Block 2: Anatomy of the Gallbladder, Liver & Spleen

Question 1

Blood supply to the gallbladder

Answer 1

cystic artery, branch of right hepatic artery

Question 2

Where is the gallbladder blood supply located?

Answer 2

triangle of calot

Question 3

Venous drainage of the gallbladder

Answer 3

small veins directly into liver or portal vein

Question 4

What is the blood supply of the bile duct?

Answer 4

1. cystic artery
2. right/left hepatic artery
   anterior/posterior superior pancreatico- duodenal arteries

Question 5

Venous drainage of the gallbladder

Answer 5

portal venous system

Question 6

How does bile drain into the gallbladder?

Answer 6

via the cystic duct

Question 7

What ducts drain into the cystic duct?

Answer 7

common hepatic duct (above cystic duct insertion)

common bile duct (below cystic duct insertion)

Question 8

What are the common locations of a biliary stone? (3)

Answer 8

1. cystic duct (exit site of the gallbladder)
2. blocking common bile duct & pancreatic duct
3. blocking common bile duct

Question 9

Explain pain related to gallstones

Answer 9

pain is poorly localized and periodic b/c peristaltic movements that would attempt to expel the stones are periodic

Question 10

Significance of portal triad anatomy

Answer 10

notorious for a wide variety of anatomical anomalies

Question 11

Borders of Calot’s Triangle

Answer 11

Common hepatic Duct
Cystic Duct
Liver

Question 12

What is located in Calot’s Triangle?

Answer 12

the cystic artery

Question 13

Percutaneous Transhepatic Cholangiography

Answer 13

insertion of a needle to the skin to release contrast medium into the bile duct, allowing for visualization of the bile duct

Question 14

How is the liver fixed to the diaphragm and the abdominal wall?

Answer 14

Triangular ligaments
Coronary ligaments
Falciform ligament
Round ligament

Question 15

Describe the surface anatomy of the liver

Answer 15

-marked by fissures that can help divide the liver into R and L (anatomically)

Question 16

Venous drainage of liver

Answer 16

into the IVC via 3 main hepataic veins

Question 17

R Hepatic Vein drains

Answer 17

right lobe of liver

Question 18

Middle hepatic vein drains

Answer 18

left medial section of liver

Question 19

Left hepatic vein drains

Answer 19

left lateral section of the liver

Question 20

Caudate Lobe drainage

Answer 20

directly into the IVC, multiple small veins

Question 21

Left Hemiliver Segments

Answer 21

1. segments I-IV
2. I-caudate lobe
3. II-III left lateral segment
4. IVa/IVb left medial segment

Question 22

Right hemiliver segments

Answer 22

V-VII

a. V/VII right anterior
b. VI/VII right posterior

Question 23

Caudate lobe significance

Answer 23

independent; does not belong to the R or L hemiliver

Question 24

What are the hemiliver segments divided by?

Answer 24

the hepatic veins

Question 25

What divides the liver into upper and lower parts?

Answer 25

transverse portion of the portal vein

Question 26

How does live donor transplantation work?

Answer 26

the segmental structure of the liver allows you to take one segment from the donor, and the remainder will regenerate in both the donor and the recipient

Question 27

Explain portal vein embolization for massive hepatectomy

Answer 27

we need to leave at least 30% of the liver behind, so you can put embolic materials to plug the R portal vein to divert the entire portal venous flow into the other side the designated lobe will get bigger, and you can safely take out the other portion

Question 28

Effect of PVE

Answer 28

safe and effective way to indue liver hypertrophy to prevent postresection failure due to insiffucient liver remains

Question 29

What is the dual blood supply of the liver?

Answer 29

hepatic arteries | portal vein

Question 30

Pringle Maneuver

Answer 30

the hepatoduodenal ligament is clamped to interrupt blood flow through the hepatic artery and portal vein

Question 31

Benefits of the Pringle Maneuver

Answer 31

control bleeding from the liver

Question 32

Anatomy of the portal venous system

Answer 32

1. inferior mesenteric vein joins the splenic vein 2. superior mesenteric vein joins the splenic vein at this confluence, it becomes the portal vein

Question 33

Difference b/w portal venous system & systemic venous system

Answer 33

in the portal venous system there is no valve in systemic venous system there are valves

Question 34

Caput Medusa

Answer 34

appearance of distended & engorged superficial epigastri veins

Question 35

Transjugular Intrahepatic Portosystemic Shunt

Answer 35

using a guidewire, a stent is passed via a vein in the neck (jugular) into the hepatic vein, through the liver, to the portal vein

Question 36

Is the pancreas intra or retropertioneal?

Answer 36

Retroperitoneal

Question 37

Pancreas location

Answer 37

posterior to stomach & transverse colon head anterior to R kidney

Question 38

List the blood supplies that the pancreas wrap around

Answer 38

around the superior mesenteric artery and vein

Question 39

What is the consequence of having a mass in the main pancreas?

Answer 39

can compress the bile duct, causing blockage of the bile duct

Question 40

What is the arterial supply to the head of the pancreas?

Answer 40

1. collaterals from celiac trunk & SMA 2. anterior superior pancreaticoduodenal off of GDA (celiac) 3. inferior PD artery from SMA

Question 41

Periampullary Tumor Location

Answer 41

around the ampullae of the pancreas

Question 42

Significance of the periampullary tumor

Answer 42

potentially invades into the large blood vessels and create metastasis

Question 43

Whipple Operation Removes

Answer 43

removal of gallbladder, extrahepatic bile duct, distal stomach, duodenum, head of pancreas and associated nodes

Question 44

Describe the cause and effect Whipple Operation

Answer 44

cause: disease in the head of the pancreas effect: organs are removed in a Whipple and reconnected to the intestine

Question 45

Tumor of the pancreatic tail

Answer 45

you can just chop it off

Question 46

Spleen location

Answer 46

LUQ b/w stomach & diaphragm

Question 47

Ligaments of the Spleen (4)

Answer 47

gastrosplenic splenonephric splenocolic splenophrenic