liver, gall bladder and pancreas

Question 1

what is Glisson’s capsule

Answer 1

A layer of connective tissue surrounding the liver and ensheathing the hepatic artery, portal vein, and bile ducts within the liver.

Question 2

how does bile produced in the liver reach the gall bladder

Answer 2

canaliculi > bile ductules> cystic duct > common hepatic ducts > right and left hepatic ducts

Question 3

what is bile made of

Answer 3

bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water and electrolytes

Question 4

what do Kupffer cells do

Answer 4

form bile products from haemoglobin

break down old red blood cells

Question 5

what are the functions of the liver

Answer 5

synthesis of bile, storage of glucose, glycogen, proteins, vitamins and fats
detoxification
synthesis of clotting and anticoagulant factors

Question 6

describe a liver lobule

Answer 6

hepatocytes radiate outwards from the central vein (axis)

sinusoids lie between the sheets and carry blood from the hepatic artery and portal vein to the central vein

bile flows in the opposite direction in canaliculi

Question 7

where is the diaphragmatic surface of the liver

Answer 7

antero superior

Question 8

where is the visceral surface of the liver

Answer 8

postero-inferior

Question 9

what separates the right and left lobes of the liver

Answer 9

falciform ligament

Question 10

where is the quadrate lobe of the liver

Answer 10

next to the gall bladder, inferiorly on the posterior surface of the liver. Part of the right lobe

Question 11

where is the caudate lobe of the liver

Answer 11

next to the IVC

superior to the quadrate lobe

Question 12

what is the porta hepatis

Answer 12

houses the portal triad: portal vein, hepatic artery and bile ducts

Question 13

where is ligamentum teres (obliterated umbilical vein)

Answer 13

in the free border of the falciform ligament at the inferior border of the liver

Question 14

where is the ligamentum venosum (obliterated ductus venosus)

Answer 14

in the lesser omentum

Question 15

from a functional perspective, what lobe are the quadrate and caudate lobes part of

Answer 15

the left lobe

Question 16

how can the liver be functionally divided

Answer 16

into Couinaud liver segments, related to their distribution from the portal veins and artery

Question 17

what forms the left and right triangular ligament

Answer 17

coronary ligaments

liver ligaments are reflections of peritoneum that surround the bare area

Question 18

what is the bare area related to

Answer 18

diaphragm, IVC, right kidney, right supra renal gland

Question 19

what is the blood supply of the liver

Answer 19

proper hepatic artery which is a branch of the coeliac trunk divides into right and left terminal branches that enter the porta hepatis

Question 20

where do the hepatic veins exit the liver

Answer 20

from the posterior surface of the liver an drain to IVC

Question 21

where does lymph from the liver go

Answer 21

lymph nodes surrounding the porta hepatis
efferent vessels pass to the coeliac nodes
some go to the posterior mediastinal lymph nodes

Question 22

how might cancer obstruct the bile ducts

Answer 22

retrograde tumour spread from the coeliac nodes to the hepatic nodes

this would cause jaundice

Question 23

what is the nerve supply of the liver

Answer 23

sympathetic nerves form the coeliac plexus- T5-9- greater splanchnic

the anterior vagal trunk gives rise to a large parasympathetic hepatic branch

Question 24

describe the shape and function of the gall bladder

Answer 24

rounded fundus, body and a neck that narrows towards the cystic duct
this combines with the common hepatic duct to form the bile duct and enter the 2nd part of the duodenum with the pancreatic duct at the ampulla of Vater

function-store and concentrate bile

Question 25

where is the gall bladder

Answer 25

between the right and quadrate lobes on the visceral surface of the liver related to the first part of the duodenum, transverse colon and pylorus

Question 26

where does the cystic duct join the hepatic duct

Answer 26

free edge of the lesser omentum

Question 27

what lies posterior to the duodenum

Answer 27

IVC and hilum of right kidney

Question 28

what is the spiral valve of Heister

Answer 28

a fold in the cystic duct which functions to keep the lumen constantly open

Question 29

what is the blood supply of the gall bladder

Answer 29

cystic artery which is a branch of the right hepatic artery

Question 30

what is the venous drainage of the gall bladder

Answer 30

cystic vein which drains straight to the portal vein

Question 31

what is the lymph drainage of the gallbladder

Answer 31

cystic lymph node near the neck of the gall bladder then to the hepatic nodes and coeliac nodes

