epithelium?

Answer 38

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

Question 39

What part of the GI tract absorbs bile acids?

Answer 39

Ileum

Question 40

What are the key enzymes secreted by the pancreas?

Answer 40

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

Question 41

What activates trypsinogen to trypsin?

Answer 41

Enterokinase (vili of the small intestine)

Question 42

What happens once trypsinogen is converted to trypsin?

Answer 42

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

Question 43

How are proteins converted to proteoses, peptones and polypeptides?

Answer 43

Pepsin

Question 44

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

Answer 44

Trypsin Chymotrypsin Carboxypolypeptidase Proelastase

Question 45

How are polypeptides converted to amino acids for absorption?

Answer 45

Peptidases located in the vili of the small intestine

Question 46

What degrades starches to maltose and 3-9 glucose polymers

Answer 46

Ptyalin (saliva) 20-40% | Pancreatic amylase 50-80%

Question 47

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

Answer 47

Maltase and alpha dextrinase in the intestinal villi

Question 48

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

Answer 48

Lactase | Sucrase

Question 49

Majority of dietary fats are in the form of:

Answer 49

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

Question 50

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

Answer 50

Pancreatic lipase (provided that the fats are esterified)

Question 51

What breaks down phosphlipids and cholesterol esters?

Answer 51

Phospholipase | Cholesterol esterase

Question 52

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

Answer 52

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

Question 53

How do the pancreatic ductule cells form bicarbonate?

Answer 53

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

Question 54

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

Answer 54

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

Question 55

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

Answer 55

Cholecystokinin

Question 56

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

Answer 56

Zone 1 (greatest blood flow, most Kupffer cells)

Question 57

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

Answer 57

Zone 3