2: Anatomy Of Git, Liver, Pancreas

Front 1

Development of the liver

Back 1

- grows in ventral mesogastrium: dividing ventral mesogastrium into 2 parts

Front 2

Ligaments of the liver [5]

Back 2

1. Bare area (not covered by peritoneum)

2. Coronary ligaments → R&L triangular ligament
- to diaphragm

3. falciform ligament: between ant. abd. wall + liver
+ free margin: (ligamentum teres~ant, inf) which contains fetal umbilical vein

4. Ligamentum venosum: Post, sup
- cut deep groove at base of LO
- remnant of ductus venosus: channel blood in umbilical vein + portal vein directly into IVC
- bypass hepatic circulation

5. Lesser omentum: between liver + foregut
w. common bile duct, proper hepatic a. + portal vein in its free margin

Front 3

describe the Porta hepatis [3]
- what is it in the 'capital-H', and what forms the right limb, left limb and what lobe lies above + below it?

Back 3

- lies in ant. wall of epiploic foramen
- gateway to liver via hepatoduodenal ligament on lesser omentum
- for structure leading in/out of liver: bile duct (right), hepatic artery (left), portal vein (post)

Cross-stroke of capital-H
- right limb = right sagittal fissure (by GB + IVC)
- left limb = left sagittal fissure (by groove for ligamentum venosum + ligamentum teres_
- caudate lobe above cross stroke, in lesser sac
- quadrate lobe: below cross stroke, in greater sac

Front 4

Anatomical division (lobes) of liver?
- divided by [2]
- divided into [2] + [1]
- features of right lobe [3]

Back 4

Liver divided by:
- ant: falciform ligament
- post: groove for ligamentum teres + ligamentum venosum

Lobes:
- Lt: small, to left of falciform + ligamentum grooves
- Rt: LARGE, to rt of falciform + ligamentum grooves + caudate + quadrate lobe
*functional/surgical division → lt/rt LIVER,
8 segment with independent portal vein drainage and hepatic arterial supply

Right lobe:
*Quadrate: visceral surface between porta hepatis, GB + ligamentum teres [ant, inf]
*Caudate: visceral surface between portal hepatis, IVC, LO/ligamentum venosum [post, sup]
*Caudate process: connect caudate to rest of rt lobe

Front 5

Blood supply of liver [3]

Back 5

- portal vein: supplies 2/3, deoxygenated
- hepatic artery (coeliac trunk): supplies 1/3, oxygenated
- central veins → hepatic vein → IVC (semi-surrounded by liver tissue)

Front 6

BIliary system
1. [3 steps]
2. [2 step]
3. [3 parts]

Back 6

1. Liver: bile canaliculi → R/L hepatic duct → common hepatic duct

2. Gall bladder: cystic duct + common hepatic duct → common bile duct

3. Common bile duct:
- upper 1/3: free edge of LO, on right side of proper hepatic artery (Both proper hepatic a. + upper 1/3 of CBD anterior to portal vein)
- middle 1/3: behind D1
- lower 1/3: joined by main pancreatic duct → ampulla of Vater (dilatation in hepatopancreatic duct)→ posteromedial wall of D2 (@ major duodenal papilla)

Front 7

effect of gallstone [4]

Back 7

1. stay in GB: no symptom or irritate GB wall

2. In cystic duct
- block duct: upper abd pain, nausea, vomit, heartburn, back pain. GB can become infected

3. Common bile duct: obstructive jaundice

4. Hepatopancreatic duct: obstructive jaundice + pancreatitis!

Front 8

Describe GB
- location [1]
- parts [1] + anatomical position [4]

Back 8

- under-surface of rt lobe

Fundus: beyond sharp ant. margin of liver
- touch parietal peritoneum of AA wall,
- tip of 9th CC,
- transpyloric plane.
- Lateral border of rectus abdominis

Front 9

blood supply of GB [1]
- also alternatives [3]

Back 9

1. cystic artery
- usually from right hepatic artery (75%)
- crosses cysteohepatic triangle of Calot [formed by cystic duct, common hepatic duct, visceral surface of liver]

- also:
proximal rt. hepatic artery,
proper hepatic artery,
gastroduodenal artery

Front 10

imaging of the biliary system [2]

what can u identify in ercp? [6]

Back 10

- USG
- ERCP (endoscopic retrograde cholangiopancreatography)

FIlling defect can imply gallstones
- hepatopancreatic duct
- main pancreatic duct
- common bile duct
- cystic duct, gall-bladder
- common hepatic duct
- L/R hepatic duct