Week 5 - Liver, biliary tree and pancreas anatomy

Question 1

What structures lie posterior to the liver?

Answer 1

• Oesophagus
• Stomach
• Gall bladder
• 1st part of duodenum

Question 2

Descrube the diaphragmatic surface of the liver

Answer 2

-Smooth and convex with a bare area which is not covered by visceral peritoneum

Question 3

Describe the ligaments of the liver

Answer 3

• Falciform -> anterior liver to anterior abdominal wall and contains ligamentum teres
• Coronary ligament -> superior liver to diaphragm
• Triangular ligaments ->outside of coronary ligament and attach superior surface to diaphragm

Question 4

What is ligamentum teres?

Answer 4

-Remnant of umbilical vein

Question 5

Describe the relationship between liver and lesser omentum

Answer 5

-attached to liver via hepatoduodenal and hepatogastric ligaments of lesser omentum

Question 6

how is the liver secured to the IVC?

Answer 6

-Posteriorly by hepatic veins and fibrous tissue

Question 7

What is the name of the capsule of the liver?

Answer 7

-Glisson’s capsule

Question 8

What is a hepatic recess? Name the hepatic recesses and their locations

Answer 8

• Hepatic recesses are spaces between the liver and its surroundings
• Subphrenic -> between diaphragm and liver
• Subhepatic-> between inferior liver and transverse colon
• Morrison’s pouch -> between posterior liver and right kidney

Question 9

Why are hepatic recess of interest?

Answer 9

-Fluids can collect in these spaces

Question 10

Describe the lobes of the liver

Answer 10

• Right and left lobes diveded by falciform
• Caudate lobe on superior posterior right lobe
• Quadrate lobe on inferior posterior right lobe between gall bladder and fossa of ligamentum teres

Question 11

What is the porta hepatis?

Answer 11

• Between caudate and quadrate lobe

- Transmits all vessels, nerves and ducts entering/leaving the liver

Question 12

Describe the arterial supply to the liver

Answer 12

-Hepatic artery proper derived from common hepatic artery of celiac trunk

Question 13

Describe the venous drainage to and from the liver

Answer 13

• Hepatic portal vein supplies the liver with all deoxygenated blood carrying nutrients absorbed from small intestine
• 3 hepatic veins take clean blood to IVC

Question 14

What converges to make portal vein?

Answer 14

• SMA

- Splenic vein

Question 15

State the nerve supply to the liver

Answer 15

• Symp = celiac plexus

- Parasym = vagus

Question 16

Describe splenic rupture

Answer 16

• Often caused by blunt/penetrating trauma or left rib fractures
• Break in fibroelastic capsule causes profuse bleeding

Question 17

What is the function of the gall bladder?

Answer 17

-Store bile

Question 18

Describe the connections of the biliary tree

Answer 18

• Left and right hepatic ducts form common hepatic bile duct from liver which becomes common bile duct after cystic duct joins
• Common bile duct goes into amuplla of varter after pancratic duct joins
• Enters 2nd part of duodenum through major duodenal papilla controlled by sphincter of oddi

Question 19

To what organ is the biliary tree bound?

Answer 19

-Posterior liver

Question 20

What artery supplies the gall bladder and billary tree? From where is it derived?

Answer 20

• Cystic artery

- Hepatic artery proper

Question 21

What is the result of parasympathetic innervation to gall bladder?

Answer 21

-Contraction and secretion

Question 22

Which hormone has a major secretory effect on the gall bladder?

Answer 22

-Cholecystokinin

Question 23

From where is cholecystokinin secreted?

Answer 23

-Duodenum

Question 24

What are the common complications of gallstones?

Answer 24

• Pain
• Jaundice
• Cholecystitis

Question 25

What are the 3 types of gall stones?

Answer 25

- Cholesterol - Pigment - Mixed

Question 26

What are risk factors for gall stones?

Answer 26

- High cholesterol - Increased age - Pregnancy - Obesity

Question 27

In who are gall stones more common?

Answer 27

-Women

Question 28

What is the treatment for gallstones?

Answer 28

- Lifestyle changes | - Cholecystectomy

Question 29

What is the function of the spleen?

Answer 29

-To filter blood and remove old RBCs

Question 30

Where is the spleen?

Answer 30

-Intraperitoneal organ in ULQ behind ribs 9-11

Question 31

Can the spleen be palpated in a healthy patient?

Answer 31

-No

Question 32

What is the exocrine function of the pancreas?

Answer 32

-Secrete digestive enzymes

Question 33

What is the endocrine function of the pancreas?

Answer 33

-Secrete hormones

Question 34

Where is the pancreas?

Answer 34

- Retroperitoneal | - Posterior to stomach with head in duodenum and tail in splenic hilum

Question 35

Where is the unicate process of the pancreas?

Answer 35

-Neck overlying SMA/SMV

Question 36

Describe how the digestive enzymes enter the duodenum

Answer 36

-Acini secrete digestive enzymes into intralobular collecting ducts which join to form the pancreatic duct which unites with common bile duct

Question 37

Name the structures in the porta hepatis

Answer 37

-Hepatic portal vein, common hepatic artery and common bile duct

Question 38

What arteries supply the pancreas?

Answer 38

-superior and inferior pancreaticoduodenal

Question 39

Describe the location of the liver

Answer 39

-Peritoneal organ in RUQ (right hypochondrium to epigastrium)