The Liver and Gallbladder Flashcards
(21 cards)
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Is the caudate lobe independent?
- Caudate lobe is an independent lobe
- Quadrate lobe to be considered part of left lobe
What is the falciforn ligament?
Falciform ligament: Double fold of peritoneum connecting liver to anterior abdominal wall
Divides left lobe into right lobe
Label this posterior liver surface and its impressions
What is the porta hepatis?
Entrance / exit point of portal triad in transverse fissure.
- Common bile duct
- Left and right hepatic duct
- Cystic duct
- Hepatic portal vein (75%)
- Hepatic artery (25%)
What are the ligaments of the liver?
Falciform ligament: Double fold of peritoneum connecting liver to anterior abdominal wall
Round ligament: Remnant of umbilical vein.
Carries oxygenated blood from placenta
Small paraumbilical veins may remain in substance of ligament
Ligamentum venosum: Remnant of ductus venosus
Shuts umbilical blood directly into IV
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Why is there a bare area on the liver?
Bare Area
- No peritoneum on top surface of liver
- Fenced by ant. and post. coronary which meet as the left and right triangular ligament
- Results from massive embryonic growth of liver within ventral mesogastrium
What is found within the hepatoduodenal ligament?
The Portal triad: runs in free edge of lesser omentum
Common bile duct (green)
Proper hepatic artery(red)
Hepatic portal vein (blue)
Vagus nerve, Lymphatics
The arrow marks a possible surgical opening into the lesser sac
Pringles manoeuvre: Haemostat clamps the hepatoduodenal ligament
Stops blood flow through hepatic duodenal artery and portal vein
What are recesses of the liver?
Sites where peritoneal fluid or metastases can localise
Subphrenic space
Hepatorenal pouch/ Pouch of Morrison
Right Subhepatic space
Label and explain this
Describe the dual blood supply of the liver
What do the numbers show?
Blood is directed from the viscera to be processed by the liver
What is portal hypertension
Caused by bstruction in liver:
Prehepatic obstruction e.g. Thrombosis or congenital obliteration of the portal vein, or cancer in head of pancreas
Hepatic obstruction e.g. Cirrhosis
Posthepetic obstruction eg Congenital stenosis in the hepatic veins
Alternative pathways open up between portal and venous systems. Portosystemic anastomoses. e.g. Caput medusa of para-umbilical veins
what are portosystemic anastamoses? Give 3 examples of them
Portosystemic Anastomoses: Collateral circulation between systemic and portal circulation
Peri-umbilical region: Portal via paraumbilical veins
Systemic via epigastric veins
Anal canal: Portal via Inferior mesenteric vein
Systemic via inferior and middle rectal veins
Oesophageal veins: Portal via left gastric vein
Systemic via azygos veins
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Where are gallstone sites of obstruction?
- Hepatopancreatic ampulla
- Cystic duct
- Hartmann’s pouch (infundibulum)
Label the arterial supply to the billiary tree. Green= billiary tree
Variations in the anatomy of the biliary system that may result in errors in gall bladder surgery
What is the triangle of calot?
Hepatobiliary Triangle (of Calot) shown in grey contains:
Fatty connective tissue
Cystic lymph node
Autonomic nerves
Cystic artery
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