Question 32

what is the nerve supply of the gall bladder

Answer 32

sympathetic- foregut T5-9 and parasympathetic vagal fibres from the coeliac plexus

Question 33

what hormone causes contraction of the gallbladder

Answer 33

cholecystokinin which is produced by the mucous membrane of the duodenum on the arrival of fatty food

Question 34

what are the boundaries of Calot's triangle

Answer 34

the inferior edge of the right lobe of the liver common hepatic duct cystic duct used to surgically locate the cystic artery during cholecystectomy variation is common the cystic duct and cystic artery must be ligated during surgery

Question 35

where is referred pain from the gall bladder

Answer 35

epigastrium (T7-9) | irritation of the peritoneum may refer pain to the shoulder tip

Question 36

what might cause painless jaundice

Answer 36

carcinoma of the head of the pancreas which obstructs the gall bladder

Question 37

what does ERCP stand for

Answer 37

Endoscopic, retrograde, cholangio pancreaticogram to look for gallbladder stones

Question 38

what structures lie at the transpyloric plane (L1, through the tips of the 9th costal cartilage)

Answer 38

``` fundus of gall bladder pylorus neck of pancreas formation of portal vein hilum of kidney spinal cord ends at l1/2 aortal and origin of SMA IVC 2nd part of duodenum ```

Question 39

what hormones are produced in the islets of Langerhans

Answer 39

insulin and glucagon

Question 40

where is the pancreas

Answer 40

retroperitoneal in epigastrium | lies in the C-shaped curve of the duodenum and extends towards the posterior abdominal wall from spleen to duodenum

Question 41

what are the relations of the pancreas

Answer 41

``` duodenum IVC aorta inf mesenteric vein inf mes artery spleen left kidney splenic artery coeliac trunk hepatic portal vein Bile duct ```

Question 42

where is the pancreas tail

Answer 42

lienorenal ligament the rest is secondarily retroperitoneal

Question 43

where does the pancreatic duct join the bile duct

Answer 43

hepatopancreatic ampulla

Question 44

what is the Sphincter of Oddi

Answer 44

sphincters: 1 around the end of the pancreatic duct 2 around the end of the bile duct 3 around the combined ducts

Question 45

where does the pancreas receive its blood supply from

Answer 45

coeliac trunk to gastroduodenal artery which goes to the pancreas splenic artery which goes to the greater and dorsal pancreatic branches SMA which goes to the inferior pancreaticoduodenal artery and then the ant and post branches

Question 46

where does lymph from the pancreas drain to

Answer 46

coeliac and superior mesenteric lymph nodes

Question 47

what is the nerve supply of the pancreas

Answer 47

t7-9 and T10-11 so difficult to diagnose pain

Question 48

what is the venous drainage of the pancreas

Answer 48

sup and inf pancreaticoduodenal veins sup mes. veins, inf mes veins splenic vein portal vein

Question 49

where is Morison's pouch

Answer 49

between the liver and the right kidney , aka right hepatorenal space

Question 50

where is the subphrenic space

Answer 50

between the diaphragm and the liver, anteriorly

Question 51

what are the branches of the coeliac trunk

Answer 51

left gastric common hepatic splenic

Question 52

what are the branches of the common hepatic artery

Answer 52

proper hepatic gastroduodenal right gastric

Question 53

what are the branches of the splenic artery

Answer 53

greater pancreatic short gastric dorsal pancreatic left gastric omental

Question 54

where does the cystic duct join the hepatic duct

Answer 54

free edge of the lesser omentum

Question 55

where is the common bile duct

Answer 55

lies in the free margin of the lesser omentum. Then behind the first part of the duodenum to the right of the gastroduodenal artery then on the posterior surface of the head of the pancreas

Question 56

what are the tributaries of the portal vein

Answer 56

splenic vein , IMV and SMV | found posterior to the neck of the pancreas

Question 57

where does the accessory pancreatic duct empty to

Answer 57

the minor duodenal papilla

Question 58

what does infrahepatic mean

Answer 58

below the liver- portal vein thrombosis or splenic vein thrombosis - causes of portal hypertension or splenomegaly

Question 59

where is the portal vein in relation to the hepatic artery

Answer 59

behind

Question 60

what is the sympathetic supply of the liver

Answer 60

greater splanchnic nerve T5-9 from the coeliac plexus

Question 61

what are the relations of the gall bladder

Answer 61

pylorus transverse colon 1st part of duodenum quadrate lobe of the liver