Midterm 1 Content (Post-Quiz Content)

Name the outlined structures:

Green = middle hepatic vein

Blue = IVC

Purple = RPV

Red = Gallbladder

Pink = RRA

Name the outlined structures:

Red = aorta

Blue = celiac axis

Green = spine

Purple = SMA

Name the outlined structures:

Red = Rt Kidney

Blue = RRV

Purple = RRA

Pink = ureter

Name the outlined structures:

Orange = left liver lobe

Dark Blue = portal confluence

Blue = IVC
White = splenic vein

Pink = LRV

Red = aorta

Green = spine

Purple = SMA

What is the largest organ in the body?

-liver

The liver is ______.

-intraperitoneal

The liver is covered by ______ capsule and _____ peritoneum.

-Glisson’s

-visceral

What are the 3 functions of the liver?

1)metabolic activities

2)production + secretion of bile

3)filtration of blood

What regions is the liver situated in?

-right hypochondrium

-epigastric

-maybe left hypochondrium

OR

-RUQ

-maybe LUQ

The diaphragm sits _____, _______ and ______ to the liver. The IVC, aorta and spine sit _____ to the liver. The stomach, spleen, and left kidney sit ________ to the liver. The right kidney, GB, and right colon sit _______ to the liver.

-superior, posterior and anterior

-posterior

-left lateral

-inferior

What are the 2 surfaces of the liver?

-diaphragmatic

-visceral

The diaphragmatic surface of the liver is _______ shaped. It is comprised of the _______, _______ and _______ regions.

-dome (convex)

-anterior, superior, posterior

The visceral surface of the liver is the ______ aspect/surface of the liver. What does it touch?

-inferior

-touches other organs

True/false the whole liver is covered in peritoneum.

-false, the bare area is not

True/false, the bare area of the liver is on the diaphragmatic surface.

-true

What are the borders that make up the bare area?

-the coronary ligaments

-triangular ligaments

The bare area includes a groove for what?

-IVC

 

What ligament divides the anterior surface of the liver?

-falciform

True/false, the visceral surface of the liver is covered by the peritoneum.

-true

True/false the visceral surface of the liver is smooth.

-false, it is lumpy + bumpy due to its contact with other organs

What method do we use to divide the liver in US?

-Functional

The traditional method divides the liver into ____ lobes. What are the lobes? Which lobe is the biggest in this method?

-4

-right, left, caudate, and quadrate

-right is the biggest

In the functional method, the liver is divided into ____ lobes. What does each lobe have?

-3

-own arterial/venous supply and biliary drainage

In the functional method, the right lobe is further divided into…

-anterior and posterior portions

What divides the right and left lobes in the functional method?

-imaginary line b/w the GB and the IVC/MHV/MLF

What divides the right lobe into anterior and posterior sections?

-the right intersegmental fissure

Since we can’t see the right intersegmental fissure sonographically, what landmark do we use to split the right lobe into anterior and posterior sections?

-RHV/RPV

The left lobe is further divided into ____ and _____ segments. The _______ divides them.

-medial and lateral

-left intersegmental fissure

Since we can’t see the left intersegmental fissure sonographically, what landmark do we use to split the left lobe into medial and lateral sections?

-LHV/LPV

Where is the caudate lobe located in the liver?

-posterior and superior

The caudate lobe receives blood from what side of the liver?

-both

What method divides the liver into 8 segments?

-couinaud’s classification

In Couinaud’s classification, what is #1? How are the rest numbered?

-caudate lobe

-in a clockwise fashion

Identify the structures with the stars.

Purple = posterior lobe
Yellow = anterior lobe

True/false the left lobe is larger than the right.

-false

What regions is the left lobe of the liver located?

-left epigastric/LUQ

The left lobe in the functional method is known as the _____ lobe in the traditional method.

-quadrate

Identify the outlined structures  

Purple = right lobe

Red = MHV

Pink = left medial lobe

White = LPV

Blue = left lateral lobe

Identify the outlined structures

Purple = right lobe

Red = MHV

Pink = left medial lobe

White = LPV

Blue = left lateral lobe

Identify the outlined structures.

Purple = right lobe

Red = MHV

Pink = left medial lobe

White = LPV

Blue = left lateral lobe

lig teres is behind the red line on the right

The anterior boundary of the caudate lobe is the _____, the posterior boundary of the caudate lobe is the _____.

-LPV/ligamentum venosum

-IVC

What is a normal variant of the liver that involves an inferior extension of the right lobe and can extend caudally to iliac crests?

-Reidel’s lobe

The falciform ligament divides the liver into _____ and _____ segments in the traditional method.

-right

-left

What does the falciform ligament connect?

-liver to diaphragm and anterior abdominal wall

Another name for the ligamentum Teres is the _____ ligament.

-round

The ligamentum teres extends _____ on the ______ surface of the liver to join the ligamentum venosum.

-posterior

-inferior

The ligamentum ______ divides the liver into medial and lateral segments in the functional method.

-Teres

The ligamentum ______ divides the left lateral lobe and the caudate lobe. This ligament runs ______ from the ligamentum teres at the level of the ______ on the visceral surface.

-venosum

-posteriorly

-porta hepatis (hilum)

What is a fissure?

