Liver, Gallbladder, Pancreas, Spleen

Largest gland in the body

Liver

Liver is intra/retroperitoneal

Intraperitoneal

Does the liver have a role in immunity

Yes, it is a major lymph producing organ

Name the 4 anatomical lobes of the liver

1. Right

2. Left

3. Quadrate

4. Caudate

How many functional lobes of the liver are there

8

What separates out the liver into functional lobes

Divided based on blood supply

Significance of having 8 functional lobes to the liver

Individual sections can be surgically removed without disturbing any other functional lobe

What is the Porta hepatis

This is the “hilum” of the liver where abdominal structures can enter or leave

What blood vessels don’t pass through the porta hepatis

The hepatic veins drain blood away from the liver and when blood is exiting it does not pass through the porta hepatis

Instead the hepatic veins drain posteriorly to the inferior vena cava

Ligamentum venosum is a remnant of what embryological structure

ductus venosus

Round ligament of the liver / Ligamentum teres hepatis is a remnant of what embryological structure

umbilical vein

Round ligament of the liver / Ligamentum teres hepatis is formed from what structure

Thick, free, inferior border of the falciform ligament

What is the bare area of the liver

Diaphragmatic area on the liver not covered in visceral peritoneum

• Liver & diaphragm in direct contact

What does the portal triad consist of

Common bile duct

Hepatic artery proper

Hepatic portal vein

The common hepatic artery is a direct branch from what

the celiac trunk

The common hepatic trunk changes its name to ______ when

Changes name to hepatic artery proper when the gastroduodenal artery branches off

Hepatic artery proper divides at the what to become what

Hepatic artery proper divides at the porta hepatis to become:

▪ Right hepatic artery

▪ Left hepatic artery

The liver receives blood from what two different sources

Arterial → Hepatic arteries (20-25%)

Venous → Hepatic portal vein (75-80%)

The hepatic portal vein carries what where

The hepatic portal vein carries all nutrients (carried in venous blood) from the gastrointestinal tract directly to the liver

Comes mainly from stomach - very high in nutrients

Blood in the hepatic portal vein has a slightly lower/higher oxygen content than the venous blood in the systemic/caval system

Blood in the hepatic portal vein has a slightly higher oxygen content than the venous blood in the systemic/caval system

Hepatic portal vein forms when the following two veins unite

Superior mesenteric vein

Splenic vein

The hepatic veins drain blood from where to where

Away from the liver and back to the systemic system

Name the veins of the liver

The central veins of the liver unite together and drain to form the left, right and middle hepatic veins respectively

What keeps the liver in position

The relationship between the hepatic veins and the inferior vena cava helps to keep the liver in position - the liver doesn’t have much connective tissue

Name the lymph nodes of the liver

Liver: Summary

Arterial Supply:

Venous Drainage:

Lymphatics:

Innervation:

Liver: Summary

Arterial Supply: Celiac trunk

Venous Drainage: Hepatic veins → Inferior vena cava → Systemic (caval) venous system

Lymphatics: Drain by following two routes, either Phrenic or Posterior Mediastinal lymph nodes or Hepatic or Celiac lymph nodes

Innervation: Vagus Nerve & Hepatic nerve plexus (part of the celiac plexus!)

Role of gallbladder

Store & concentrate bile

Emulsification

The breakdown of large fat globules into smaller, uniformly distributed particles prior to being digested by specific enzymes

Role of bile

Bile is a yellow-brown (or green) fluid that aids in the emulsification of fat

Bile is produced & secreted in the liver by ……….

Hepatocytes

What transports bile from the liver and deposit it into the gastrointestinal tract.

