[ANA] LIVER, GALLBLADDER, BILIARY TREE, PANCREAS, AND SPLEEN

Glisson’s capsule

Liver is cmpletely covered by a fibrous connective tissue called

supero-posterior surface; bare area of the liver

This surface of the liver is not covered by parietal or visceral peritoneum and is called?

hepatogastric ligament

Attachment found in the thin part of the lesser omentum

hepatoduodenal ligament

Attachment found in the thick part of the lesser omentum

portal triad (portal vein, hepatic artery, bile duct)

important structures found in the hepatoduodenal ligament

Falciform Ligament

This connects the liver to the umbilicus and divides the liver into the left and right lobes

Coronary Ligament

This is the continuation of the falciform ligament, in which its posterior and anterior leaflet is viewed posteriorly

Triangular Ligament

Found at the junction of the coronary ligament at the lateral side

anterosuperior and posteroinferior

What are the surfaces of the liver

Abdominal wall, pleura

structure anterior to the liver

Transverse colon, Abdominal Esophagus

structure posterior to the liver

Recesses

These are potential spaces created by liver, diaphragm, and inferiorly located kidney where fluid may accumulate

Subphrenic

Recess found between the diaphragm and the superior surface of the liver

Hepatorenal

Recess found between the liver and the kidney

Subhepatic

Recess created by the liver

renal, colic, gastric, duodenal

Enumerate the impressions created by organs near the liver

Lobar Division (Anatomic)

Division created by the falciform ligament that divides the liver into R & L lobes

F: NOT a true division

T/F: The Lobar Division (Anatomic) is a true division of the liver function-wise

IVC’s fossa and gallbladder

The True Division (Functional) is demarcated by the line from which structures

segment IV

This particular portion of the left liver is located in the right lobe, following the anatomical division

T

T/F: The one followed in surgery in terms of liver sections and defining the location of the tumor is the True Division (Functional)

Segments 1-4

Left lobe of the liver contains which segments?

True

T/F: Each segment cannot survive on its own if it does not have these 3 components (portal triad)

Celiac Plexus

Nerve supply of the Liver

Ganglia T7 - T10

SNS innervation of the Liver

Anterior Vagal Trunk

PSNS innervation of the Liver

Portal vein; nutrient-rich

This provides the major blood supply (70%) of the liver and contains what type of blood

superior mesenteric and splenic veins

Formation of the portal vein

hepatic artery; common hepatic artery

This supplies oxygen-rich blood to the liver, which is a branch of which artery?

Flow of bile from the liver follows this sequence

inferior surface of the liver

The gallbladder is located in a fossa at the

cystic duct

What suspends the gallbladder

cystic artery; right hepatic artery

blood supply of the gallbladder and its usual origin

cystic vein; portal vein

blood drainage of the gallbladder and where does it drain to

fundus; transpyloric plane

Part of the gallbladder that is very close to the anterior abdominal wall, which also lies at this plane

body

This part of the gallbladder lies in contact with the visceral surface of the liver

Hartman’s pouch

This is a dilatation just prior to the neck the gallbladder and can be a rare congenital anomaly of the gallbladder

cystic duct

The neck of the gallbladder becomes continues with this structure

spiral valves of Heister

The cystic duct is surrounded by which structure that will join the common bile duct

Abdominal wall; inferior surface of liver

structures anterior to gallbladder

transverse colon

structures posterior to gallbladder

common bile duct

The cystic duct surrounded by spiral valves of Heister joins the?

cystic duct and common hepatic duct

Variations in the cystic duct in which it is located at the low junction between which structures

right hepatic duct

Variations in the cystic duct in which it drains into this structure instead of the common bile duct

behind the duodenum

Variations in the cystic duct in which it joins with the common hepatic duct (instead of common bile duct) behind which structure?

Cystohepatic Triangle of Calot

Structure that must be first identified during surgery before dividing anything

Inferior surface of liver, Common hepatic duct, Cystic duct

The Cystohepatic Triangle of Calot is bounded by which structures?

Cystic artery

What is found within the Cystohepatic Triangle of Calot

• common hepatic a.

• left hepatic a.

• multiple cystic arteries

• directly from celiac trunk

What are the other variations in the origin of the cystic artery?

Cystic Duct and Common Hepatic Duct

Formation of the common bile duct

right of hepatic artery; anterior of portal vein

Within the hepatoduodenal ligament, CBD is found at the ( ) of the hepatic artery and ( ) of the portal vein

four (4)

The CBD has how many parts?

supraduodenal (1st part)

Location of the first part of the CBD where it spans from its formation down to the superior border of the duodenum

behind D1

second part of the CBD is located

behind the head of the pancreas

second part of the CBD is located

at the medial side of the duodenum

fourth part of the CBD is located

Ampulla of Vater; Major Duodenal Papilla

This is the dilated portion of the Hepatopancreatic Duct, which drains into which structure at the medial wall of D2

Sphincter of Oddi

This surrounds both the CBD and the Pancreatic Duct, which also surrounds the Ampullary and Duodenal Papilla Complex

Epigastric area, LUQ

Location of the pancreas

Left hypochondriac

The tail of the pancreas is located at which region

superior mesenteric vessels

The uncinate process of the pancreas is located posterior to which structure?

formation of the portal vein

The neck of the pancreas lies immediately anterior to?

Tail

This part of the spleen is located nearest to the spleen

Body of stomach, Transverse colon

Structure anterior to the head of the pancreas

IVC, Right kidney, right adrenal gland

Structure posterior to the head of the pancreas

Uncinate process

Structure inferior to the head of the pancreas

Main Pancreatic Duct of “Wirsung”

This structure of the pancreas penetrates medial (posteromedial) border of 2nd part of duodenum and opens through greater duodenal papilla

upper pancreatic head

The Accessory Pancreatic Duct of Santorini drains which part of the pancreas

Union of splenic vein and superior mesenteric vein (SMV)

Formation of the portal vein

behind the neck of the pancreas

Commencement of the Portal Vein

porta hepatis

The portal vein divides into left and right branch at which structure

cystic vein

What is the right tributaries of the portal vein

Paraumbilical Vein of Sappey

This is a left branch/tributary of the portal vein which connects the left branch of the portal vein with the paraumbilical vein/ superficial veins in the abdominal wall

hepatic vein

The normal blood flow leaves the porto-systemic anastomoses via this vessel

SMV

The right lobe of the liver receives blood mainly from the intestine via which vessel

left lobe + quadrate and caudate lobe

blood from the stomach and spleen (Splenic v.) goes to which lobe/s of the liver

Left hypochondriac region

Region where the spleen can be located

fundus of the stomach and diaphragm (between Rib 9-11)

The spleen is found between which structures

Rib 10

Long axis of the spleen lies at which rib

midclavicular line

the most medial extent of a normal spleen is around which structure

Superior, Diaphragmatic/Posterior, Visceral, Inferior

Enumerate the surfaces of the spleen

hilum with the neurovascular structures

The visceral surface of the spleen contains which structure

concave, notched anterior border, irregular

Characteristics of the Visceral surface

convex, smooth

Characteristics of the Diaphragmatic/Posterior surface

Rib 10

The Diaphragmatic/Posterior surface lies along which structure

Gastrosplenic ligament

Attachment of the Spleen that contains left gastroepiploic & short gastric vessels

Splenorenal/Splenicorenal ligament

Attachment of the Spleen that contains splenic vessels

underneath the gastrosplenic ligament

Splenorenal ligament is located at which orientation relative to the gastrosplenic ligament

Splenic artery and vein

Blood supply and drainage of Spleen

Celiac plexus

Nerve Supply of the Spleen