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Hepatopancreatic System Flashcards

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1
Q

Function of liver

A

Storage, metabolism and release of nutrients and some vitamins.

Detoxification and elimination of toxins, drugs and metabolites.

Synthesis of proteins: albumin, clotting factors.

Synthesis and secretion of bile, important for lipid digestion and absorption.

Role in immune function and clearance of intestinally absorbed bacteria.

Removal of red blood cells. Kupfer cells – specialised macrophages in liver.

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2
Q

Location of liver

A

Right hypochondrium and extends out to epigastrium

(Sometimes lobes of liver can be seen in left hypochondrium)

Inferior to diaphragm- moves with it in respiration

INTRAPERITONEAL

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3
Q

Blood from GI tract goes where?

A

Blood from digestive system first goes to liver to be processed then circulated around rest of body

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4
Q

Which ribs protect the liver?

A

Ribs 7-11

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5
Q

Which ribs protect the liver?

A

Ribs 7-11

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6
Q

Lobes of the liver

A

Left
Right
Cordate (tail)
Quadrate

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7
Q

Caudate vs Quadrate lobes

A

Caudate lobe is an independent lobe. (arises from right lobe)
Quadrate lobe to be considered part of left lobe (though it arises from right lobe)

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8
Q

Functional Anatomical Divisions / segments of liver

A

8 functional segments
Based on distribution of portal venous branches- each segment has own individual blood supply, so can remove one segment and will not affect rest of functioning units of liver (eg can remove cancerous part of liver)
Important for surgical resection surgery

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9
Q

Falciform ligament

A

Double fold of peritoneum connecting liver to anterior abdominal wall.

Divides left lobe into right lobe

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10
Q

Diaphragmatic surface vs Visceral surface of liver

A
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11
Q
A
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12
Q

Ligaments of the lung

A

Falciform ligament:
- Double fold of peritoneum connecting liver to anterior abdominal wall.

Fissure for ligamentum venosum:

  • Remnant of ductus venosus
  • Shuts umbilical blood directly into IVC

Round ligament / ligamentum teres:

  • Remnant of umbilical vein
  • Carries oxygenated blood from placenta
  • Small paraumbilical veins may remain in substance of ligament
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13
Q

How is bile transported to duodenum?

A

Via common bile duct- receives it from cystic duct or from liver via common hepatic duct (right and left hepatic duct come together to form common hepatic duct)

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14
Q

Round ligament of liver

A

Embryological remnant of umbilical vein

Continuous with ligament venosum

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15
Q
A

Umbilical vein goes to ductus venosus, inters IVC to right atrium of heart -> blood pumped through fossa ovale into left ventricle and up into aorta to main circulation

Ductus venosus becomes ligament venosum post birth

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16
Q

Bare area of liver

A

No peritoneum on top surface of liver.

Fenced by ant. and post. coronary which meet as the left and right triangular ligament.

Results from massive embryonic growth of liver within ventral mesogastrium.

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17
Q

Recesses of liver

A

Sites where peritoneal fluid or metastases can localise.

Recesses important for pooling of fluid and indication of pathological process

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18
Q

Peritoneal folds: lesser omentum

A

Double ford of peritoneum that connects the inferior surface of the liver to the lesser curvature of the stomach and first part of duodenum
Hepatogastric ligament
Hepatoduodenal ligament

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19
Q

What part of the liver is not covered in peritoneum?

A

Superior surface

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20
Q

Coronary ligaments of liver

A

Falciform ligament split into two going over superior surface of liver

Fuse with as triangular ligaments - fenced off area they create is the Bare area

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21
Q

From where does the common hepatic artery arise?