Biliary ducts

What part of the GI tract is bile released into

2nd part of the duodenum

Do biliary ducts secrete bile as a constant flow into the GI tract or intermittently

Intermittently when needed

3 parts of gall bladder

Fundus

Body

Neck

arterial supply of gallbladder

Cystic artery from right hepatic artery from common hepatic artery from celiac trunk

(The cystic artery is highly variable, however, it most commonly branches directly from the right hepatic artery)

The cystic artery travels in a significant triangle called

cystohepatic triangle (Triangle of Calot)

Venous drainage of the gallbladder

cystic veins drain blood away from the gallbladder

Where do cystic veins drain to

The gallbladder is in direct contact with what part of the liver

The gallbladder is in direct contact with the visceral (inferior) surface of the liver and is firmly adhered

Most small veins from the body of the gallbladder pass directly into the

hepatic sinusoids that are within the liver

Most veins around the neck of the gallbladder drain into the

hepatic portal vein

Gallbladder: Summary

Arterial supply:

Venous drainage:

Lymphatics:

Innervation:

Gallbladder: Summary

Arterial supply: Celiac trunk

Venous drainage: Direct or via the hepatic portal vein → Portal venous system

Lymphatics: Ultimately drain by following the arteries towards → Celiac lymph nodes

Innervation: Vagus nerve & celiac nerve plexus

The gallbladder receives general somatic afferent (GSA) innervation through what nerve

the right phrenic nerve

What kind of pain is associated with the right phrenic nerve innervating the gallbladder

referred pain

Irritation of what structures lead to pain in each patch

(diaphragm can be felt on either side)

What nerve & nerve roots supply the diaphragm

Phrenic nerve

Name the parts of the pancreas

Where is the head & neck & the uncinate process of the pancreas in relation to the superior mesenteric artery

Head = right of it

Uncinate process = Posterior to it

Body = left of it

Where is the neck of the pancreas in relation to a specific part of the stomach

directly behind the PYLORUS of the stomach

The pancreas is mostly retroperitoneal. What is the intraperitoneal part of the pancreas

The tail

The tail of the pancreas lies within what ligament

lies within the splenorenal ligament

link between the Transpyloric plane and the pancreas

The pancreas (especially its neck) lies along the transpyloric plane.

The body and tail of the pancreas extend slightly above this plane.

The head of the pancreas is positioned slightly below it, nestled within the curve of the duodenum.

What ducts are associated with the pancreas

Which duct joins with the common bile duct

The main pancreatic duct

(Main) Pancreatic Duct unites with the common bile duct opens into the GI tract with the common bile duct via the _________

(Major) duodenal papilla

The Accessory Pancreatic Duct IF present & patent opens into the GI tract via the _______

minor duodenal papilla

What is a Papilla

Defined as a small rounded protuberance on an organ of the body

What is an Ampulla

Dilated end of a vessel named after ancient flasks

Name an ampulla associated with the pancreas

Hepatopancreatic ampulla

What is a Sphincter

Defined as a ring of muscle surrounding and serving to guard or close an opening

Name a sphincter associated with the pancreas

Hepatopancreatic sphincter - Sphincter of Oddi

What does the Dual Arterial Supply of the pancreas consist of (& what they branch from)

4 in total:

Anterior SUPERIOR pancreaticoduodenal artery - Branch of the celiac trunk via gastroduodenal a.

Anterior INFERIOR pancreaticoduodenal artery - Branch of the superior mesenteric artery

Posterior SUPERIOR pancreaticoduodenal artery - Branch of the celiac trunk via gastroduodenal a.

Posterior INFERIOR pancreaticoduodenal artery Branch of the superior mesenteric artery

The pancreatic veins drain blood from the pancreas and as they are part of what system of veins

the portal system

Pancreatic veins drain where

will first drain to the liver before heading to the heart

What 2 veins merge to form the hepatic portal vein

The splenic vein & The superior mesenteric vein

Majority of veins follow the arteries, therefore most veins will drain into what vein

The splenic vein → hepatic portal vein

Some veins, particularly around the head of the pancreas, will drain via the _______

superior mesenteric vein → hepatic portal vein

Pancreas: Summary

Arterial Supply:

Venous drainage:

Lymphatics:

Innervation:

Pancreas: Summary

Arterial Supply: Celiac trunk and Superior mesenteric artery

Venous drainage: Ultimately to the Hepatic portal vein → Portal venous system

Lymphatics: Ultimately drain by following the arteries → Celiac lymph nodes, or → Superior mesenteric lymph nodes