-a cleft/groove/deep furrow in an organ that forms natural divisions

What vessel courses superiorly through the right intersegmental fissure? Inferiorly?

-RHV

-RPV

The ______ separates the functional right and left lobes. The ______ courses superiorly through this fissure.

-main lobar fissure (the milf separates right from wrong)

-MHV

The MLF is seen as a hyperechoic line on US extending from the ______ to the ______.

-GB neck

-RPV

What’s the function of hepatic veins? They course from _____ _____ to _____ _____. They are located in the _____.

-drain blood from liver into IVC

-inferior anterior to posterior superior

-intersegmental fissures

True/false the hepatic veins narrow in diameter as they approach the IVC.

-false they widen

The hepatic artery supply ________% of the blood to the liver.

-20-30%

True/false the hepatic artery is a left branch of the celiac axis.

-false it is a right branch

What are the branches of the hepatic artery?

1)common hepatic artery (extrahepatic)

2) hepatic artery proper (extrahepatic)

3) right and left hepatic arteries (intrahepatic)

Where is the portal triad and what is it?

-consists of a HA, HV and BD

-is located at the porta hepatis (hilum)

The HAP is located _____ to the CBD, and _____ to the MPV.

-medial

-anterior

The function of the portal venous system is to __________. It supplies ______% of blood to the liver.

-carries nutrient-rich blood from GI tract

-70-80

True/false the portal venous system directly connects to the IVC.

-false

What 2 vessels make up the MPV?

-splenic vein and superior mesenteric

What vessel meets the splenic vein at the portal confluence? The portal confluence is the origin of what?

-SMV

-origin of the MPV

What level does the MPV enter the liver at?

-porta hepatis

The RPV branches into ____ and _____ segments. (hint: think of how the right lobe is divided).

-anterior and posterior

The LPV branches into ____ and _____ segments. (hint: think of how the left lobe is divided).

-medial and lateral

Bile is used in the digestion of which macronutrient?

-fats

The biliary system is located in which regions?

-right hypochondrium, epigastric sometimes and the RUQ

The GB is _____peritoneal. It lies ____ to the IVC and _____ to the right kidney.

-intra

-lateral to IVC, medial to RK

Only the ____ of the GB is in a fixed position.

-neck

What are 3 normal variants of the GB?

1)Phrygian cap: fold b/w fundus and body

2)Hartman's pouch: out pouch in neck region

3)junctional fold: fold b/w neck and body

Intrahepatic ducts get ____ as they move along the biliary tree and eventually form the _____ and _____ hepatic ducts.

-larger

-right and left

The right and left hepatic ducts join to form the ______, an extrahepatic duct. It then turns into the cystic duct.

-common hepatic duct

What specialized feature does the cystic duct possess to provide structural support?

-spiral valves of Heister

The ______ and the _____ merge to form the common bile duct.

-common hepatic duct

-cystic duct

The junction of the pancreatic duct and the CBD form the _________. It is like a door frame.

-ampulla of Vater

The _____ controls the flow of bile into the duodenum. It is like a door.

-Sphincter of Oddi

The CBD is located ____ to the MPV, and _____ to the HAP.

-anterior

-lateral

What makes up the Mickey Mouse?

-left ear = CBD (comes from liver on rt side)

-right ear = HAP (comes off celiac axis from aorta therefore from left side of body)

-mouth = MPV

The pancreas lies ____ and ____ across the midline.

-transverse

-oblique

T/F the pancreas has a capsule.

False, this is why it’s hard to see on US

The pancreas is predominantly ____peritoneal.

-retro

T/F the pancreas is both an endocrine and exocrine gland.

-true

____% of the pancreas function is exocrine(production of enzymes), and __% is endocrine (production of hormones).

-99%

-1%

The pancreas is located in which regions?

-epigastric, left hypochondrium, RUQ and LUQ

What are the 4 potential shapes of the pancreas?

1)tadpole

2)dumbbell

3)sausage

4)boomerang

The head of the pancreas lies ____ to IVC.

-anteior

Which is more anterior in a transverse view? CBD or GDA?

-GDA (think A for anterior) in Laura’s fav pic which is a trans view

A posteromedial extension of the pancreas head is referred to as an _______. It lies posterior to the SMV/anterior to IVC.

-uncinate process

In a sagittal view the neck of the pancreas lies directly anterior to the _____. In a transverse view the neck of the pancreas lies directly anterior to the _____.

-SMV

-portal confluence

The main pancreatic duct is a.k.a. the duct of _____.

-Wirsung

The main pancreatic duct joins the ____ in the head at the _____.

-CBD

-ampulla of vater

The accessory pancreatic duct is a.k.a. the ______.

-duct of Santorini

What is the main function of the kidneys?

-water

-electrolytes

-BP regulation

-pH balance

-excretes liquid waste products

T/F the left kidney is higher than the right kidney.

-true because of the liver

Normal kidney length measurement is _____cm in adults.

-9-12 cm

T/F the kidneys lie obliquely in the abdomen at the level of T12-L4.

-true the kidneys lie obliquely in the abdomen at the level of T12-L4.

T/F the kidneys lie lateral to the spine, aorta and IVC.

-true

T/F the kidneys lie posteromedial to the psoas muscle.

-false they lie anterolateral

T/F the kidneys lie posterior to the quadratus lumborum muscle.

-false they lie anterior