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20 Cards in this Set
- Front
- Back
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describe the liver and its location
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-largest internal organ, largest gland, extends to left mid-clavicular line, in contact with diaphragm at 4th intercostal space
-venous drainage from digestive tract through liver, metabolizes (detoxifies), stores glycogen and produces bile -visceral surface faces posteroinferiorly; everywhere except where liver contacts diaphragm, in teh bed of teh gallbladder and at porta hepatic -falciform ligament partitions right and left subphrenic spaces -porta hepatis is hilum of liver, with branches of hepatic art, portal vein, hepatic ducts, nerves and lympathic vessels |
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describe the fetal veins in the porta hepatis
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-ligamentum teres hepatis- round ligament of liver, in free margin of falciform ligament, obliterated umbilical vein
-ligamentum venosum- obliterated ductus venosus which was a shunt from umbilical vein past liver to IVC; ligament is between caudate and left lobes -ligaments retain connections to left branch of portal vein |
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describe peritoneal ligaments of liver
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-lesser omentum attaches lesser curvature of stomach and first part of duodenum to visceral surface of liver
-hepatogastric lig inserts into fissure for ligamentum venous -hepatoduodenal attaches in porta hepatis -directly post to hepatoduodenal is epiploic foramen -falciform ligament is peritoneal reflection from ant abdominal wall and diaphragm to diaphragmatic surface of liver -coronary ligament- right, surrounds bare area with superior leaf reflecting from diaphragm to superior surface of liver; inferior leaf is superior limit of hepatorenal recess (pouch of Morison) and reflects from inferior surface of liver onto diaphragm and right kidney -on posterior surface of liver, left triangular- to left falciform ligament; right is joining of superior and inferior leaves of coronary ligament |
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describe the lobes of the liver
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-left, right, quadrate and posterior to lesser omentum, caudate (superior to quadrate, named for tail like process)
H on right line from gallbladder to IVC, left through fissure for ligamentum teres and venous, crossbar of H through port hepatis -principal plane through gallbladder and caudate lobe divides liver into 2 functional lobes --right consists of right anatomical lobe and right side of caudate; left left anatomical lobe, quadrate and left side of caudate lobe --each supplied by separate branches of hepatic artery and portal vein and release bile into corresponding hepatic ducts |
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describe the 8 functional segments of the liver
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-each receives portal triad- hepatic art, bile duct, and portal vein
-right functional lobe is divided by intersegmental plane that closely follows right hepatic vein -principal plane at middle hepatic vein -falciform lig adn lig venosum separates anatomical left lobe at left hepatic vein -transverse plane at horizontal portal branches -3 intersegmental hepatic veins carry blood from liver directly to IVC --right hepatic vein between ant and post segments --middle vein between right and left lobes --left vein between medial and lateral seg 1 caudate; 2 and 3 are left lobe, lateral; 4 quadrate, medial; 5 and 8 anterior; 6 and 7 posterior |
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describe the gall bladder location and function
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-fundus between right border of rectus abdominis and right costal margin; contacts visceral surface of liver (no peritoneum between)
-neck continuous with cystic duct -near midclavicular line at 9th costal cartilage -bile storage and concentration by water absorption -pain in URQ- gall stones?- accretions of bile salts in gallbaldder or related ducts -bile passes down let and right hepatic ducts and into common bile duct to second part of duodenum- if closed, bile passes back up the duct to be stored and concentrated in gallbladder |
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describe various gallstones and pathlogies
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-gallstones from inflamed gallbladder pass through abnormal openings (fistulas) into duodenum or colon
--duodenum- cholecystenteric fistulas --large gallstone may become impacted at ileocecal valve due to restricted space called gallstone ileus |
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describe the blood supply to liver and gallbladder
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-to liver- common hepatic artery and one of 3 branches of celiac artery passing to right, near upper quadrant
-common hepatic artery gives proper hepatic which at porta hepatis gives right and left hepatic artery to 2 functional lobes of liver; right hepatic gives cystic artery to gall bladder -common hepatic also gives gastroduodenal -note variations in blood supply- 18% left hepatic gives left gastric (usually from celiac art); 14% right hepatic art comes from SMA instead of proper hepatic, passing post to portal vein and may completely replace right hepatic or be accessory artery |
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describe the cystic triangle
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-cystic triangle of calot
-in most cases, cystic artery arises from right hepatic in cystic triangle of calot -triangle is bordered superiorly by liver, on right by cystic duct and left by common hepatic duct -24% of cases outside duct- 13 cystic artery from right hepatic and passes anterior to common hepatic duct |
