Anatomy of the biliary tract, pancreas and spleen

Question 1

Where is the gallbladder located?

Answer 1

The gallbladder is located in the fossa of the gallbladder on the visceral surface of the liver. Surface anatomy-wise, the gallbladder can be found at the 9th costal cartilage in the midclavicular line (MCL) or at the transpyloric plane in the MCL.

Question 2

What are the relations of the common bile duct (CBD)?

Answer 2

The CBD is positioned posterior to the first part of the duodenum and then courses medially to the second part of the duodenum.

Question 3

What are the features of the gallbladder?

Answer 3

The gallbladder has a pear-shaped structure and consists of the fundus, body, infundibulum, and neck. The neck of the gallbladder is continuous with the cystic duct and contains a spiral valve.

Question 4

What are the functions of the gallbladder?

Answer 4

The gallbladder serves two primary functions. Firstly, it functions as a storage organ for bile, which is produced by the liver. Secondly, it conveys bile into the digestive tract for the digestion and absorption of dietary fats.

Question 5

What is the general location of the pancreas?

Answer 5

The pancreas is a 15cm long structure that lies retroperitoneally, except for its tail. It is located around the transpyloric plane, specifically the neck region.

Question 6

What are the relations of the pancreas?

Answer 6

The pancreas has various relations. Anteriorly, it is related to the stomach, superior mesenteric artery (SMA) (specifically the uncinate process), and superior mesenteric vein (SMV) (also in the uncinate process). Posteriorly, it is related to the L1-3 vertebrae, abdominal aorta, SMA (in the neck region), inferior vena cava (IVC), and SMV (also in the neck region). Medially, it is related to the duodenum (head and uncinate process), and laterally, it is related to the spleen (tail).

Question 7

What are the features of the pancreas?

Answer 7

The pancreas consists of the head, uncinate process (a projection from the head), neck, body, and tail.

Question 8

What are the functions of the pancreas?

Answer 8

The pancreas has both endocrine and exocrine functions. It secretes hormones such as glucagon and insulin into the bloodstream (endocrine function) and produces pancreatic digestive enzymes that aid in the digestion of food (exocrine function). It has a main pancreatic duct that carries these digestive enzymes, and it also has an accessory pancreatic duct, which opens at the minor duodenal papilla

Question 9

Where is the spleen located?

Answer 9

The spleen is located in the superolateral upper left quadrant (ULQ) of the abdomen, specifically in the left hypochondrium. Surface anatomy-wise, it is associated with the left ribs 9-11.

Question 10

What are the relations of the spleen?

Answer 10

The spleen has several relations. Anteriorly, it is related to the stomach through the gastrosplenic ligament. Posteriorly, it is in contact with the left hemidiaphragm. Inferiorly, it is related to the splenic flexure of the colon. Medially, it is in relation to the left kidney through the splenorenal ligament.

Question 11

What are the features of the spleen?

Answer 11

The spleen is an ovoid lymphoid mass with a fibroelastic capsule. It measures approximately 12x7cm in size. It has a diaphragmatic surface, a hilum for vessels, a superoanterior notched border, and an inferoposterior smooth border.

Question 12

What are the functions of the spleen?

Answer 12

The spleen serves two main functions. Firstly, it has a haemopoietic function in the red pulp, where it stores red blood cells (RBCs) and platelets. It also performs phagocytosis of defective RBCs. Secondly, it has a lymphoid function in the white pulp, where it contains T and B lymphocytes as well as macrophages.

Question 13

What is the function of the biliary system?

Answer 13

The function of the biliary system is to convey bile, which is produced by the liver, to the duodenum for the digestion and absorption of fats.

Question 14

What is the organization of the biliary system in the liver?

Answer 14

In the liver, bile is initially collected by the right and left hepatic ducts. These ducts then join together to form the common hepatic duct. The common hepatic duct is connected to the gallbladder through the cystic duct.

Question 15

What is the organization of the biliary system in the hepatopancreatic part?

