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GI Lecture 5
SMP
23
Medical
Graduate
01/27/2012

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Term
What vessels and fluid enter the liver, and which ones leave?
Definition
Portal vein, hepatic artery proper, bring blood into the liver, while the IVC, bile, and lymph all leave the liver.
Term
What creates the subphrenic recess and the hepatorenal recess?
Definition
Folding back of the peritoneum. In these areas, where the parietal peritoneum becomes continuous with the visceral peritoneum, it's called the coronary ligament.
Term
Which portion of the liver is the bare area?
Definition
Superior and posterior.
Term
What attaches the liver to the anterior body wall?
Definition
The falciform ligament. This also separates the left and right lobes of the liver.
Term
What are the triangular ligaments?
Definition
Portions of the coronary ligaments, and these attach the liver to the diaphragm.
Term
Which structures constitute the 'H' like appearance of the underside of the liver?
Definition
Gall bladder, IVC, ligamentum teres, ligamentum venosa, and the Porta Hepatis (which consists of portal vein, hepatic artery proper, common hepatic duct).
Term
What is the connection between the liver and the lesser curvature of the stomach called? What structures are located here?
Definition
Lesser omentum. Hepatoduodenal and hepatogastric ligaments are here.
Term
What three structures consist of the hepatoduodenal ligament?
Definition
Portal vein, common bile duct, and the hepatic artery proper.
Term
Why is portal hypertension a concern?
Definition
The portal vein has a very low blood pressure, because the blood flowing to through it has passed through 2 capillary beds. Also, portal vein doesn't have any valves to prevent backflow, so if damage occurs (cirrhosis) to increase pressure, it'll create a back up of blood.
Term
What are the three tributaries of the portal vein?
Definition
SMV, IMV, and the splenic vein.
Term
With portal hypertension, blood will look to flow back to the heart through 4 other anastomoses. What are they?
Definition
Esophageal varices: Near stomach area, the left gastric and azygous veins become enlarged.

Internal hemorrhoids: blood from superior rectal vein can leak into middle and inferior rectal vein.

Caput Medusa: Blood flows from paraumbilical veins to the superficial veins of anterior abdominal wall.

Retroperitoneal anastomoses: Aren't usually problematic.
Term
Describe the path of bile, and the different ducts involved.
Definition
Bile is made in all 8 functional lobes of the liver. It is taken up via L and R hepatic ducts, which join together to make the common hepatic duct. Common hepatic duct joins with cystic duct (coming from gall bladder) to give common bile duct, which joins with pancreatic duct, and it finally empties in duodenum.
Term
Which two structures (in addition to the liver) is the gall bladder in contact with?
Definition
Duodenum and the transverse colon. Gall bladders in these areas can lead to fistulas (shortcuts).
Term
Does referred pain occur if there's an irritation in the visceral layer of these organs, or in the parietal layer?
Definition
The visceral layer. If Pain migrates to parietal layer, then pain will become localized.
Term
What part of pancreas isn't retroperitoneal?
Definition
The tail
Term
What is the anatomical relationship of the SMA and SMV to the pancreas?
Definition
These vessels are located posteriorly to the body of the pancreas, but they pass anteriorly over the uncinate process of the pancreas.
Term
Describe the pathway of the major pancreatic duct.
Definition
It joins with the common bile duct, then empties into the ampulla of vatter/aka the sphincter of oddi.
Term
What is the most common site for gall stones to get stuck?
Definition
Sphincter of oddi.
Term
What's the blood supply to the pancreas look like?
Definition
Pancreas is part of foregut, and it does get some blood from branches off the celiac trunk. BUT it mostly gets blood from SMA branches. In particular, from the Superior and inferior (anterior and posterior as well, so 4 total vessels) pancreaticoduodenal arteries.
Term
Why is pancreatic cancer usually deadly?
Definition
Symptoms show up late, surgery in the area is difficult because of the proximity of the celiac trunk and the SMA. Cancer cells can spread to the liver pretty easily too. If patient is lucky, tumor will be in the uncinate process of pancreas, and they'll present with symptoms of jaundice.
Term
Which two ligaments anchor the spleen into place?
Definition
The gastrosplenic ligament attaches it to the stomach, and the splenorenal ligament attaches it to the left kidney.
Term
Blood supply to the spleen?
Definition
Splenic artery and splenic vein basically.
Term
Lymphatics to the spleen?
Definition
NONE. trick question. It's the largest lymph organ but it lacks lymph vessels.
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