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Liver, Gallbladder, Pancreas, & Spleen
Cole 4/4/11 lecture 2 hrs
69
Anatomy
Undergraduate 4
03/21/2011

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Term
have the patient inhale, so the diaphragm pushes down, then reach under the RIGHT rib cage in the right upper quadrant

though Cole says it will be hard to do this unless the liver is enlarged...who knows
Definition
how do you palpate a NORMAL liver?
Term
triangular
Definition
what is the shape of the left lobe of the liver?
Term
half n' half

the retroperitoneal part is secondarily retroperitoneal
Definition
is the liver mesenteric or retroperitoneal?
Term
falciform ligament
Definition
what divides left and right lobes of the liver anteriorly?
Term
falciform ligament(a mesentery) (note: this is the only organ attached to the front side)
Definition
what attaches the liver to the front body wall?
Term
caudate and quadrate lobes?
Definition
what divides the left and right lobes of the liver posteriorly?
Term
right sagittal fissure
left sagittal fissure
horizontal fissure
Definition
list the fissures of the liver
Term
caudate and quadrate lobes
Definition
what lobes lie between the sagittal fissures?
Term
the hilum of the liver aka porta hepatis
Definition
what is found at right side of the horizontal fissure?
Term
in between the 2 layers of the lesser omentum
Definition
where are the blood vessels, biles ducts, lymph, and nerves found that supply the liver (in what mesentery/ligament)?
Term
the round ligament(ligamentum teres), & the paraumbilical veins
Definition
what is found inside the falciform ligament?
Term
Left sagittal fissure (at least the anterior part with the ligamentum teres)
Definition
what liver structure is located approximately midline?
Term
anterior left sagittal fissure
Definition
which liver fissure corresponds to the ligamentum teres?
Term
anterior right sagittal fissure
Definition
which liver fissure corresponds to the gall bladder?
Term
posterior right sagittal fissure
Definition
which liver fissure corresponds to the IVC?
Term
posterior left sagittal fissure & horizontal(up to porta hepatis)

this makes a C shape
Definition
which liver fissure corresponds to the ligamentum venosum and root of lesser omentum?
Term
Right, anterior: gallbladder
right posterior: IVC

left anterior: ligamentum teres
left posterior: ligamentum venosum & root of lesser omentum
Definition
what lies in the sagittal fissure of the liver?
Term
root of lesser omentum

this makes a C from the IVC to the porta hepatis
Definition
a connective tissue strand embedded in the posterior left saggital fissure(& part of horizontal fissure?) of the liver that carries blood and bile ducts
Term
the omental/epiploic foramen
Definition
what lies between the porta hepatis and the IVC?
Term
Definition
http://e-medicaltextbook.blogspot.com/2008/08/liver-anatomy.html
Term
right, superior, posterior part where the liver contacts the posterior body wall. There is no visceral peritoneum covering it. This is the secondarily retroperitoneal part.
Definition
where is the bare area of the liver?
Term
lesser omentum
Definition
what suspends the stomach from the liver and attaches to the horizontal/ posterior left sagittal fissure?
Term
visceral peritoneum
Definition
what kind of peritoneum covers the liver?
Term
in the reflections of peritoneum where the pus can become trapped in corners because the peritoneal fluid doesn't circulate
Definition
where do infections and abcesses usually form around the liver?
Term
at sharp changes in the direction of the messenteries (at the edges of the anterior and posterior cornonary ligaments)
Definition
where are triangular ligaments found?
Term
the bare area of the liver is in contact with the abdominal wall(diaphragm)

also lymph from the bare area drains through the diaphragm to the thoracic nodes
Definition
how can disease travel from the thorax to the abdomen and vice versa?
Term
from the liver, the left and right bile ducts combine to form the common hepatic duct.

the cystic duct then joins to form the common bile duct

the main pancreatic duct then joins and forms the ampulla of Vater which enters the duodenum at the major duodenal papilla (sphincter of Oddi)
Definition
describe the path of bile to the small intestine
Term
1) horizontal and backward segment
2) vertical segment (descending duodenum)
3) the horizontal segment
4) the part that turns upward toward the jejunum
Definition
describe each segment of the duodenum (1-4)
Term
at the bottom of the second segment of the duodenum where the blood supply changes from the celiac to the SMA
Definition
where is the foregut-midgut transition?
Term
the second segment (the vertical part)
Definition
where do the liver, pancreas, and gallbladder dump into the duodenum?
Term
spiral valves, really just folds of mucosa

this is where gallstones get trapped
Definition
what are the valves of the cystic duct like? what is significant about them?
Term
cholesterol and bile salts
Definition
what are gallstones made of?
Term
the common bile duct passes behind the duodenum and dumps into the duodenum at the curve of the "C"
Definition
where is the common bile duct in relation to the duodenum?
Term
the main pancreatic duct enters the ampulla of vater and, if present, the accessory pancreatic duct goes directly to the second segment of jejunum and out the minor duodenal papilla
Definition
how do pancreatic enzymes reach the duodenum?
Term
there are 3 sphincters:

