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MD3002 - GI Anatomy > Liver, Gallbladder, Biliary System and Pancreas > Flashcards

Liver, Gallbladder, Biliary System and Pancreas Flashcards

(64 cards)

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1
Q

What is the liver

A

largest gland

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2
Q

Where is the liver located in the abdomen?

A

Lies across the upper abdomen under the diaphragm; in the right hypochondrium and most of epigastric region

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3
Q

How does the liver move in inspiration?

A

Descends

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4
Q

What is the liver surrounded by?

A

Surrounded by peritoneum except for the bare area (related to diaphragm posteriorly)

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5
Q

Where should the liver not be palpable?

A

below the costal margin

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6
Q

What is the liver surrounded by deep it its peritoneum?

A

the liver is completely surrounded by the Glisson’s capsule that is a thin connective tissue layer sending extensions into the organ in-between the lobules

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7
Q

What two sources does the lvier receieve blood from?

A
  • Hepatic portal vein: Brings absorbed nutrients and drains venous blood of stomach, small intestine, part of large intestine, pancreas and spleen
  • Hepatic artery proper: Supplies the hepatocytes with oxygen
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8
Q

How is bile drained from the liver?

A

drained via canaliculi that lie between the hepatocytes into bile ductules & eventually into bile ducts

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9
Q

What is the venous drainage of the liver?

A

Venous drainage is by hepatic veins that enter the inferior vena cava

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10
Q

What are the four main functions of the liver?

A
  • Synthesis & secretion of bile
  • Storage of glucose, glycogen, proteins, vitamins and fats
  • Detoxification of metabolic waste
  • Synthesis of blood clotting & anticoagulant factors (fibrinogen & prothrombin)
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11
Q

Describe the processes involved in the synthesis and secretion of bile

A
  • Constituents of bile: bile pigments (chiefly bilirubin), cholesterol, phospholipids (lecithin), fatty acids, water & electrolytes
  • Bile pigments are derived as the breakdown products of haemoglobin
  • Kupffer cells (fixed phagocytes) play a role in the formation of bile pigments
  • Bile salts are responsible for the detergent & emulsifying effect of bile on fats
  • Bile salts also increase the absorption of fats by the small intestine
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12
Q

What is a hepatic lobule?

A

smallesr functional unit of the liver

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13
Q

Where does blood from the hepatic artery proper and portal vein pass into?

A

sinusoids and flow into the central vein

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14
Q

Where do sinusoids lie?

A

between sheets of hepatocytes

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15
Q

What is the function of hepatocytes?

A

produce bile and detoxify blood

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16
Q

How does bile flow in the liver?

A

lows in the canaliculi between the hepatocytes towards biliary ducts

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17
Q

What are the 2 main surfaces of the liver

A

diaphragmatic and visceral surfaces

  • bare area on the diaphragmatic surface
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18
Q

What are the 4 lobes of the liver?

A
  • right
  • left
  • caudate
  • quadrate
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19
Q

What lobe are the quadrate and caudate lobes connected to?

A

From a functional/vascular distribution point of view the caudate & quadrate lobes are part of the left lobe

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20
Q
A

red = caudate

blue = quadrate

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21
Q

What are ligaments of the liver?

A

reflections of the peritoneum

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22
Q

What is the falciform ligament a remnant of?

A

ventral mesentery

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23
Q

What is the function of the falciform ligament?

A

anchors the liver to the anterior abdominal wall

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24
Q

Where does ligamentum teres lie?

A

in the free border of the falciform ligament (inferior border)