A

Coeliac trunk

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22
Q

Subphrenic space

A

Gap between diaphragm and liver

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23
Q

Hepatorenal pouch of Morrison

A

Gap between kidney and liver

If patient supine, this is where fluid is likely to accumulate

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24
Q

Subhepatic space

A

Gap under liver

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25
What runs in the free edge of the lesser omentum?
Portal triad: 1. Common bile duct 2. Proper hepatic artery 3. Hepatic portal vein 4. Vagus nerve 5. Lymphatics
26
What acts as the opening into the lesser sac (omental bursa)?
Lesser omentum
27
Boundaries of lesser sac
Superior: Caudate process of liver Inferior: 1st part of duodenum Posterior: Inferior vena cava and right crus of diaphragm Anterior: Portal triad (in free edge of lesser omentum)
28
Pringle's manoeuvre
Haemostat used to clamp hepatoduodenal ligament. Stops blood flow through hepatic duodenal artery and portal vein
29
Blood supply of liver
Dual system 25% from Hepatic artery proper 75% from Hepatic portal vein (GI tract) Then processed in sinusoids -> hepatic veins x3 -> IVC -> right atrium
30
Hepatic portal system
31
What vessels make up the hepatic portal vein?
Superior mesenteric vein - brings blood from midgut Splenic vein - unites with superior mesenteric to form hepatic portal vein Inferior mesenteric vein - brings blood from hindgut, usually enters into splenic vein (in 1/3 of people also enters in hepatic portal vein)
32
Portal hypertension
Obstruction in liver increases pressure in hepatic portal vein (eg. Cirrhosis). --> May cause enlargement of spleen bc blood can't flow back out of spleen due to HBP in liver Collateral (alternative) pathways open up between portal and systemic venous systems = Portosystemic anastomoses. Caput medusa of para-umbilical veins.
33
Portosystemic Anastomoses
Collateral circulation between systemic and portal circulation Occurs in: Oesophageal veins Peri-umbilical region Anal canal
34
Oesophageal vein portosystemic anastomoses
Portal via left gastric vein | Systemic via azygos veins
35
Anal canal portosystemic anastomoses
Portal via Inferior mesenteric vein | Systemic via inferior and middle rectal veins
36
Peri-umbilical region portosystemic anastomoses
Portal via paraumbilical veins | Systemic via epigastric veins
37
38
Sites of gallstone obstruction
Sites of obstruction: Hepatopancreatic ampulla Cystic duct Hartmann’s pouch (infundibulum) Jaundice occurs when bile cannot leave the gallbladder and enters the blood.
39
Referred gallbladder pain
Back of shoulder due to right phrenic nerves C3 C4 C5 corresponding to dermatomes of shoulder region
40
Where does the inferior mesenteric vein normally drain?
Splenic vein
41
Location of pancreas
Posterior to stomach. Transpyloric plane passes through neck (L1). Secondary retroperitoneal apart from tail (splenorenal ligament).
42
Function of pancreas
Exocrine: Pancreatic juice: acinar cells. Enters duodenum through main and accessory ducts. Endocrine: Produces Glucagon and insulin: Pancreatic islets of Langerhans. Enters blood.
43
Ampulla of Vater
formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla. The ampulla of Vater is an important landmark halfway along the second part of the duodenum that marks the anatomical transition from foregut to midgut, and hence the point where the celiac trunk stops supplying the gut and the superior mesenteric artery takes over.
44
What opens cystic duct to release bile?
Spiral valve (spiral folds)
45
46
Function of duodenum
Receives: Chyme from pyloric part of stomach. Bile from liver and gallbladder via common bile duct. Enzymes from pancreas via main and accessory pancreatic duct.
47
Duodenum structure
First part of small intestine. ‘C’-shaped structure. Widest lumen of small intestine. First 2-3 cm: intraperitoneal (hepatoduodenal ligament). Remaining portion is retroperitoneal.
48
First/superior part of duodenum
Referred to as ampulla or duodenal cap Smooth wall Common site of duodenal ulcers Clinical consequence, as gastroduodenal artery runs posteriorly.
49
What is the most common site for diverticula?
Second / Descending Part of duodenum
50
Second/descending part of duodenum
Opening of: Hepatopancreatic ampulla --> major duodenal papilla (of vater). - Marks division of foregut and midgut - Consequence for neurovasculature. Opening of: Accessory pancreatic duct --> minor duodenal papilla
51
What part of the duodenum is intraperitoneal?
First part only
52
What can haemorrhage if a duodenal ulcer rips through duodenal wall?
Gastroduodenal artery
53
What artery crosses the third/horizontal/inferior part of the duodenum?
Superior mesenteric artery (and vein)
54
Where does the ascending part of the duodenum join the jejunum?
Duodenojejunal flexure
55
What holds the ascending part of the duodenum in place?
Ligament of Treitz
56
57
Lymphatics of duodenum
Follows arteries superiorly from superior pancreaticoduodenal to gastroduodenal to coeliac nodes. Follows arteries inferiorly from inferior pancreaticoduodenal to superior mesenteric nodes.