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describe the pancreas
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-in posterior abdominal wall at L1-L2
-curve of duodenum surrounds head -crosses vertebral column so sudden, forceful impact to abdomen can fracture it against vertebral bodies -omental bursa (lesser sac) lies between pancreas and stomach -transverse mesocolon attached on ant surface of pancreas -most retroperitoneal except tail in splenorenal ligament -uncinate process is a lower extension of head -body of pancreas is ant to abdominal aorta, left kidney at level of hilum, and lower half of left adrenal |
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describe path of SM artery and veins
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-SMA passes ant to left renal vein, uncinate process of pancreas and third part of duodenum; passes posterior to neck of pancreas
-SMV passes ant to third part of duodenum, uncinate process and joins splenic vein post to neck of pancreas to form portal vein |
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describe the gland features of the pancreas
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-exocrine- secretion of enzymes (tyrosine and chymotrypsin) for digestion of carbs, proteins and lipids carried to second part of duodenum by major or minor pancreatic ducts
--major duct begins in tail (of Wirsung) with smaller ducts joining it along body, neck and head- ampulla of vater (union of pancreatic duct and common bile duct), greater duodenal papilla --minor duct connects to major duct in neck -endocrine- secretion of hormones insulin and glucagon into circulatory system from islets of langerhans |
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describe the bile duct system
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-bile from right or left liver lobes to right or left hepatic ducts
-join common hepatic duct at porta hepatic -cystic duct joins common hepatic duct to form common bile duct which passes posterior to first part of duodenum and into head of pancreas -joined by major pancreatic duct to form a short channel, the hepatopancreatic ampulla (ampulla of Vater) which empties into posteromedial wall of second part of duodenum (controlled by sphincter of oddi); minor pancreatic duct has opening at minor duodenal papilla 2 cm superior to major papilla -cholecystokinin promotes gallbladder contraction and release of bile into duodenum |
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describe obstructive jaundice
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-because common bile duct passes posterior to and also within head of pancreas, cancer in pancreatic head can obstruct flow of bile to duodenum
-gallbladder will become greatly distended and pt will present with jaundice -because no bile enters GI tract, stools will lose their normal color |
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describe arterial supply of pancreas
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-splenic art from celiac trunk in tortuous course along superior border of pancreas
-gastroduodenal from common hepatic art descends post to 1st part of duodenum and divides into right gastroepiploic and superior pancreaticoduodenal art supplying head and neck of pancreas -SMA gives inferior pancreaticoduodenal art supplying uncinate process, head and neck -note gastroduodenal gives ant and post superior pancreaticoduodenal art which anastomoses with inferior pancreaticoduodenal art- arches supply head of pancreas and duodenum |
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describe venous drainage of pancreas
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-venous drainage to splenic vein (inf to splenic art)
-IMV drains to splenic vein left of duodenojejunal junction -post to neck of pancreas, splenic v joins SMV to form portal vein |
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describe spleen
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-mobile, ovoid lymphatic organ also responsible for removal of wornout RBCs
-intraperitoneal -almost completely surrounded by peritoneum except at hilum where splenic art and vein enter and leave -protected by ribs 9-11, located adjacent to left costodiaphragmatic recess -superior/ant borders are notched -phrenicocolic lig from posterolateral abdominal wall to left colic flexure supports spleen ("on colon") -splenorenal lig form post abodom wall to kidney contains tail of pancreas with splenic art and vein -gastrosplenic lig- from upper part of greater curvature of stomach contains short gastric branches from splenic vessels to stomach -splenic ligaments are left boundary of omental bursa |
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describe the blood supply of the spleen
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-splenic art passing along superior edge of pancreas
-splenic vein passes parallel and inf to art on posterior side of pancreas to join SMV; IMV joins splenic vein |
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describe spleen disorders
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-splenic rupture on thin splenic capsule can cause profuse bleeding in peritoneal cavity leading to shock. splenectomy is emergency response with no serious side effects usually and other organs take up immune functions
-splenic enlargement (splenomegaly)- can result from diseases of reticuloendothelial system (leukemia, lymphoma, certain types of infections) causing lymphadenopathy- spleen is palpable |
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describe lymphatic drainage of liver, spleen and pancreas
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-liver follows blood supply to hepatic nodes in porta hepatis which drain to celiac nodes; some passes through diaphragm to post mediastinal nodes in thorax
-lymph drainage of pancreas and spleen follows splenic art to celiac nodes, superior pancreaticoduodenal art to celiac nodes or inf pancreaticoduodenal art to superior mesenteric nodes |
