Anatomy of the biliary tract and the spleen

Question 1

Name the gut associated organs

Answer 1

Liver

Gallbladder

Pancreas

Spleen

Question 2

How is bile produced?

Answer 2

Produced by hepatocytes

Secreted into canaliculi

Canaliculi join to enter bile ductules and ducts in the portal triad.

Question 3

Label the lobule

Answer 3

Question 4

What type of epithelium are ductules and ducts made of?

Answer 4

Ductules = cuboidal epithelium

Ducts = columnar epithelium

Question 5

Complete the diagram of the biliary tree

Answer 5

Question 6

What is the structure of the biliary tree?

Answer 6

Smaller ducts continuously join together.

Liver, gallbladder and pancreas secretions enter the duodenum.

Question 7

Where are the Hepatic, Cystic and Bile Ducts?

Answer 7

Left and right hepatic ducts leave via porta hepatis.

-Join to form the common hepatic duct.

Cystic ducts joins to form the common bile duct.

Question 8

Complete the diagram on the biliary tree

Answer 8

Question 9

What is the structure of the Extrahepatic Bile Duct?

Answer 9

Duct wall now contains fibrous connective tissue and smooth muscle.

Meets the pancreatic duct to form the (hepatopancreatic) ampulla of Vater.

Finally, the sphincter of Oddi moderates emptying into the duodenum.

Question 10

What are the anatomical relations of the bile duct and portal triad?

Answer 10

Anatomical relations in this area are a crucial surgical consideration.

Bile duct is anterior to the portal vein.

Bile duct is to the right of the hepatic artery.

Question 11

Label the portal triad

Answer 11

Question 12

What are the functions on the gallbladder?

Answer 12

●Store and concentrate bile

●Selectively absorb bile salts

●Excrete cholesterol and mucous

Question 13

What is bile?

Answer 13

Bile is an important digestive fluid which emulsifies fats.

Question 14

What is the gross anatomy of the gallbladder?

Answer 14

Characteristically conical/pear-shaped.

Divided into the fundus, body and neck

Question 15

Where is the gallbladder located?

Answer 15

Located on the inferior surface of the right lobe of the liver.

Question 16

Answer 16

Question 17

Blockages of the biliary tree can occur and inhibit the movement of bile to the duodenum. Which of the following is most likely to worsen symptoms related to a blockage such as this?

A.Emotional stress

B.Heavy exercise

C.Ingesting fatty foods

D.Pregnancy

E.Smoking

Answer 17

C.Ingesting fatty foods

Question 18

Where is the pancreas?

Answer 18

Located posterior to the stomach

Question 19

What is the function of the pancreas?

Answer 19

Exocrine and endocrine gland

• Exocrine: secrete digestive enzymes into the duodenum
• Endocrine: secretes hormones such as insulin

Question 20

What is the pancreas divided into?

Answer 20

Divided into the head, body and tail.

Question 21

What supplies the pancreas (artery, vein and nerve)?

Answer 21

Arteries - Splenic, Coeliac trunk, pacreaticduodenal

Veins - Pancreatic (drain into the portal vein)

Nerves: Coeliac ganglia and Vagus

Question 22

Label the pancreas

Answer 22

Question 23

What is the exocrine pathway of the pancreas?

Answer 23

• Pancreatic secretions collect in small ducts
• These ducts join to form the Wirsung
• The Wirsung meets the common bile duct to form the hepatopancreatic ampulla / ampulla of Vater
• This then empties into the duodenum at the major duodenal papilla

Question 24

Answer 24

Question 25

What does this show?

Answer 25

Question 26

What are the causes of pancreatitis?

Answer 26

Inflammation (Pancreatitis) - Causes: - Gallstones - High alcohol intake - Cystic fibrosis - High levels of calcium or blood fats.

Question 27

What are the causes of pancreatic cancer?

Answer 27

- Obstructive jaundice (gallstones) - High alcohol intake - Smoking Genetics

Question 28

Whats the diagnosis?

Answer 28

Question 29

Type 1 Diabetes Mellitus is caused by what issue within the pancreas? A.Blockage of the Wirsung B.Ischaemia of the pancreas C.Lack of insulin production D.Lack of glucagon production E.Trauma to the organ

Answer 29

C. Lack of insulin production

Question 30

What are the functions of the spleen?

Answer 30

Lymphoid organ -Associated with the lymphatic system, and has an immune role Blood gland - Removes old blood cells - Stores platelets - Produces blood cells during foetal life

Question 31

What does friable mean?

Answer 31

Spleen Delicate and friable -Friable means “easily crumbled”

Question 32

What is the anatomy of the spleen?

Answer 32

Surrounded by a connective tissue (CT) capsule The inner portion is known as parenchyma -This contains red and white pulp Red pulp - blood filled sinuses White pulp - lymphatic tissue (think white blood cells)

Question 33

Answer 33

Question 34

What type of capillaries would you expect to see within the spleen? A.Continuous B.Sinusoidal C.Fenestrated

Answer 34

Answer: B Sinusoidal capillaries will allow easier movement of larger molecules from the blood.

Question 35

What is visceral pain?

Answer 35

Pain felt from the organs (viscera) Described as dull, aching, pressure etc.

Question 36

What is the difference between visceral pain and somatic pain?

Answer 36

Visceral pain is poorly localised in comparison to somatic pain -Due to innervation of structures Somatic vs autonomic innervation

Question 37

What is referred pain and what is it caused by?

Answer 37

-Where pain is felt in a different location to where organ or structure injured Caused by visceral pain

Question 38

A patient presents to A&E with pain in their shoulder. There is no surface lesion or MSK injury visible. Which of the abdominal organs could cause referred pain in the shoulder? A.Ileum B.Liver C.Pancreas D.Stomach E.Spleen

Answer 38

Liver

Question 39

What lobes do the caudate and quatrate lobes belong to?

Answer 39

Despite the obvious demarcation produced by the lesser omentum and falciform ligaments that suggest the quadrate and caudate lobes are part of the right lobe, functionally the quadrate lobe is regarded as part of the left lobe, since its arterial supply is from the left hepatic artery and bile from this lobe flows to the left hepatic duct. As for the caudate lobe, some sources consider it as a third lobe, since it receives blood (arterial and portal) from both the left and right side, and drains straight into the IVC rather than the left or right hepatic veins

Question 40

The gall bladder and cystic duct are supplied by the _____ artery, usually a branch from the _______ artery. The lower part of the biliary tree – the common bile duct – is in turn, supplied by the _________ artery.

Answer 40

The gall bladder and cystic duct are supplied by the cystic artery, usually a branch from the right hepatic artery. The lower part of the biliary tree – the common bile duct – is in turn, supplied by the gastroduodenal artery.

Question 41

The pancreas is a very useful landmark to not just locate but also distinguish between ______ and _________ arteries, the former branching from above and the latter from below this organ

Answer 41

The pancreas is a very useful landmark to not just locate but also distinguish between coeliac and superior mesenteric arteries, the former branching from above and the latter from below this organ