What are the adjacent structures related to the bare area of the liver?
- right kidney - right suprarenal gland - diaphragm - IVC
Name the 4 portal systemic anastomoses
1. esophophogeal vv. draining into azygos vein (systemic) or left gastric (portal) 2. rectal vv. between the inferior and middle vv. draining into the IVC (systemic) and the superior rectal v. (continues as superior mesentaric v.) (portal) 3. paraumbilical vv. of anterior abdominal wall (portal) anastomsing with superficial epigastric vv. (systemic) 4. colic vv. (portal) with retroperiotoneal vv. (systemic)
What may develop during portal hypertension when the paraumbilical anastomoses are dilated?
- caput medusae (varicose veins radiating outward from the umbilicus)
What may develop during portal hypertension when the esophageal anastmoses are dilated?
- esophageal varices (dilated submucosal vv. in the lower third of the esophagus) - patients have a strong tendency to develop bleeding which is often severe and may be fatal
What are the common causes of portal hypertension?
- cirrhosis due to:
- alcohol abuse - hepatitis
Is the pancreas an exocrine gland or an endocrine gland?
What are the functions of the pancreas?
- Exocrine: secrete digestive juices (pancreatic juice) into the duodenum through the major duodenal papilla (main pancreatic duct) or minor duodenal papilla (accessory pancreatic duct)
- Endocrine: release of hormones directly into the bloodstream (insulin) (glucagon) for regulation of blood glucose
What is the eponym for the main pancreatic duct? Accesory pancreatic duct?
- duct of Wirsung
- duct of Santorini
Is the pancreas intraperitoneal or retroperitoneal?
- head, neck and body of pancreas are secondarily retroperitoneal - tail of pancreas is intraperitoneal
Within what ligament is the tail of pancreas located?
- splenorenal (lienorenal) ligament
How many sphincters are located in the area of the hepatopancreatic ampulla? What are there functions?
- sphincter of pancreatic duct (prevents reflux of bile into pancreatic duct) - sphincter of bile duct (controls flow of bile) - sphincter of hepatopancreatic ampulla (prevents contents of duodenum from entering the the ampulla)
What is the eponym for the hepatopancreatic sphincter?
- sphincter of Oddi
Is the spleen intraperitoneal or retroperitoneal?
Where is the spleen not surrounded by peritoneum?
- its hilum
What ribs are associated with the spleen?
- left ribs 9 to 11
Is damage of the spleen life-threatening? Can a person live without the spleen?
- yes to both
- damage to the spleen usually results in massive bleeding which can be fatal if left untreated - if spleen cannot be repaired it can be safely removed without extreme issue to the patient
What are the consequences of a splenectomy to the patient?
- increased vulnerability to certain diseases such as pneumonia, meningitis, and malaria