Innervation: Vagus & greater splanchnic

Largest lymphatic organ in the body

Spleen

The spleen is what shape

The spleen is ovoid in shape

The spleen is a pulpy mass in what quadrant

LUQ

The spleen lies on what anatomical line

midaxillary line

The spleen is a retro/intraperitoneal organ

intraperitoneal organ

Roles of spleen

Largest lymphatic organ in the body

Acts as a blood reservoir

Is the spleen a vital organ

No

The spleen is vulnerable to damage when what ribs are hit

Ribs 9, 10, 11

Spleen close anatomical relationships:

Anteriorly:

Posterolateral:

Medially:

Inferiorly:

How does the splenic artery travel to the spleen (in what)

Splenic artery travels in the splenorenal ligament with the tail of the pancreas

Celiac trunk arises from the abdominal aorta at what vertebral level

T12

What is the largest branch of the celiac trunk

The splenic artery

Course of the splenic artery (with reference to the pancreas)

Courses along the superior border of the pancreas

The splenic vein is formed by what

many tributaries that leave the hilum of the spleen

The splenic vein runs __________ to the pancreas

Posterior

Relation of the splenic vein with the superior & inferior mesenteric veins

The inferior mesenteric vein usually drains into the splenic v.

The splenic vein unites with the superior mesenteric vein to form the Hepatic Portal Vein

Spleen summary:

Arterial Supply:

Venous drainage:

Lymphatics:

Innervation:

Spleen summary:

Arterial Supply: Celiac trunk

Venous drainage: Ultimately to the Hepatic portal vein → Portal venous system

Lymphatics: Ultimately drain by following the arteries towards → Celiac lymph nodes

Innervation: Vagus & greater & lesser splanchnics

Boundaries of the Cystohepatic Triangle / Triangle of Calot

Superior border: Inferior border of the Liver

Medial border: Common hepatic duct

Lateral border: Cystic duct

What is a Cholecystectomy

Cholecystectomy is a surgical procedure to remove the gallbladder

Why would a Cholecystectomy be done

The gallbladder is not a vital organ, therefore if gallstones have a high risk of reoccurrence and regularly cause severe biliary colic then an individual may elect to undergo a cholecystectomy to remove the gallbladder

Important to identify the cystohepatic triangle in a Cholecystectomy why?

to determine if there is a variation the cystic artery or biliary apparatus

Once identified, the cystic duct and cystic artery are ligated and divided to prevent bleeding and the release of bile

What are Cholelithiasis

small lumps of solid stone-like deposits which form in the gallbladder (gallstones)

How do Cholelithiasis form

Crystals form when there are high concentrations of cholesterol

Who is at risk of gallstones

Individuals who are regularly dehydrated

Relatively common in females

Cholelithiasis are asymptomatic, however, symptoms may include:

• Pain in the right upper quadrant (RUQ)

• Pain may be referred to the right neck/shoulder region

• Nausea

• Cholecystitis → Inflammation of the gallbladder

• Jaundice

Where do Cholelithiasis sometimes become painfully lodged

hepatopancreatic ampulla is a common constriction site where cholelithiasis often become painfully lodged

Difference between intrahepatic bile duct stones (hepatolithiasis), extrahepatic bile duct stones (choledocholithiasis) & gallbladder stones (cholecystolithiasis)

most commonly injured abdominal organ

The spleen

Despite being protected by the rib cage, a traumatic blow to the left side may fracture the ribs and result in fragments of bone lacerating the spleen

→ Example could be becoming impacted against the steering wheel during a road traffic accident

If the spleen ruptures, this will lead to

Shock

• Intraperitoneal hemorrhage – profuse internal bleeding

Splenectomy

Surgical removal of the spleen to prevent bleeding to death

Splenomegaly

Pathological enlargement of the spleen (up to 10x normal size) accompanied by high blood pressure

What is bigger ratio wise - liver in adult/liver in embryo

Liver in embryo