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25
What happens the falciform ligament superiorly?
the two peritoneal layers are continuous with coronary (anterior and posterior) and triangular ligaments (left and right) on the undersurface of the diaphragm
26
red = falciform ligament blue = ligamentum teres
27
green = coronary ligaments purple = triangular ligaments
28
What is ligamentum teres (round ligament of liver) a remnant of?
obliterated umbilical vein
29
What is ligamentum venosum a remnant of?
oblierated ductus venosus
30
blue = ligamentum teres green = ligamentum venosum
31
What is the liver divided into?
8 functionall independent segments R = 4 L = 4
32
What does each segment of the liver have?
its own vascular inflow, vascular outflow and biliary drainage
33
Describe the arterial supply into the liver
The hepatic artery proper, a branch of the celiac trunk, divides into right & left hepatic arteries that enter the porta hepatis
34
How and where does the portal vein divide?
divides into right & left branches that enter the porta hepatis behind the arteries
35
Where do the hepatic veins emerge?
hepatic veins (three or more) emerge from the posterior surface of the liver & drain into the inferior vena cava
36
Describe the lymphatic drainage of the liver
follows the arteries * The liver produces a large amount of lymph (about 1/3 to 1/2 of all body lymph) * The lymph vessels leave the liver & enter several lymph nodes in the porta hepatis * The efferent vessels pass to the celiac nodes from hepatic nodes * A few vessels pass from the bare area of the liver through the diaphragm to the posterior mediastinal lymph nodes * Retrograde tumour spread from the celiac nodes may involve the hepatic nodes in the porta hepatis & obstruct the bile ducts causing jaundice
37
Describe the nerve supply of the liver
* Sympathetic nerves form the celiac plexus (from foregut therefore greater splanchnic nerve, T5-T9) * The anterior vagal trunk gives rise to a large parasympathetic hepatic branch that passes directly to the liver
38
What is the gallbladder?
Muscular sac in a shallow depression on the visceral surface of the right lobe of the liver
39
What is the function of the gallbladder?
stores and concentrates bile produced by the liver (non-essential functions)
40
What are the three components of the gallbladder?
Fundus, body and neck
41
Where is the fundus of the gallbladder located?
Fundus of the gall bladder is located at Murphy’s point where the right midclavicular line crosses the costal margin − Tip of the right 9th costal cartilage − Linea semilunaris crosses the right costal margin
42
What does positive Murphy's sign suggest?
acute cholecystitis (5F/6F disease)
43
What is the blood supply of the gallbladder
* Cystic artery (branch of right hepatic artery) − High variation * Cystic vein drains directly into the portal vein
44
What is the lymph drainage of the gallbladder?
* a cystic lymph situated near the gallbladder neck * lymph passes to the hepatic nodes along the course of the hepatic artery proper and then into the coeliac nodes
45
Describe the nerve supply of the gallbladder
* sympathetics = T5-9 * Parasympathetics = vagal fibres from coeliacl plexus
46
How long is the cystic duct?
~4cm long
47
What are the spiral folds of the mucous membrane of the cystic duct and neck of gall bladder known as ?
spiral valves (of Heister)
48
What does the cystic duct join and form?
joins with the common hepatic duct (derived from right & left hepatic ducts) and forms the common bile duct (Ductus choledochus)
49
Describe the common bile duct
* 4-6 mm diameter * Runs in hepatoduodenal ligament (portal triad)
50
What does the common bile duct join with?
joins with the main pancreatic duct at the hepatopancreatic ampulla (of Vater) before entering into the 2nd (descending) part of the duodenum at major duodenal papilla
51
What sphincter is in the final part of the common bile duct?
Sphincter of Oddi
52
53
Where is pain from the gallbladder usually referred to?
referred to the epigastrium (T7-T9). But if the adjacent peritoneum is involved, pain may be referred to the right shoulder by the phrenic nerve (C3, 4, 5, supraclavicular nerve)
54
Where is the pancreas located within the peritoneum?
secondarily retroperitoneal
55
Where is the pancreas located?
Lies across the epigastrium close to major blood vessels Extended from the duodenum to the hilum of the spleen
56
What are the 4 main components of the pancreas and where is each located?
Head, neck, body, tail & uncinate process * The head lies in duodenal arch * Uncinate process extends posterior to the superior mesenteric vessels
57
Where does the main pancreatic duct begin anf what does it join?
* The main pancreatic duct begins in the tail of the pancreas * Joins the common bile duct at the hepatopancreatic ampulla (of Vater)
58
What could occur as a result of carcinoma in the head of the pancreas?
may obstruct the common bile duct causing painless jaundice
59
What is the main arterial supply of the pancreas?
* Coeliac trunk ⇒ common hepatic artery ⇒ gastroduodenal artery ⇒ superior pancreatico-duodenal aa. * Coeliac trunk ⇒ Splenic artery ⇒ dorsal and greater pancreatic arteries * Superior mesenteric artery ⇒ inferior pancreatico-duodenal aa.
60
What is the venous drainage of the pancreas?
Veins mirror the arteries and eventually drain into the hepatic portal vein
61
What is the lymph drainage of the pancreas?
* Lymph nodes are situated along the arteries that supply the pancreas * Efferent lymph vessels drain into the celiac & superior mesenteric lymph nodes
62
What is the nerve supply of the pancreas?
Sympathetics comes from T7-9 along the arteries & parasympathetics from vagus
63
Where is the transpyloric plane
* Midway between the suprasternal/jugular notch & the superior border of the pubic symphysis * Corresponds to a plane that is midway between the xiphisternal joint & the umbilicus * Intersects with L1 vertebra and the costal margin of the 9th costal cartilage
64
What is located at the cross-section called the trans-pyloric plane?
* Fundus of gallbladder * Pylorus of stomach * Neck of pancreas * 1st (superior) part of duodenum * Hilum of kidney (right lower than left) * Duodenojejunal flexure * Termination of spinal cord at L1/2 * Origin of superior mesenteric artery * Formation of portal vein

MD3002 - GI Anatomy (11 decks)

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