Lec 7 Anatomy of the biliary tract

Question 1

Where does the right hepatic duct receive bile from?

Answer 1

Sectoral ducts of right liver lobe

Question 2

Where does the left hepatic duct receive bile from?

Answer 2

Segmental ducts of left liver

Question 3

What two ducts join to form the common hepatic duct?

Answer 3

Left and right hepatic ducts

Question 4

What two ducts join to form the common bile duct?

Answer 4

Cystic duct and common hepatic duct

Question 5

What two ducts join to form the hepatopancreatic ampulla of vater?

Answer 5

common bile duct and pancreatic duct

Question 6

Where does the intrahepatic bile duct run parallel to?

Answer 6

It runs parallel to portal vein and hepatic artery

Question 7

Describe smaller intrahepatic bile ducts

Answer 7

Much thinner wall and cuboidal epithelium

Question 8

Describe larger intrahepatic bile ducts

Answer 8

Larger bile ducts have a loose connective tissue(flexible) and a single layer of columnar epithelium

Question 9

Describe the extrahepatic bile duct

Answer 9

7 cms and runs in free edge lesser omentum

Question 10

What does the extrahepatic bile duct join with?

Answer 10

Joined by cystic duct near porta hepatis

Meets with right end of pancreatic duct - ampulla vater

Enters 2nd part of duodenum at sphincter of oddi

Question 11

Describe the duct wall and lumen of the extrahepatic bile duct

Answer 11

Duct wall - dense fibrous connective tissue

Duct wall also contains smooth muscle cells

Lumen - highly columnar epithelium

Blood - cystic vessels(from coeliac and into portal)

Question 12

Location of the gall bladder

Answer 12

Lodged in a fossa on the visceral surface, right lobe of liver between inferior border of liver(ant) and duodenum(post)

Question 13

Physical appearance of the gall bladder

Answer 13

Conical, pear shaped

About 10 cm in length and 3 in diameter

Question 14

What is the gall bladder held by?

Answer 14

Held by peritoneum(forms outer wall)

Question 15

What is the gall bladder divided into

Answer 15

fundus(lower aspect), body, neck

Question 16

What does the wall of the gall bladder consist off

Answer 16

Simple columnar epithelium, smooth muscle

Question 17

What are the functions of the gall bladder?

Answer 17

Concentrate and store bile
Selectively absorb bile salts
Excrete cholesterol
Excrete mucous

Question 18

What is the mechanism that leads to emulsification of fat

Answer 18

Contraction/emptying of stomach –> fatty foods in duodenum –> cholecystokinin release –> sphincter of oddi relaxed –> emulsification of fat

Question 19

How do gall stones form?

Answer 19

physical changes in bile (eg low bile salts and excessive cholesterol)

Question 20

What is biliary colic

Answer 20

crampy right upper abdominal pain that comes and goes repeatedly

Question 21

What is acute cholecystitis

Answer 21

inflammation of gall bladder that also causes pain on right upper quadrant

Question 22

How is visceral pain detected?

Answer 22

Abdominopelvic splanchnic nerves contain this 2-way(afferent and efferent) nerve transmission from viscera within the abdominal cavity

Pain sensation from ‘foregut’ organs, so including gallbladder, pass via the coeliac ganglion

Question 23

Physical appearance of pancreas

Answer 23

Oblong in shape(comma shaped)

12-15 cm long and 3 in width

Question 24

What is the pancreas divided into?

Answer 24

Divided into (broad) head, (tapering) body and (sharp) tail

Question 25

What is the location of pancreas?

Answer 25

- Head at the level of the descending duodenum | - Body behind stomach and extends towards spleen

Question 26

What collects the exocrine secretions of the pancreas

Answer 26

Small ducts

Question 27

What do small ducts unite to form?

Answer 27

The pancreatic duct(wirsung)

Question 28

What does the duct of wirsung form when it joins with the common bile duct?

Answer 28

Hepatopancreatic ampulla(of vater)

Question 29

Where does the ampulla of vater enter the duodenum?

Answer 29

Ampulla of vater enters duodenum about 10 cm post-pyloric sphincter - major duodenal papilla

Question 30

Where does the secondary duct(of santorini) enter?

Answer 30

Secondary duct(of santorini) enters duodenum about 2 cm superior to major duodenal papilla

Question 31

Arterial supply of pancreas

Answer 31

Pancreatic, branches from the coeliac(eg splenic) which join to form an arc(gastroduodenal + pancreaticoduodenal)

Question 32

Veins of pancreas

Answer 32

Portal(originally from splenic + sup mesenteric)

Question 33

Innervation of the pancreas

Answer 33

Coeliac ganglia and vagus

Question 34

What type of gland is pancreas?

Answer 34

Both an exocrine and endocrine gland

Question 35

What constitutes the exocrine portion of the pancreas

Answer 35

cluster AKA acini cells - pyramidal epithelium(98-99%)

Question 36

What does the exocrine portion of the pancreas secrete?

Answer 36

Digestive enzymes, the pancreatic juice

Question 37

What constitutes the endocrine portion of the pancreas?

Answer 37

Centroacinar cells aka islets of langerhans - cuboidal epithelium (1-2%)

Question 38

What does the endocrine portion of the pancreas secrete

Answer 38

Secretion of hormones eg insulin

Question 39

What are the causes of pancreatitis(inflammation)

Answer 39

Gallstones, heavy alcohol intake, cystic fibrosis and high levels of calcium or blood fats

Question 40

What are the causes of pancreatic cancer?

Answer 40

Obstructive jaundice(gallstones) , heavy alcohol intake, smoking and genetics

Question 41

location of stomach with regards to pancreas

Answer 41

Separated from the pancreas by the lesser sac, the stomach and pylorus lie anterior and to the pancreas

Question 42

What system is the spleen a part of?

Answer 42

Part of the lymphatic system and is the largest single mass of lymphoid tissue

Question 43

What type of gland is the spleen?

Answer 43

Regarded as a blood gland(not excretory nor ducts)

Question 44

location of the spleen

Answer 44

underlies 9th, 10th, 11th rib on LHS. At the left hypochondriac region of the abdomen

Question 45

Shape of spleen

Answer 45

oval in shape

Question 46

Physical appearance of spleen

Answer 46

12 cm in length but can vary - age, disease, etc outer surface shows identations, caused by neighbouring organs(stomach, left kidney and left flexure of colon)

Question 47

What does the parenchyma(inner part of spleen) contain?

Answer 47

Lymphatic tissue and blood vessels

Question 48

nerve supply of the spleen

Answer 48

branches of celiac nerve plexus

Question 49

Parts of the spleen parenchyma

Answer 49

CT capsule --> red pulp --> white pulp --> hilum

Question 50

Constituents of the red pulp in spleen

Answer 50

blood-filled venous sinuses

Question 51

Constituents of white pulp in spleen

Answer 51

Lymphatic tissue(lymphocytes, macrophages)

Question 52

Functions of spleen

Answer 52

Immune(like in lymph nodes) Removal by macrophages of old blood cells Storage of platelets Production of blood cells(fetal life)