Anatomy

where is the gall bladder found

sits in fossa on visceral surface of liver at the level of the 9th costal cartilage

shape of the gall bladder

Pear-shaped sac, 7-10cm long in the adult

how much bile does the gall bladder hold

30-50ml

what does the gall bladder contract to do

eject bile

what drains the gall bladder

the cystic duct

what arrangement does the cystic duct take

spiral

what structure does the mucosa of the gall bladder take

transversely ridged at medial end

what does the ductules of gall bladder join to form

intrahepatic ducts

what do the intrahepatic ducts join to form

left and right hepatic ducts (intrahepatic and extrahepatic ducts)

what does the left and right hepatic ducts join to form

common hepatic duct

what does the common hepatic ducts join and cystic duct join to form

bile duct

what does the bile duct join and where

main pancreatic duct at the hepatopancreatic ampulla

where does the hepatopancreatic ampulla enter

descending part of the duodenum

where does the bile duct course

posterior to superior duodenum

where does the bile duct sit

in groove posterior to the head of the pancreas

what is the blood supply of the arteries

cystic artery

where does the cystic artery usually arise from

right hepatic artery

what is the blood supply of the bile duct

posterior superior pacreaticoduodenal artery

what is the venous drainage of the fundus and body of the gall bladder

directly into the liver

what is the venous drainage of the neck and biliary duct of the gall bladder

cystic veins drain into the liver or the hepatic portal vein

what is the parasympathetic nerve supply of the gall bladder

anterior vagal trunk

how does the vagus nerve lead to trunks to the abdomen

Vagus nerve make a plexus on the oesophagus and will create vagal trunks when they are coming into the abdomen; anterior and posterior and will find their way to the gall bladder

how does the parasympathetic duct cause relaxation of sphincters

Rest and digest and for this we need bile secretion so includes relaxation of sphincter to do so

what action does the anterior vagal trunk take on the gall bladder

contraction of the gall bladder and relaxation of sphincters

what is the sympathetic nerve supply to the gall bladder

sympathetic chain

what action does the sympathetic chain have on the gall bladder

inhibits contraction

how will sympathetic chains supply the bile duct

Get some of chain coming off and they will form the splanchnic nerves and they will make their way to different arteries and will form plexuses around arteries to get to the specific organs.

They have ganglia and plexuses around coeliac and superior mesenteric artery, this is where ganglia are and the cell bodies will synapse, they will inhibit contraction when we do not want bile

 

where is CCK produced from

enteroendocrine cells of small intestine

where are gall stones most likely to occur

hepatopancreatic ampulla

where do gall stones in the cystic duct pass back to

gall bladder

what can gall stones cause

inflammation which will cause jaundice

where is the liver located

right upper quadrant, extending into the left upper quadrant

right hypochondrium and epigastric region extending into the left hypochondrium

what rib levels will protect the liver

ribs 5-11

how much does the liver move during ventilation

normal: 2.5cm

max: 5-8cm

when is the liver palpable

deep inspiration

how is the liver usually assessed

through percussion

what type of peritoneum is the liver

intraperitoneal

what does peritoneal reflections form

recesses where fluid can collect

what does thickened peritoneum form

ligaments

what weight does the liver take up in the body

2%

when does the liver grow until

15-18 years

what are the two surfaces of the liver

diaphragmatic and visceral

what are the 4 anatomical lobes of the liver

left, right, caudate and quadrate

what are the embryological remnants of the liver

ligamentum teres and ligamentum venosum

what are the fissures of the liver

left and right sagittal and porta hepatis

what is the porta hepatis

the fissure of the liver which contains the portal triad

what is the portal triad

hepatic artery proper

hepatic portal vein

bile duct

where does the portal triad sit

the free border of the lesser omentum

what does the functional lobes of the liver receive

branch of the hepatic portal vein and the hepatic artery proper and is drained by a hepatic duct (bile)

how many functional segments does the liver have

eight

what does each functional segment of the liver have

Each segment has a 2° or 3° branch of the hepatic portal vein and hepatic artery proper

 

Each segment has its own biliary and venous drainage

what is the dual blood supply of the liver

hepatic artery proper and hepatic portal vein

% of liver blood supply from hepatic artery proper

25-30%

% of liver blood supply from hepatic portal vein

70-75%

what is the hepatic artery proper a branch of

common hepatic artery from coeliac trunk

what does the hepatic artery proper branch into

left and right hepatic arteries

what is the nerve supply of the liver

hepatic plexus

what is the sympathetic supply of the liver

sympathetic supply from coeliac and superior mesenteric plexuses

what is the parasympathetic supply of the liver

vagal trunks

what is referred pain with regards to liver

liver parenchyma is poorly localised within the epigastric region

dermatome of the diaphragm

C3-5 on right side only

referred pain of the fibrous capsule

well localised somatic pain

venous drainage of the liver

3 major hepatic veins drain directly into the IVC

what is the hepatic portal vein formed from

convergence of superior mesenteric and splenic veins, posterior to the neck of the pancreas

length and diameter of the hepatic portal vein

8cm long

2.2cm in diameter

percentage of blood supply to liver supplied by hepatic portal vein

70-75%

what is portal hypertension

increased pressure in the portal system

what commonly causes portal hypertension

cirrhosis of the liver

pathophysiology of portal hypertension

not enough blood can pass through the liver, so backs up into portal veins

porto-systemic anastomoses enlarge due to increased pressure

how to treat porta hypertension

transjugular intrahepatic port-systemic shunt

what are the ligaments of the liver

anterior and posterior coronary

right and left triangular ligament

falciform ligament

during dissection, to free the liver superiorly from the diaphragm, what vessel is cut

IVC

enlargement of which portosystemic anastomoses results in caput medusae

umbilical and epigastric veins

what is the anatomical landmarks to identify the caudate lobe

between the IVC and the ligamentum venosum

enlargement of which portosystemic anastomoses results in oesophageal and gastric varices

left gastric vein and distal oesophageal veins

enlargement of which portosystemic anastomoses results in surgical issues

colonic veins and retroperitoneal veins

enlargement of which portosystemic anastomoses results in rectal varices

superior anorectal veins and middle/inferior anorectal veins

what are the recesses of the peritoneum

subphrenic

hepatorenal

what is formed when the anterior coronary ligaments come together

falciform ligament

what is formed when the anterior and posterior coronary ligaments come together

left and right triangular ligaments

what is the left functional lobe made up of

the left anatomical lobe and some of the right anatomical lobe

where does the hepatic portal vein lie

posterior to the pancreas