The Liver, Gallbladder, Duodenum And Pancreas Flashcards
(149 cards)
1
Q
Where does the liver lie in abdominal regions
A
Right upper quadrant and epigastrium of abdomen
2
Q
Position of liver
A
Right side of body under diaphragm
Protected by the ribs
Moves inferiority with inspiration
3
Q
What transports products of digestion , except lipids, to liver from the gut
A
Hepatic portal vein
4
Q
Which product of digestion doesn’t go to the liver
A
Lipids
5
Q
Where is bile produced
A
Liver
6
Q
Where is bile stored
A
Gallbladder
7
Q
Function of bile
A
Emulsifies lipid in the chyme entering the duodenum from the stomach
8
Q
2 surfaces of liver
A
Diaphragmatic surface- lies anterosuperiorly
Visceral surface- lies posteroinferiorly
9
Q
What regions of the liver are not covered by visceral peritoneum
A
Bare area of the liver
Region where the gallbladder lies in contact with the liver
Region of porta hepatis
10
Q
Bare area of the liver
A
Region on posterior surface that lies in contact with diaphragm
No visceral peritoneum
11
Q
Region of porta hepatis
A
Where hepatic blood vessels and ducts of the biliary system enter and exit the liver
No visceral peritoneum
12
Q
How many lobes does the liver have
A
2
13
Q
2 lobes of liver
A
Large right lobe
Small left lobe
14
Q
Falciform ligament
A
Separates 2 lobes of liver
Connects anterior surface of the liver to the internal aspect of the anterior abdominal wall
15
Q
What separates the 2 anatomical lobes of the liver
A
Falciform ligament
16
Q
2 accessory lobes of the liver
A
Caudate lobe
Quadrate lobe
17
Q
Where are the accessory lobes located on the liver
A
Posteroinferior surface
18
Q
How many functional segments of the liver are there
A
8
19
Q
How is each segment of the liver functional
A
All served by own branch of hepatic artery, portal vein and hepatic duct
20
Q
What connects the liver and diaphragm
A
Coronary and triangular ligaments
21
Q
What connects the liver and anterior abdominal wall
A
Falciform ligament
22
Q
What connects the liver to the stomach and duodenum
A
Lesser omentum
23
Q
Portal triad
A
Hepatic artery, hepatic portal vein and bile duct run together in free edge of lesser omentum
24
Q
Epiploic Foramen
A
Entrance of the lesser sac
Anterior boundary = portal triad and free edge of lesser omentum
25
What forms the anterior boundary of the epiploic foramen
Portal triad and free edge of lesser omentum
26
2 recesses related to the liver
Hepatorenal recess
Subphrenic recesses
27
Hepatorenal recess
Lies between the right kidney and posterior surface of the right side of the liver
Fluid flows into this space in supine position
28
Left and right subphrenic recesses
Lie either side of falciform ligament, between the anterosuperior surface of the liver and diaphragm
29
What does the liver develop from
Embryological foregut
Grows from a tissue bud that develops in ventral mesentery
As the liver grows and migrates to the right side of the abdomen, its peritoneal attachments are pulled with it. The remains of the ventral mesentery form the lesser omentum and the falciform ligament. The peritoneal attachments of the liver anchor it to surrounding structures, including the diaphragm superior to it.