Answer 15

In the hepatopancreatic part, the common hepatic duct merges with the main pancreatic duct to form the hepatopancreatic ampulla, also known as the ampulla of Vater. The hepatopancreatic ampulla is controlled by the hepatopancreatic sphincter, also called the sphincter of Oddi. The ampulla opens into the duodenum through the major duodenal papilla, which is located in the second part of the duodenum.

Question 16

What is the lesser omentum?

Answer 16

The lesser omentum is a double-layer fold of peritoneum that arises from the development and rotation of the foregut.

Question 17

How many ligaments does the lesser omentum have, and what are their names?

Answer 17

The lesser omentum consists of two ligaments: the hepatoduodenal ligament and the hepatogastric ligament.

Question 18

What is the omental foramen also known as, and what is its function?

Answer 18

The omental foramen is also known as the epiploic foramen or the foramen of Winslow. It serves as a communication point between the greater and lesser sacs of the peritoneal cavity.

Question 19

What are the boundaries of the omental foramen?

Answer 19

The omental foramen has the following boundaries:

Anterior: Hepatoduodenal ligament and portal triad (hepatic artery, portal vein, common bile duct)
Posterior: Inferior vena cava (IVC) and right crus of the diaphragm
Superior: Caudate lobe of the liver
Inferior: First part of the duodenum

Question 20

Which artery supplies the gallbladder and what is its origin?

Answer 20

The gallbladder is primarily supplied by the cystic artery, which is a branch of the right hepatic artery.

Question 21

Which arteries contribute to the blood supply of the common bile duct?

Answer 21

The common bile duct receives blood supply from the right hepatic artery (through the cystic artery) and the posterior superior and inferior pancreaticoduodenal arteries.

Question 22

What are the venous drainage and lymphatic drainage of the gallbladder?

Answer 22

The venous drainage of the gallbladder is through the cystic veins, which ultimately drain into the portal vein. The lymphatic drainage involves the cystic lymph nodes, which are part of the coeliac nodes.

Question 23

What are the components of the coeliac plexus and their functions?

Answer 23

he coeliac plexus is a complex network of nerves involved in the innervation of abdominal organs. It includes:

Vagus nerve (CN X): Provides parasympathetic innervation (PNS).
Greater and lesser splanchnic nerves: Contribute sympathetic innervation (SNS) and contain visceral afferent fibers.
Phrenic nerve: Conveys somatosensory information from the diaphragm.

Question 24

Which arteries supply the pancreas and what are their names?

Answer 24

The pancreas receives its arterial blood supply from the anterior and posterior inferior pancreaticoduodenal arteries.

Question 25

What are the veins that drain the pancreas?

Answer 25

The pancreatic veins drain into the splenic vein and the superior mesenteric vein.

Question 26

What are the lymph nodes associated with the pancreas?

Answer 26

The pancreaticosplenic lymph nodes, which are part of the coeliac nodes, are involved in the lymphatic drainage of the pancreas.

Question 27

What are the components of the coeliac plexus and their functions in relation to the pancreas?

Answer 27

The coeliac plexus, which is a network of nerves, plays a role in the innervation of abdominal organs including the pancreas. Its components include:

Vagus nerve (CN X): Provides parasympathetic innervation (PNS) to the pancreas.
Greater and lesser splanchnic nerves: Contribute sympathetic innervation (SNS) to the pancreas.

Question 28

What are the blood vessels and lymph nodes associated with the spleen?

Answer 28

The spleen is supplied by the splenic artery (a branch of the coeliac trunk) and drained by the splenic vein. The pancreaticosplenic lymph nodes, part of the coeliac nodes, are also associated with the spleen.

Question 29

What are the components of the coeliac plexus and their functions in relation to the spleen?

Answer 29

The coeliac plexus includes:

Vagus nerve (CN X): Provides parasympathetic innervation (PNS) to the spleen.
Greater and lesser splanchnic nerves: Contribute sympathetic innervation (SNS) to the spleen.