the sphincter of Oddi (sphincter of hepatopancreatic ampulla) clamps down so bile backs up and gets stored in the gallbladder

the other two sphincters are the sphincter of the common bile duct and the sphincter of the pancreatic duct which may have something to do with this
Definition
describe how bile gets into the gallbladder
Term
it is a widened portion of the tube where where the two juices can mix
Definition
what is the purpose of the hepato pancreatic ampulla? (ampulla of Vater)
Term
it is incorporated into the wall, the sphincter is just a thickened part
Definition
how is the smooth muscle of the sphincter of Oddi related to the smooth muscle in the wall of the duodenum?
Term
left bile duct: left, quadrate, and caudate lobes

right: right lobe

remember the left side is long and narrow, this is the functional division of the liver based on bile drainage
Definition
what lobes of the liver contribute to the left bile duct? the right bile duct?
Term
right side: blood supply includes the quadrate lobe in addition to the right lobe

left side: caudate, quadrate, left side

-the quadrate lobe is part of BOTH functional sides of the liver in terms of arterial supply
Definition
how does the blood supply to the liver differ from the bile drainage?
Term
the cystic artery ALWAYS passes through a triangle made from the cystic duct and right hepatic duct (liver superiorly)

there is also Calot's node, a lypmh structure
Definition
describe the contents and border of Calot's triangle (cystohepatic triangle)
Term
the hepatoduodenal ligament
Definition
what ligament contains the porta hepatis structures?
Term
between the liver and stomach, the left and right gastric arteries are contained within it
Definition
where is the hepatogastric ligament? what is found in it?
Term
hepatogastric and hepatoduodenal ligaments
Definition
what ligaments make up the lesser omentum?
Term
only the first part, the rest is retroperitoneal
Definition
what parts of the duodenum have mesentery?
Term
right and anterior: bile duct
left and anterior: hepatic artery proper
posterior: portal vein
Definition
what structures make up the porta hepatis, what is most anterior(how are they physically related?)
Term
the IVC
Definition
what lies on the other side of the peritoneum posterior to the second segment of the duodenum?
Term
portal vein
Definition
what vessel carries venous blood from the gut?
Term
hepatic veins in the right hepatic fissure(3-4) each enter the IVC right under the diaphragm
Definition
where does the liver drain to the IVC? what vessels do this?
Term
portal veins (names don't match)
Definition
what veins are paired with hepatic arteries (proper)
Term
the neck is the fusion of dorsal and ventral pancreas

the head is the thickest part of the pancreas in contact with the duodenum made of ventral pancreas
Definition
where is the neck of the pancreas? the head?
Term
it the part that hooks back off the head of the pancreas and has no important function
Definition
where is the uncinate process of the pancreas?
Term
made of dorsal mesentery, point to the spleen
Definition
what are the tail and body of the pancreas made of? what do they point to?
Term
the spine and great vessels
Definition
the pancreas curves, what does it wrap around?
Term
it has a DUAL blood supply!

the body and tail are supplied by the splenic artery(celiac)

the head and neck are supplied by the superior pancreaticoduodenal arteries (celiac)

the head and uncinate process are supplied by the inferior pancraticoduodenal arteries (superior mesenteric)
Definition
what is the blood supply to the pancreas (celiac, SMA, or IMA?)
Term
the transitions between embryonic gut parts
Definition
where are the major blood vessel anastamoses in the gut?
Term
SMA
Definition
what artery passes under the body, and over the uncinate process giving off the inferior pancreaticoduodenal arteries?
Term
SMA
Definition
what artery passes under the body, and over the uncinate process giving off the inferior pancreaticoduodenal arteries?
Term
splenic artery
Definition
what artery is very twisty, and found in the superior margin of the pancreas embedded in a connective tissue capsule?
Term
leinorenal ligament
Definition
what ligament contains the splenic artery?
Term
leinorenal and gastrosplenic
Definition
what are the 2 mesenteries of the spleen?
Term
it is retroperitoneal until it emerges with a small chunk of the tail of the pancreas into the leinorenal ligament where it becomes INTRAperitoneal(mesenteric)
Definition
is the splenic artery mesenteric or retroperitoneal?
Term
coronary ligament (anterior and posterior)
Definition
what ligament surrounds the bare area of the liver?
Term
through the bare area
Definition
where does the IVC run in relation to the liver?
Term
it is mesenteric and posterior to the greater curvature of the stomach to the left.
Definition
where is the spleen in relationship to the stomach? is it mesenteric or retroperitoneal?
Term
size of your fist, normally not palpable but will be if it becomes enlarged(splenomegaly) below the left costal margin
Definition
how big is a normal spleen? is it palpable?
Term
yes, the liver takes over function
Definition
can you live without your spleen?
Term
trauma, such as a car accident, or portal hypertension
Definition
what can cause splenomegaly?
Term
it can be stabbed, or a rib fracture(ribs 7-9) can break open the thin bloody capsule

this is a surgical emergency because the spleen is so bloody, you can bleed out.
Definition
how can the spleen rupture? is this bad?
Term
a splenectomy, it is usually too hard to sew up the spleen because it is so bloody
Definition
what is done to treat a splenic rupture?
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