30
Ligamentum teres
Round ligament of the liver in free edge of falciform ligament
Remnant of umbilical vein
31
Umbilical vein
In the fetus, carries oxygenated blood from placenta to fetus
32
Ligamentum venosum
Lies on posterior surface of liver in groove between caudate lobe and left lobe of liver
Remains of ductus venosus
33
Ductus venosus
In fetal life diverts blood from umbilical vein to the IVC, shunting oxygen-rich blood to heart and bypassing the liver
34
Arterial supply of liver
Right and left hepatic arteries(branches of coeliac trunk)
35
Coeliac trunk —> left and right hepatic arteries
Coeliac trunk:
1. Left gastric
2. Splenic
3, common hepatic arteries
Common hepatic artery—> gastroduodenal artery and hepatic artery proper
Hepatic artery proper —> left and right hepatic arteries
36
3 branches of coeliac trunk
Left gastric artery
Splenic artery
Common hepatic artery
37
Which artery bifurcates to form the left and right hepatic arteries
Hepatic artery proper
38
What branch comes off the common hepatic artery to form the hepatic artery proper
Gastroduodenal artery
39
Venous drainage of liver
Venous blood exits via 2/3 large hepatic veins that lie within the liver
Unite with inferior vena cava as it passes posterior to the liver
40
Hepatic portal vein
Nutrient-rich venous blood that leaves the gut is transported to the liver via the hepatic portal vein
Receives blood from the superior and inferior mesenteric veins and the splenic veins
41
Which veins feed into the hepatic portal vein
Superior mesenteric vein
Inferior mesenteric vein
Splenic vein
42
Hepatic plexus
Parasympathetic fibres from the vagus nerve
Sympathetic fibres
Follows paths of hepatic vessels and ducts of biliary tree
43
Parasympathetic fibres to liver stem from which nerve
Vagus nerve
44
Pain from the liver is felt in which region
Epigastric
45
Function of gallbladder
Stores and concentrates bile
46
Location of gallbladder
Lies on posteroinferior surface of liver
Lies close to duodenum
47
3 parts of gallbladder
Fundus
Body
Neck
48
Body of gallbladder
Forms main part which sits in gallbladder fossa on the visceral surface of the liver
It tapers towards the neck
49
Neck of gallbladder
Shape tapers
Communicates with the cystic duct
50
Fundus of gallbladder
Rounded end of the gallbladder
Typically extends to inferior border of liver
51
Surface marking of Fundus of gallbladder
Tip of 9th costal cartilage at the point where the right midclavicular line intersects the right costal margin
52
Which cells produce bile
Hepatocytes
53
Biliary tree
Bile first excreted into small channels called bile canaliculi which drain into ducts of increasing calibre that converge to form right and left hepatic ducts
54
Common hepatic duct
Left and right hepatic ducts converge
Receives the cystic duct from the gallbladder
55
Common bile duct
Distal to where cystic duct joins common hepatic duct
Runs in free edge of lesser omentum
Descends posterior to superior part of duodenum and head of pancreas
Enters the duodenum
56
Cystic duct
Bile leaving the liver not needed for digestion enters the gallbladder
Or bile flows from gallbladder to common bile duct and duodenum
57
Spiral fold/valve
Lies at junction between the gallbladder neck and cystic duct
58
When does common hepatic duct —-> common bile duct
When cystic duct joins
59
Arterial supply to gallbladder
Cystic artery (branch of right hepatic artery)
60
Venous drainage of gallbladder
Cystic veins that pass directly into liver or join hepatic portal vein
61
Which artery does the cystic artery branch from usually
Right hepatic artery
62
Referred pain and the gallbladder
may also be referred to the right shoulder if gallbladder pathology (e.g. inflammation) irritates the diaphragm. The diaphragm is innervated by the phrenic nerve (C3-5). Spinal cord segments C3-5 also receive somatic sensory information from the skin over the shoulder. Therefore gallbladder pathology involving the diaphragm may be felt in the right shoulder.
63
Visceral afferents to gallbladder
return to the CNS with the sympathetic fibres. Visceral pain from the gallbladder enters spinal cord levels T5 – T9 and is therefore referred to (i.e. felt in) the epigastrium.
64
If gallbladder pathology irritates parietal peritoneum
innervated by somatic nerves, so pain is well localised to the right hypochondrium.
65
Hepatomegaly
Hepatomegaly is enlargement of the liver. Causes include hepatitis (inflammation of the liver from various causes), malignancy, and heart failure. When the liver is enlarged, its inferior border becomes palpable inferior to the right costal margin.
66
Liver metastases
Although primary cancer of the liver does occur, most cancers of the liver are metastases from cancer elsewhere in the body. Because venous blood from the gut passes through the liver, bowel cancers often metastasize to the liver.
67
Cirrhosis of the liver
Cirrhosis is sometimes referred to as ‘scarring’ of the liver. It is caused by chronic excess alcohol consumption, chronic infection with hepatitis B or C, or a build-up of fat in the liver. Hepatocytes are destroyed and replaced with fibrous tissue. The liver becomes shrunken, hard, and nodular. Loss of hepatocytes impairs the function of the liver and liver failure may ultimately result.
68
Portal hypotension and portosystemic anastomoses
Portal hypertension is high blood pressure in the portal venous system. It results when blood flow through the liver and portal vein is obstructed (e.g. in cirrhosis of the liver). Portosystemic anastomoses are communications between veins draining to the systemic circulation and veins draining to the portal circulation. For example, in the distal oesophagus, venous blood drains into both the systemic veins (via the azygos) and into the portal system (via the gastric veins). If flow in the portal system is obstructed, pressure in the portal system increases and blood is diverted from the portal veins into the systemic veins. The systemic veins become distended and varicose (in the oesophagus these are called oesophageal varices) and prone to rupture, which can result in catastrophic bleeding.
