Accessory Glands of the GIT Flashcards
(30 cards)
What is the ligament that separates the Right and left lobes of the Liver?
Falciform Ligament.
Is the Round (teres) Ligament when viewed from posterior.
What is the “Bare Area?”
The point where the Liver makes contact with the thoracic Diaphragm.
See Troisier’s Sign for further details on the clinical importance of this area.
What is the Porta Hepatis?
A deep fissure in the inferior surface of the liver. All the Neurovascular structures EXCEPT the Hepatic Veins.
What are the Visceral Impressions?
(Inferioposterior Surface, most posterior to anterior) Right Lobe Impressions: Bare Area Adrenal Impression Renal Impression Duodenal Impression Colic Impression
Left Lobe Impressions:
Esophageal Impression
Gastric Impression
What is Troisier’s sign?
An enlargement at the base of the neck; caused by lymphatic vessels carrying pathological agents from the Bare Area to the neck.
Can also detect cancer in supraclavicular and pre-scalene lymph nodes.
What are the anatomical/suspensory ligaments associated with the Liver? What is their function?
Falciform/Teres (Round)
Coronary
Triangular
Lesser Omentum
Describe the borders of the Foramen of Winslow
Posterior: IVC, Right crus of Diaphragm
Superior: Caudate Lobe of the LIver
Anterior: Hepatoduodenal ligament (Contains Portal Triad)
Inferior: First part of duodenum
How many segments of the Liver are there? How do you orient yourself?
8 Lobes. Caudate Lobe is I; go clockwise for each segment in order.
Note: This method only works when looking at the Liver anteriorly and upright.
What is the blood supply of the liver?
Hepatic Proper Artery (25%)
Hepatic Portal Vein (40% of OXYGENATED blood)
- carries nutrients EXCEPT lipids, which are carried through chyme into lymphatics into Cisterna Chyli
Describe the lymphatic drainage of the Liver. (This one’s long. Buckle up, buttercup.)
COME BACK AND DO THIS CARD OVER IT’S GARBAGE
Superficial Group
- Right lobe around triangular ligament: Thoracic Duct (direct)
- Right lobe: hepatic nodes -> celiac nodes -> cisterna chyli -> thoracic duct
- Porta Hepatis region: Hepatic Nodes
- Left lobe: Paracardiac nodes
Deep Group
Ascending Group aka “Non-comformists” (these drain via efferents into Right Bronchomediastinal lobes, then into Right Lymphatic duct)
- Left Lobe: Paracardiac/Juxtaphrenic nodes
- Area around Porta Hepatis: Hepatic nodes
COME BACK AND EDIT ME YOU JACKASS
What are the variations of Hepatic Arterial Supply discussed in class?
Type 1: classic
Type 2: Left Gastric will give off Left Hepatic Branch
Type 3: Right Hepatic Artery comes off of SMA
What is a Porto-caval shunt?
Anastamosis of Portal Vein to IVC or Splenic vein to Renal Vein.
It is done to allow alternate blood pathway to the heart in cases where there may be blockages of the hepatic portal vein.
What causes Portal hypertension?
Alcoholism: result in caput medusa
Budd-Chiari Syndrome: occlusion of normal hepatic venous flow
Treated by shunting or transplant of liver
What two ducts join to form the Common Bile Duct? (Hint: one from Gallbladder, one from Liver)
Cystic Duct (of Heister); from Gallbladder
Hepatic Duct: from Liver
If a patient presents with pain associated with stone blockage (like gallstones) but does not show any signs of jaundice, where is the blockage likely to be? Why?
Cystic duct
Lack of jaundice = blockage does not produce backflow into liver, so Common Bile Duct, Hepatic Duct, and Right and Left Hepatic Ducts are out of the question.
Gallbladder already stores bile; body can and will adjust to blockage.
Define the borders of the Hepatocystic Triangle of Calot. What important structure is located inside the triangle?
Superiorly: Inferior surface of Caudate Lobe
Laterally: Common Hepatic Duct and Cystic Duct.
The Cystic Artery (branch of the Right Hepatic Artery(?)
What is cholelithiasis? What are the two types?
Stones in the gallbladder or biliary tree.
- Cholesterol type (80%), green colored
- Pigmented type (20%), black colored
What is Mirizzi Syndrome?
Stone obstructing biliary duct that causes either intrahepatic dilation or proximal biliary tree dilation.
What is Hartmann’s pouch?
Out-pouching of the wall between neck of gallbladder and Cystic Duct.
What is Cholecystitis?
Inflammation of the gallbladder.
What kind of patient might exhibit both Cholelithiasis and Cholecystitis?
Patient with 4 F’s
- Fat (Obesity)
- Female
- Fertile
- Forty or Fifty years old
What is the arterial supply of the Pancreas?
Splenic Artery
Common Hepatic Artery
- Gastroduodenal Artery
- Right Gastro-omental Artery
- Posterior/Anterior Pancreaticoduodenal Artery
Note that the SMA treads onto the Uncinate Process of the Pancreas and the 3rd part of the duodenum (REMEMBER SMA SYNDROME?)
What does the venous drainage of the Pancreas involve?
Splenic Vein and Superior Mesenteric Vein
- Inferior Mesenteric Vein tributes to Splenic
Splenic and SMV join to form Portal Vein
Describe the lymphatic drainage of the Pancreas.
Head: Posterior and Anterior Pancreaticoduodenal Lymph Nodes
Uncinate Process: Superior Mesenteric Nodes
Distal Neck: Inferior Body -> Superior Body Lymph nodes -> Celiac Lymph nodes and Superior Body Lymph nodes (direct) -> Celiac Lymph nodes
Tip of Tail: Splenic Lymph nodes -> Superior Body etc. etc.
