How is the liver attached to the diaphragm?
Coronary and falciform ligaments. Coronary ligaments have two extensions that form the right and left triangular ligaments.
What is the "bare area" of the liver? Blood supply of the liver?
On its diaphragmatic surface, limited by layers of coronary ligaments (devoid of peritoneum), is the "bare area". Oxygenated blood from hepatic artery and drains in the hepatic veins into IVC. Also receives nutrient-rich, deoxygenated blood from protal vein.
Divisions of the right lobe of the liver?
Anterior and posterior segments, each is divided into superior and inferior segments.
Divisons of the left lobe of the liver? Which is the caudate and quadrate lobe?
Medial and lateral segments, each is divided into superior and inferior segments. Includes: Medial superior (caudate lobe), medial inferior (quadrate lobe)
Blood and bile supply/drainage to the quadrate and caudate lobe?
1. Caudate lobe: Blood from right and left hepatic arteries and drains bile into both right and left hepatic ducts.
2. Quadrate lobe: Blood from the left hepatic artery and drains bile into the left hepatic duct.
Which fissures and ligaments, except porta hepatis, can we find in the liver? Location?
1. Fissure for the round ligament of the liver (ligamentum teres hepatis) between lateral portion of left lobe and quadrate lobe.
2. Fissure for the ligamentum venosum between caudate lobe and the lateral portion of the left lobe.
3. Fossa for the gallbladder between the quadrate lobe and the major part of right lobe
4. Fissure for the IVC between caudate lobe and the major part of right lobe
What is the porta hepatis?
Transverse fissure on the visceral surface of the liver between quadrate and caudate lobes. Lodges:
1. Hepatic ducts
2. Hepatic arteries
3. Branches of the portal vein
4. Hepatic nerves
5. Lympahtic vessels
Where is the gallbladder located? Also in relation to the liver and other viscera? Volume?
1. Junction between right ninth costal cartilage and lateral border of rectus abdominis
2. Inferior surface of the liver, in a fossa between the right and quadrate lobes, with a capacity around 30-50 mL. In contact with duodenum and transverse colon.
What do we divide the gallbladder into? Location?
1. Fundus: rounded blind end at the tip of the right ninth costal cartilage in contact with transverse colon in the midclavicular line
2. Body: major part, rests on the upper part of duodenum and transverse colon
3. Neck: narrow part and gives rise to the cystic duct with spiral valves
Function of gallbladder? Stimulation of contraction? What is Hartmann's pouch?
1. Receives bile and concentrates it (by absorbing water and salts)
2. Contracts to expel the bile as a result of stimulation by the hormone cholecystokinin (produced by duodenal mucosa or by parasymphatetic stimulation)
3. Hartmann's pouch is a abnormal conical pouch in its neck. It is also called ampulla of the gallbladder
Where is the pancreas? Intra or extraperitoneal?
1. Largerly in the floor of the lesser sac in the epigastric and left hypochondriac regions (it forms a major portion of the stomach bed).
2. It is mainly retroperitoneal except for its tail, which lies in the splenorenal ligament
Where is the head of the pancreas? Clinical correlate? Where is the uncinate process?
1. Lies within the C-shaped concavity of the duodenum. If tumors are present, bile-flow is obstructed, resulting in jaundice.
2. Uncinate process is a projection of the lower part of the head to the left side behind the superior mesenteric vessels
Blood supply to the pancreas?
1. Branches from splenic artery
2. Superior and inferior pancreaticoduodenal aa.
Where is the ducts of the pancreas? Other names?
1. Main pancreatic duct (Duct of Wirsung) begins in the tail and runs to the right along the entire pancreas. Joins the bile duct to form hepatopancreatic ampulla (ampulla of Vater) before entering the second part of the duodenum at the greater papillae.
2. Accessory pancreatic duct (Santorini's duct) begins in the lower portion of the head and drains a small portion of the head and body. Empties at the lesser duodenal papilla approx. 2cm above the greater papilla.
Name the passage of the bile duct system:
1. Right and left hepatic ducts (receives from intrahepatic ductules)
2. Common hepatic duct
4. Common bile duct (cystic duct fuse with common hepatic)
5. Hepatopancreatic duct or ampulla
What accompanies the common hepatic duct? How does bile enter the gallbladder?
Proper hepatic artery and portal vein accompany the common hepatic duct. The cystic duct has spiral folds (valves) which keeps it constantly open, thus, bile can pass up and into the gallbladder if the common bile duct is closed.
Where is the common bile duct?
Lateral to the proper hepatic artery and anterior to the portal vein in the right free margin of the lesser omentum. It descends behind the first part of the duodenum and runs through the head of the pancreas.
What is the sphincter of Oddi?
Circular muscle layer in the hepatopancreatic duct close to the greater duodenal papilla.
What is the spleen? Where is it? Intra or extraperitoneal? Ligaments?
1. Large vascular lymphatic organ
2. Lying against the diaphragm and ribs 9-11 in the left hypochondriac region.
It is covered by peritoneum except at the hilum (supported by the splenogastric and splenorenal ligaments)
What is the spleen composed of? Function?
1. White pulp: Primarily lymphatic tissue around the central arteries and is the primary site of immune and phagocytic action.
2. Red pulp: Consists of venous sinusoids and splenic cords and is the primary site of filtration