69
Portosystemic anastomoses
communications between veins draining to the systemic circulation and veins draining to the portal circulation
70
Gallstones, biliary colic and cholecystitis
Gallstones are common in the UK population. They are mostly composed of cholesterol. They are often asymptomatic but cause symptoms when they migrate into the biliary tree and lodge there. When a gallstone lodges in the cystic duct, contraction of the gallbladder against it causes severe pain termed biliary colic. If the stone moves back into the gallbladder, the pain eases. If it does not, and the stone becomes stuck, it blocks the flow of bile into the cystic duct and the gallbladder becomes inflamed (cholecystitis). Cholecystectomy is removal of the gallbladder. It is usually performed laparoscopically.
71
What are gallstones most commonly composed of
Cholesterol
72
Cholecystectomy
Removal of the gallbladder
Usually performed laparoscopically
73
At what level does the coeliac trunk leave the anterior aspect of he aorta
T12
74
What does the left gastric artery supply
Distal oesophagus
Lesser curvature of stomach
75
What does the common hepatic artery supply
Liver
Stomach
Duodenum
76
What does the splenic artery supply
Stomach
Pancreas
Spleen
77
Duodenum shape
C-shaped that cups the head of the pancreas
Continuous proximally with pylorus if stomach and distally with Jejunum
78
Is the duodenum retroperitoneal or intraperitoneal
Retroperitoneal
79
How many parts is the duodenum described in
4
80
4 parts of duodenum
1. Superior
2. Descending
3. Inferior
4. Ascending
81
What enters the first part (superior) of duodenum posteriorly
Common bile duct
Gastroduodenal artery
Hepatic portal vein
82
Where does the superior mesenteric artery lie in the duodenum
Third part- inferior
83
Duodenojejunal flexure
Where the fourth part (ascending) of the duodenum meets the Jejunum
84
Major duodenal papilla
Halfway along the internal wall of duodenum
Small elevation that marks the point at which bile and digestive pancreatic secretions enter the duodenum
85
Where do bile and digestive pancreatic secretions enter the duodenum
Major duodenal papilla
86
Arterial supply to first half of duodenum
Gastroduodenal artery from the common hepatic artery and do from the Coeliac trunk
87
Arterial supply to the second half of the duodenum
Inferior pancreaticoduodenal arteries from superior mesenteric artery
88
Venous drainage of duodenum
Tributaries of the hepatic portal vein
89
At what level does the pancreas lie
Horizontally on the posterior abdominal wall at L1
90
Is the pancreas Intraperitoneal or retroperitoneal
Retroperitoneal
91
What does the pancreas develop from
Dorsal and ventral pancreatic buds which fuse
92
How many parts of the pancreas are there
4
93
4 parts of pancreas
Head
Neck
Body
Tail
94
Uncinate process
Hook-like projection of the head of the pancreas
95
Where does the pancreas lie
Head is cupped by C-shaped duodenum
Tail extends to hills of spleen
Forms part of posterior wall of lesser sac
96
Splenic artery and pancreas
splenic artery runs towards the spleen embedded in the upper border of the pancreas
97
Splenic vein and pancreas
Lies posterior to pancreas
98
Where are the main pancreatic duct and accessory pancreatic duct
Within the substance of the pancreas
99
Function of the pancreas
Endocrine and exocrine
Synthesis and secretes insulin and glucagon
Produces pancreatic juice that contains digestive enzymes
100
How is pancreatic juice transported from pancreas to duodenum
Through main pancreatic duct and accessory pancreatic duct
101
Hepatopancreatic ampulla
Where the common bile duct and main pancreatic duct merge
Opens into 2nd part of duodenum at major duodenal papilla
Surrounded by smooth muscle (hepatopancreatic sphincter)
102
Hepatopancreatic sphincter/ sphincter of Oddi
Smooth muscle that surrounds the Hepatopancreatic ampulla
103
Where does the Hepatopancreatic ampulla open into the duodenum
Major duodenal papilla
104
Where does the accessory pancreatic duct empty pancreatic juice into the duodenum
Minor duodenal papilla
Proximal to major duodenal papilla
105
Arterial supply to pancreas
Pancreatic arteries derived from the splenic artery
Superior pancreaticoduodenal artery derived from the Gastroduodenal artery
Inferior pancreaticoduodenal arteries derived from the superior mesenteric artery
106
What are the pancreatic arteries derived from
Splenic artery (major branch of coeliac trunk)
107
What are the superior pancreaticoduodenal arteries derived from
Gastroduodenal artery (from common hepatic artery so coeliac trunk)
108
What are the inferior pancreaticoduodenal arteries derived from
Superior mesenteric artery
109
Venous drainage of the pancreas
Splenic vein drains the pancreas and united with the superior mesenteric vein to form the hepatic portal vein posterior to neck of pancreas
110
Duodenal ulcer
Duodenal (peptic) ulcers are most common in the first part of the duodenum. A duodenal ulcer here may erode the duodenal wall and the gastroduodenal artery, which lies posterior to the first part of the duodenum, resulting in severe intra-abdominal bleeding.
