Liver, Pancreas and Biliary System Flashcards
(52 cards)
Liver embryology
develops from foregut
Functions of the liver
Metabolism of glucose: glycogenesis, glycogenolysis, gluconeogenesis
Metabolism of lipids: production of free fatty acids, synthesis of cholesterol
Metabolism of protein: breakdown of ammonia, synthesis of clotting factors and ammonia
Vitamins: activation of vitamin D, storage fo ADEK adn B12
Detoxification of drugs, toxins and hormones
Haematopoeisis in children
Surfaces of the liver
3 borders, 2 surfaces
Superior inferior and anterior surfaces
diaphragmatic surface
- subphrenic and heaptorenal pouches
visceral surface
- posterio-inferiour
- stomach, duodenum, gallbladder, kidney, colon
H on visceral surface liver
anterior rightgallbladder fossa, anterior left ligamentum teres
posterior right IVC bed, posterior left ligamentum venosum
horizontal porta hepatis
orientation portal triad
P and LARD
portal vein posterior
left artery
right duct
falciform ligament
Attaches liver to anteiror abdominal wall
seperates liver into rightand left anatomical lobes
anteiror and posterior coronary liagments
refelections of peritoneum from diaphragmatic surface
right and left triangular ligaments
enxtensions of the coronary ligaments to delineate the bare area
ligamentum teres
fetal remanant of left umbilcal vein
ligamentum venosum
fetal remnant of ductus arteriosus
hepatoduodenal ligament
free edge of lesser ommentum
runs between liver and duodenum
contains common epatic artery, portal vein, common heptaic duct
bare area
only part of the liver not covered by visceral peritoneum
on diaphragmatic surface
anatomical lobes liver
right and left, divided by falciform
ligamentum venosum and teres define caudate and quadrate lobes
caudate - venosum and ivc
quadrate teres and gb fossa
functional lobes live
vertical live between ivc and gb fossa
8 segments according to branches of portal vein and hepatic arteries
blood supply and venous drainage liver
portal vein supplies 70%
- union of smv and splenic vein and pancreatic nec, transpyloric plane
left and right hepatic arteries supply the rest. originate from coeliac artery via common hepatic
drains via 3 hepatic veins directly into IVC just bwelow the level of the diaphragm
portosystemic shunts
oeophageal and left gastric
superior rectal and middle/inferior rectsl
(The superior rectal vein empties into the inferior mesenteric vein and then into the portal system. The middle and inferior rectal veins empty into the internal iliac vein and the inferior vena cava)
paraumbilical and epigastric
(Superior epigastric veins drain to the internal thoracic vein, inferior epigastric vein to external iliac vein)
retroperitoneal splenic branches and pancreatic veins with left renal vein
function of the gallbladder
receive concentrate, store, seceret bile into duodenum
secretion of bile primarily controlled by CCK being released in respinse to fat in duodenum
pringle maneuver
portal triad compressed as it runs in the epiploic foramen
anatomy gallbladder
10cm long adherent to visceral surface of liver
fundus, body, neck
hartmanns pouch
pathological dilatation just proximal to gallbladder neck
Rouviere’s sulcus
Rouviere’s sulcus is a 2-5 cm fissure on the liver between the right lobe and caudate process. The benefit of finding the Rouviere’s sulcus during laparoscopic cholecystectomy is supported by the fact that the cystic duct and artery lay anterosuperior to the sulcus, and the common bile duct (CBD) lays below the level of the Rouviere’s sulcus.
blood supply gallbladder
cystic artery (branch of right hepatic)
some branches of hepatic artery via fossa
no cystic vein - drainage happens through the bed
gallstone complications
biliary colic, cholecystitis, obstructive jaundice, pancreatitis, cholagitis, gallstone ileus
calot’s triangle
contains the cystic artery
superior - liver
infereior - cystic duct
medial - common hepatic duct