58
Whipple's procedure
Pancreaticoduodenectomy ``` Cancer in head of pancreas Remove: Head of pancreas Duodenum Gallbladder Bile duct ```
59
Annular pancreas
Congenital condition Ventral pancreatic bud consists two components. During development two parts migrate in different directions around the duodenum. Constrict the duodenum and may result sin complete obstruction. Causes reflux and vomiting
60
Spleen structure
Lymphatic organ. Protected by 9th – 11th ribs. Left upper quadrant / left hypochondrium. Intraperitoneal organ Size of it depends on blood flow- can get bigger
61
Spleen function
White cell proliferation. Immune surveillance. Filters and stores red blood cells and platelets. Recycles iron and globin
62
Where are the splenic artery and vein?
Hilum of spleen | Run in splenorenal ligament
63
Splenomegaly
May be caused by portal hypertension 10Xs normal size! May be palpable in right iliac fossa Can treat with splenectomy.
64
What structure is this
Quadrate lobe
65
Identify this structure
Falciform Ligament attaches to anterior abdominal wall
66
Identify this structure
Ligamentum teres | was umbilical vein during embryo
67
What structure is this
Caudate lobe
68
What is this line
Round ligament
69
What is this line
Fissure for ligamentum venosum
70
What is the clinical relevance of the fissure for ligamentum venosum?
Embryological remnant of ductus venosus
71
What is the entry point into liver?
Porta hepatis
72
Identify the vessel
Common bile duct
73
Identify the vessel
Hepatic portal vein
74
Identify the vessel
Proper hepatic artery (brings blood from coeliac trunk)
75
What nerves go into liver?
Vagus nerve branches
76
Identify the vessel
Proper hepatic artery
77
What 3 structures run in the lesser omentum?
Proper hepatic artery Hepatic portal vein Common bile duct
78
Where does hepatic portal vein arise from?
Superior mesenteric vein and splenic vein form hepatic portal vein (posterior to pancreas)
79
Name the peritoneal reflection
Anterior coronary ligament
80
Name the peritoneal reflection
Posterior coronary ligament
81
What do the anterior and posterior coronary ligaments come together to form
Triangular ligament
82
Identify the vessel
Inferior vena cava
83
What is the space between the diaphragm and liver?
Subphrenic space
84
Space between kidney and liver
Pouch of Morrison / hepatorenal pouch
85
Why are peritoneal recesses clinically significant?
Peritoneal fluid can fill these areas
86
Identify the structure
Hartman's Pouch/infundibulum
87
How is common bile duct formed?
Cystic duct of gallbladder unites with common hepatic duct (formed by L and R hepatic ducts)
88
Where in pancreas does common bile duct enter?
Head of pancreas
89
What duct does common bile duct fuse with in pancreas?
Main pancreatic duct
90
What forms the hepatopancreatic ampulla?
Common bile duct | Main pancreatic duct
91
Where does bile enter into duodenum?
Major duodenal papilla
92
Endocrine function of pancreas
Insulin production
93
Exocrine function
Digestive juices travel through duct to enter digestive system
94
Which part of the pancreas is not retroperitoneal?
Tail- intraperitoneal
95
What runs behind neck of pancreas?
Superior mesenteric vein and artery
96
What vessel runs along body of pancreas?
Splenic vein | splenic artery from coeliac trunk on superior surface
97
What leads directly into duodenum?
Pylorus of stomach
98
What part of duodenum is not retroperitoneal?
Superior part- intraperitoneal
99
What part of duodenum is this?
Duodenal cap/ampulla
100
What vessel is this
Gastroduodenal artery (can rupture in ulcer)
101
Identify the structure
Major duodenal papilla opening of common bile duct and main pancreatic duct
102
What marks the division between the foregut and midgut?
Major duodenal papilla
103
What are the vessels running in the mesentery?
Superior mesenteric artery and vein
104
At what point does the duodenum become the jejunum?
Duodenojejunal junction (ascending part of duodenum)
105
What hold duodenaljejunal junction in place?
Ligament of treitiz
106
What is the largest lymphatic organ and is intraperitoneal?
Spleen
107
Spleen blood supply
Coeliac trunk and splenic artery Splenic vein
108
What is spleen closely related to?
Kidney
109
What is this large area
Greater sac
110
What is greater sac of peritoneal cavity divided into?
Supracolic compartment (above transverse colon) Infracolic compartment (below transverse colon)
111
What allows surgeons to go in behind stomach?
Lesser omentum through lesser sac/omental bursa
112
What is this area
Epiploic foramen
113
What attaches the transverse colon to the greater omentum?
Transverse mesocolon
114
What runs down from duodenal jejunal junction to sacroiliac joint?
Root of mesentery
115
What is this structure>
Round ligament (remnant of umbilical vein)
116
What are these two points?
Paracolic gutters
117
Rectovesical pouch
Between superior surface of bladder and rectum
118
What is this space?
Vesico uterine pouch
119
What is this space?
Recto uterine pouch of Douglas

Anatomy (13 decks)

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