111
Pancreatitis
Inflammation of the pancreas may be chronic or acute. Acute pancreatitis is a life-threatening condition. There are many causes, but in the UK, it is most commonly due to excess alcohol intake or impaction of a gallstone at the hepatopancreatic ampulla. In gallstone pancreatitis, impaction of the gallstone prevents pancreatic juice from leaving the pancreas and it starts to break down the pancreas (autolysis). It is extremely painful, typically causing pain that radiates to the back.
112
Pancreatic cancer
Cancer can affect any part of the pancreas and typically causes pain that radiates to the back. When it affects the head of the pancreas, it can obstruct the flow of bile in the bile duct. This leads to an accumulation of bile pigments in the blood and results in jaundice (yellowing of the skin).
113
Diabetes mellitus
Diabetes mellitus results when the insulin-producing cells of the pancreas no longer produce insulin (or produce inadequate amounts). This leads to sustained high blood glucose levels which are detrimental to many tissues of the body and are ultimately fatal if not controlled. Some patients develop diabetes secondary to pancreatitis.
114
Splenomegaly
Enlargement of the spleen is splenomegaly. Causes include infection (e.g. infectious mononucleosis, malaria), haematological malignancy (e.g. leukaemia) and portal hypertension. When the spleen enlarges, it does so towards the midline, in the direction of the right iliac fossa, because the phrenicocolic ligament prevents its direct descent towards the left iliac fossa.
115
In which direction does the spleen enlarge
Towards the midline in the direction of the right iliac fossa
116
Splenic rupture
The spleen is soft and highly vascular and is therefore vulnerable to blunt abdominal trauma or rib fractures that may puncture the spleen. Splenic haemorrhage is life-threatening and is managed by removing the spleen (splenectomy). The spleen is not essential for life, although patients are more prone to some bacterial infections after splenectomy.
117
Arterial supply of the spleen
Splenic artery (branch of coeliac trunk)
118
Venous drainage of the spleen
Splenic vein
119
Which 2 veins form the hepatic portal vein
Splenic vein
Superior mesenteric vein
120
Number of branches of splenic artery
5
121
Where does the splenic artery branch
Hilum of spleen
122
Where does the splenic artery lie
Runs along superior border of pancreas embedded within it
123
Spleen
Haematopoetic and lymphoid organ
124
Function of spleen
Breakdown of red blood cells
Storage of red blood cells and platelets
Various immune response, including production of IgG
125
Which antibodies does the spleen produce
IgG
126
Location of spleen
Left upper quadrant
127
Which ribs protect the spleen
9-11
128
Number of surfaces of spleen
2
129
Number of borders of spleen
4
130
2 surfaces of spleen
Diaphragmatic
Visceral
131
Which viscera does the spleen lie in contact with
Stomach
Left kidney
Colon
132
Where is the hilum on the spleen
Visceral surface
133
4 borders of the spleen
Anterior
Superior
Posterior
Inferior
134
Which borders of the spleen are typically notched
Anterior and superior
135
Which borders of the spleen are smooth
Posterior and inferior
136
Size of spleen
normal sized spleen is not palpable below the costal margin. If it is palpable, it is enlarged by at least three times its normal size.
137
The duodenum receives:
• bile from the liver and gallbladder via the
Common bile duct
138
The duodenum receives:
• pancreatic juice from the pancreas via the
Main and accessory pancreatic ducts
139
What connects gall bladder to common bile duct
Cystic duct
140
Which accessory lobe of the liver is superior
Caudate is superior to quadrate
141
Effects of cholecystectomy (removal of gallbladder)
Commonly no effects as bile still produced by liver and enters duodenum via common bile duct
Just no bile storage
142
Endoscopic retrograde cholangiopancreatography (ERCP)
Diagnose and treat gallstones
143
2 main causes of pancreatitis
Gallstones- block Hepatopancreatic ampulla and so pancreatic duct
Alcohol
144
What is the Ligamentum teres the remnant of
Umbilical vein
145
What separates the left and right lobe of the liver anteriorly
Falciform ligament and liagmentum teres
146
What structures are contained in calot’s triangle
Cystic artery
Cystic lymph node (of Lund)
Lymphatic
Right hepatic artery
147
Which part of the pancreas is Intraperitoneal
Tail
148
Which artery is found in the porta hepatis
Hepatic artery proper
149
Functionally the liver can be split into how many segments
8
