Lecture 7 Flashcards
(17 cards)
Describe the biliary tree
intrahepatic biliary tree:
Sectoral ducts of R liver->R hepatic duct
Segmental ducts of L liver->L hepatic duct
Extrahepatic biliary tree:
L&R hepatic duct->Common hepatic duct
Common hepatic duct +Cystic duct->Common bile duct
Common bile duct+Pancreatic duct->duodenum (sphincter of Oddi)
Describe the hepatic bile duct
Runs parallel to portal vein and hepatic artery
describe the difference between ductules and larger bile ducts
Smaller bile ducts (ductules) – much thinner wall and cuboidal epithelium
Larger bile ducts have a loose connective tissue (flexible) and single layer of columnar epithelium
Describe the extra hepatic bile duct
Runs in free edge lesser omentum
Joined by cystic duct near porta hepatis
Meets with right end of pancreatic duct – ampulla Vater
Enters 2nd part duodenum at sphincter of Oddi
Duct wall – dense fibrous connective tissue also contains smooth muscle cells
Lumen – highly columnar epithelium
Blood: cystic vessels (from Coeliac and into Portal)
Describe the gall bladder’s anatomy
Lodged in a fossa on the visceral surface, right lobe of liver
Between inferior border of liver (ant) and duodenum (post)
Conical, pear shaped
Held by peritoneum (forms outer wall)
Divided into fundus (lower aspect), body, neck
Wall: simple columnar epithelium, smooth muscle
Describe the functions of the gall bladder
Concentrate and store bile
Selectively absorb bile salts
Excrete cholesterol
Excrete mucous
Describe the mechanism of the gall bladder
Contraction /emptying of stomach
Fatty foods in duodenum
Cholecystokinin release
Sphincter of Oddi relaxed
Emulsification of fat
Describe gall stones
Physical changes in bile, e.g.
low bile salts
excessive cholesterol
Stones can partially or fully obstruct flow of bile
Biliary colic: crampy right upper abdominal pain that comes and goes repeatedly
Acute cholecystitis – inflammation gall bladder that also causes pain on right upper quadrant
Describe the pathway for visceral pain in the abdomen
Sympathetic trunk, splanchnic nerve and prevertebral ganglia
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
Describe the anatomy of the pancreas
Divided into (broad) head, (tapering) body and (sharp) tail
Pancreas exocrine secretions are collected into small ducts
Small ducts unite to form the pancreatic duct (Wirsung)
Duct of Wirsung joins common bile duct to become the hepatopancreatic ampulla (of Vater)
Ampulla of Vater enters duodenum about 10 cm post-pyloric sphincter – major duodenal papilla
Secondary duct (of Santorini) enters duodenum about 2 cm superior to major duodenal papilla
Describe the location of the pancreas
Head at the level of the descending duodenum
Body behind stomach and extends towards spleen
Describe the VAN of the pancreas
Arteries: pancreatic, branches from the Coeliac (e.g. splenic)
These join forming an arc (gastroduodenal + pancreaticoduodenal)
Veins: Portal (originally from splenic + sup mesenteric)
Nerves: Coeliac ganglia and Vagus
Describe the histology and function of the pancreas
Pancreas is both an exocrine and endocrine gland
Exocrine portion: cluster aka acini cells – pyramidal epithelium (98-99%)
Exocrine: secretion of digestive enzymes, the pancreatic juice
Endocrine portion: centroacinar cells aka islets of Langerhans – cuboidal epithelium (1-2%)
Endocrine: secretion of hormones, e.g. insulin
What are the two main diseases relating to the pancreas and their main causes?
Inflammation (pancreatitis): gallstones heavy alcohol intake cystic fibrosis high levels of calcium or blood fats
Pancreatic cancer: obstructive jaundice (gallstones) heavy alcohol intake smoking genetics
Describe the location of the spleen
Regarded as a blood gland (not excretory nor ducts)
Underlies 9-11th rib on LHS
At the left hypocondriac region of the abdomen
Describe the anatomy of the spleen
Outer surface shows indentations, caused by neighbouring organs (stomach, left kidney and left flexure of colon)
Parenchyma (inner part of spleen): contain the lymphatic tissue and blood vessels
Nerve supply: braches of celiac nerve plexus
Describe the function of the spleen
Parenchima: two pulps – red and white
Red pulp: blood-filled venous sinuses
White pulp: lymphatic tissue (lymphocytes, macrophages)
Functions immune (like in lymph nodes) removal by macrophages of old blood cells storage of platelets production blood cells (fetal life)
