Anatomy - Liver, Biliary System and spleen

Question 1

What ligaments make up the lesser omentum?

Answer 1

• Gastrohepatic ligament

- Hepatoduodenal ligament

Question 2

Name the ligament attaching the stomach to the spleen

Answer 2

Gastrosplenic ligament

Question 3

Name the ligament attaching the spleen to the posterior abdominal wall

Answer 3

Splenorenal ligament

Question 4

Name the ligament connecting the liver to the anterior abdominal wall

Answer 4

Falciform ligament

Question 5

How does is the liver in contact with the diaphragm?

Answer 5

Directly - via the bare area of the liver

Question 6

Describe the surface anatomy of the liver

Answer 6

• Deep to ribs 7-11
• Mistly under the ribs
• In the right hypochondrium, epigastrium, and left hypochondrium

Question 7

What is the ligmentum teres?

Answer 7

• The remnant of the left umbilical vein, the ligamentum teres is attached to the free edge of the falciform ligament of the liver.
• Also called the round ligament

Question 8

How is the liver divided anatomically?

Answer 8

• Right and left lobes via the falciform ligament
• Caudate and quadrate lobe
• Quadrate lobe is sitting on the gallbladder

Question 9

What is the ligamentum venosum?

Answer 9

Remnant of the ductus venosus

Question 10

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

Answer 10

• Coronary ligament (over the right lobe)

- Left triangular ligament (over the left lobe)

Question 11

How is the liver divided functionally?

Answer 11

• Split by the gall bladder and IVC
• Right vascular lobe
• Left vascular lobe (contianing caudate and quadrate)
• Both lobes splitted into 4 functionally independent lobules

Question 12

How are the quadrate and caudate lobes marked out?

Answer 12

• Grooves for foetal veins

- Porta of the liver (hepatic artery, portal vein, and bile duct)

Question 13

List the anatomical relations of the liver

Answer 13

• Covered by costal margin except in the upper epigastrium

- Visceral surface in contact with the stomach, duodenum, right kidney and colon

Question 14

Name the recesses in the liver

Answer 14

• Two subphrenic recesses, the right and left. Between the diaphragm and the liver
• Separated by the falciform ligament
• Potential spaces in the supracolic compartment of the greater sac

Question 15

List the arteries supplying blood to the liver

Answer 15

Right and left hepatic arteries from the hepatic artery proper (branch of common hepatic artery from celiac trunk).

Question 16

How does venous blood from the liver drain?

Answer 16

Directly into the IVC via 3 short hepatic veins

Question 17

List the 4 sites of portal-systemic anastomeses in the gut

Answer 17

• Oesophageal veins to left gastric veins
• Inferior rectal vein to superior rectal vein
• Epigastric vein to paraumbilical vein
• Retroperitoneal vein to visceral vein

Question 18

Why are portal-systemic anastamoses important?

Answer 18

• They become dilated if portal blood flow through the liver is obstructed in disease
• Haemmorage is common in the oesophageal and recal veins

Question 19

Describe the pathway of bile drainage

Answer 19

• Right and left hepatic ducts combine to form the common hepatic duct
• This and the cystic duct combine to form the common bile duct
• Common bile duct passes behind 1st part of duodenum and the head of the pacreas to enter the 2nd part of the duodenum at the major papilla, joining the major pancreatic duct

Question 20

Name the structure formed by the pancreatic duct and bile duct joining

Answer 20

Hepatopancreatic ampulla of Vater

Question 21

Where is the sphincter of oddi?

Answer 21

At the ampulla of vater, controlling entry of bile into the duodenum

Question 22

Name the sphincters of the bile duct and pancreatic duct

Answer 22

• Sphincter of bile duct (common hepatic duct to ampulla of Vater)
• Sphincter of pancreatic duct (main pancreatic duct to amulla of Vater)

Question 23

What is cholecystoenteric fistula?

Answer 23

A connection between the gallbladder and duodenum where large gallstones ma enter the duodenum

Question 24

Describe the position of the spleen

Answer 24

(- Largest lymphoid organ in the body)

• Suspended in the dorsal foregut mesentery
• Lies posteriorly on the left under ribs 9-11

Question 25

List the relations of the spleen

Answer 25

• Stomach
• Left kidney
• Splenic flexure of the colon
• Tail of the pancreas

Question 26

List the components of the hilum of the spleen

Answer 26

• Splenorenal and gastrosplenic ligament
• Short gastric and left gastro-omental vessels in the gastrosplenic ligament
• Splenorenal ligament contains splenic vessels and the tail of the pancreas
• Both ligaments are part of the greater omentum

Question 27

List the blood vessels supplying the spleen

Answer 27

• Splenic artery from the celiac trunk
• WIggly so is called serpentine splenic
• Drained by the splenic vein (part of the hepatic portal system)