Hepatobiliary System, Pancreas, Spleen Flashcards Preview

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Flashcards in Hepatobiliary System, Pancreas, Spleen Deck (17):

Liver Functions

 Storage of glycogen
 Synthesis of blood plasma proteins (albumin, globulins, clotting factors)
 Synthesis of urea
 Modification of fats so cells can use them efficiently
 Manufacture of bile
 Recycling/elimination of break down products of RBC once eliminated in spleen; breakdown products are eliminated in bile and gives stool its characteristic dark color
 Detoxification of alcohol and drugs
 Storage of some vitamins and iron


Liver relationships

 Superior: diaphragm
• BARE AREA OF LIVER – part that is not covered by diaphragm and is in direct contact with the diaphragm (superior/posterior portion)
• Visceral peritoneum reflects around margins of bare area and becomes parietal peritoneum (coronary ligaments)
 Inferior (from lateral/right to median/left)
• Right colic flexure and right transverse colon
• Gallbladder
• Lesser omentum
• Superior part of duodenum
• Right side of anterior aspect of the stomach
 Posterior
• Right kidney and right adrenal gland
• Inferior vena cava



More than 12 cm long at midclavicular line


Liver Anatomy and Anatomical Divisions

 2 lobes (right and left) with falciform ligament in between
• Left lobe is single lobe
• Right lobe divided into 3 lobes: right, quadrate, caudate
o Quadrate lobe (anterior) (bound on left by fissure for ligamentum teres) and right by gallbladder; more superior
 Divided in middle by porta hepatis
o Caudate lobe (posterior) (bound on left by fissure of ligamentum venosum) and right by groove of IVC
 Round ligament of liver (ligamentum teres) - inferior portion of falciform ligament


Functional Divisions of Liver

-determined by the position of the hepatic artery and when it divides into left and right hepatic arteries


Liver Plumbing

– most important vessels enter and exit liver through Hepatic Triad formed by hepatoduodenal ligament (hepatic artery, portal vein, common bile duct)
 2 in (arterial and portal blood); 3 out (venous blood, bile, lymph)
 Right and Left hepatic artery (30% of blood)
• Abdominal aorta  celiac  hepatic artery proper  right/left hepatic artery
 Portal vein (70% of blood) – drains GI tract, pancreas, spleen, gallbladder
• Inferior mesenteric v.  splenic & superior mesenteric v.  portal vein
• NO VALVES; therefore pressure changes will cause retrograde flow
 Biliary System
• Right & left hepatic ducts  common hepatic duct that joins cystic duct (from gallbladder)  common bile duct (enters pancreas) joins pancreatic duct  empties into 2nd part of duodenum


Portal System Anastomoses

– alternate routes for venous blood during portal hypertension
 Esophageal varices – left gastric vein & azygous vein/system
• 30% are fatal
 Internal hemorrhoids – superior rectal vein & and middle/inferior rectal veins
 Caput medusa – anterior abdominal wall around umbilicus (superficial veins and paraumbilical veins)
 Retroperitoneal – colic veins & posterior abdominal wall


Liver Lymphatics

 From anterior diaphragmatic and visceral surface and from portal triad
• Superficial hepatic lymphatics join deep hepatic lymphatics  hepatic lymph nodes (in lesser omentum)  celiac lymph nodes  cistern chili
 From Posterior diaphragmatic and visceral service
• Superficial hepatic lymphatics drain towards the Bare Area  phrenic lymph nodes or join deep lymphatics posterior mediastinal lymph nodes  right lymphatic and thoracic ducts


Gallbladder (function, suface anatomy, relationships)

o Function
 Stores up to 30-50ml and releases bile once chyme enters duodenum
o Lies on inferior surface of liver in fossa between right and quadrate lobe
o Surface Anatomy
 Fundus located at junction of right 9th costal cartilage at mid-clavicular line
o Relationships
 Superior – liver
 Inferior – transverse colon
 Posterior – duodenum


Gall Stones

 Gallbladder stones cause problem if lodged in Ampulla of Vater because it will block pancreatic juices from exiting and increase risk for pancreatitis


Pancreas Location and Function

o Accessory digestive gland that lies posterior to stomach; bound on left by spleen and right by duodenum
 Retroperitoneal organ at level of T12/L1/L2
o Function
 Produces exocrine (pancreatic juice) and endocrine secretions (glucagons & insulin)


Pancreas Anatomy

 Head – duodenum curves around head
• Pancreatic duct runs entire length of pancreas (duct of Wirsung) and joins bile duct here then enters the 2nd part of duodenum in major papilla
• Accessory pancreatic duct (of Santorini); enters duodenum at the minor papilla
• Bile duct travels within posterior groove of head of pancreas
o Hepatopancreatic ampulla is narrowest part of biliary tract
 Uncinate process projects from lower part of head and extends posterior to superior mesenteric vessels
 Neck – posterior to 1st part of duodenum and anterior to superior mesenteric vessels
 Body – anterior to left kidney
 Tail – extends anteriorly to spleen
 Posterior – superior


Pancreas Blood Supply

 Pancreatic arteries – branches of splenic artery
 Head supplied by anterior/posterior superior pancreaticoduodenal arteries (branches of gastroduodenal artery) and by anterior/posterior inferior pancreaticoduodenal arteries (branches of superior mesenteric artery)


Panceatitis & Pancreatic Cancer

o Acute Pancreatitis – 10% fatal; most common causes – gall stones and alcoholism
o Pancreatic Cancer – obstructive jaundice is common complication (esp. in head of pancreas)


Spleen Function

 Immunity (largest lymphoid organ in body)
 Fetal Hematopoiesis
 Destroys aged/worn-out RBC in adulthood
 Platelet storage


Spleen Location and Relations

o Size of fist and located in upper left abdomen; projects posterior to mid-axillary line at level of ribs 9-11; lies on posterior abdominal wall
o Relations
 Anterior - stomach, tail of pancreas
 Posterior/medial – kidney
 Inferior - splenic flexure of colon


Spleen Blood Supply, Injuries, Splenomegaly

o Blood Supply – splenic artery (largest branch of celiac trunk)
o Penetrating (stabbing) or blunt trauma can cause splenic rupture; can cause penumothorax because pleural space runs down lateral side of spleen along inner costal surface
o Splenomegaly – must enlarge 3x normal size before it can be palpable; will feel the notches of the spleen