Exam 4 (part 3)

cystic duct

- About 4 cm in length that connects the neck of the gallbladder to the common hepatic duct. - The cystic duct joins the common hepatic duct to form the common bile duct.

hepatic triad

- Anterior: The common bile duct is located to the right. - Anterior: The proper hepatic artery is located to the left. - Posterior: The portal vein

Gallstones

- Common in female - Increase with age - 50% of persons -no symptom - Longer asymptomatic- less likely symptom are to develop

Parts of the Pancreas

- Head: embraced by C-shaped curve of duodenum. - Uncinate process: behind the superior mesenteric artery and vein. - Neck: overlies the superior mesenteric artery and vein. - Body: from its neck to tail. Lies posterior to the stomach. - Tail: The tail of the pancreas extends to the hilum of the spleen, embedded in the splenorenal ligament

Splenomegaly

- Is an enlargement of the spleen. - Due to hypersplenism, liver diseases, hemolytic anemia's (Sickle cell anemia) and certain cancers.

Pancreas

- It lies in the epigastric and left hypochondriac region, between duodenum (right) and spleen (left) and posterior to the stomach. - It is retroperitoneal, except for its tail.

The left functional lobe

- Receives blood from left hepatic arteries. Secrets bile into left hepatic duct. - Consists of the left lobe, quadrate lobe.

Caudate lobe third lobe

- Receives blood from right and left hepatic arteries. - Secrets bile into both right and left hepatic duct.

The right functional lobe

- Receives blood from right hepatic arteries. Secrets bile into right hepatic duct. -It consists of the right lobe and caudate process of the caudate lobe.

Pancreatectomy

- Sometimes performed in patients with chronic pancreatitis, pancreatic tumors and pancreatic cancer. - pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, and segmental pancreatectomy.

Lymphatic drainage of Pancreas

- The lymph from spleen drains into pancreaticosplenic lymph nodes. - The efferent vessels from these lymph nodes drain into celiac or superior mesenteric lymph nodes.

Bile Drainage from Liver:

- The right and left hepatic ducts drain bile from the right and left functional lobes and caudate lobe of the liver. - The right and left hepatic ducts unites and form the common hepatic duct. - The common hepatic duct and the cystic duct (which drains the gallbladder) unite and form the common bile duct. - The common bile duct unites with pancreatic duct and form hepatopancreatc ampulla which enters the 2nd or descending part of the duodenum (major duodenal papilla).

Arterial supply of Pancreas

- The tail, body and neck of the pancreas by Branches of the splenic artery - The head of the pancreas by The anterior and posterior superior pancreatico- duodenal arteries , branches from the gastroduodenal artery.

Lymphatic drainage of spleen

- drains into pancreaticosplenic lymph nodes. - The efferent vessels from these lymph nodes drain into celiac or superior mesenteric lymph nodes.

Cystohepatic triangle (of Calot)

- lies between the liver, common hepatic duct and cystic duct or gall bladder. The boundaries include the: - Common hepatic duct (left), Cystic duct and gallbladder (right) and liver (superiorly).

Hepatic Artery

-Hepatic artery proper lies within the hepatoduodenal ligament: -The hepatic artery proper divides into right and left hepatic arteries at the porta hepatis

Liver

-right hypochondriac and epigastric region and extends into the left hypochondriac region -Deep to the right 7th to 11th rib.

Venous drainage of Liver

A total of 3 hepatic (right, intermediate and left) veins drain into the inferior vena cava.

Relations of the spleen

Anteriorly- stomach Posteriorly- diaphragm Inferiorly- the left colic flexure Medially -the left kidney

The major pancreatic duct (of Wirsung)

Both pancreatic and bile ducts unite and form hepatopancreatic ampulla (of vater), which drain into the 2nd part of the duodenum at the major duodenal papilla.

Venous drainage of gallbladder

Cystic vein may drain into the right branch of the portal vein or, more directly drain into the liver.

Surfaces of the Liver

Diaphragmatic surface and visceral surface

Pancreatitis

Inflammation of the pancreas is termed pancreatitis

Spleen Location

Left hypochondriac region It is related to the left 9th, 10th and 11th rib.

Antomical Lobes of Liver

Liver divided four anatomical lobes (the right lobe, quadrate lobe, and caudate lobe, and the left lobe) by the reflections of peritoneum from its surface (the fissures).

Peritoneal relationships of the liver

Liver is covered with peritoneum except at fossa of the gall bladder and porta hepatis (hilum of the liver) on the visceral surface and bare area on the diaphragmatic surface

Blood supply of Liver

Liver is supplied by portal vein and hepatic artery.

Innervation of Gallbladder

Parasympathetic- Vagus nerve via celiac plexus. Sympathetic supply- T6-T8 portion of the Greater splanchnic nerves. Via celiac plexus. Visceral afferents- reach levelsT6-T8 of the spinal cord via greater splanchnic nerves.

Hepatic lobectomies

Removal of the right or left part of the liver can be done without excessive bleeding

Blood supply of the spleen

Splenic artery - branch of the celiac trunk Splenic vein- portal vein

Lymphatic drainage of Liver and Gall bladder

Superficial lymphatics (in the Subperitoeal fibrous capsule - phrenic lymph node - mediastinal lymph node -hepatic lymph node —celiac lymph node- cisterna chyli Deep lymphatics- (surrounding portal triads) - hepatic lymph nodes

Nerve supply of the spleen

The nerves of the spleen derived from the celiac plexus.

Nerve supply of the spleen:

The nerves of the spleen derived from the celiac plexus.

Venous drainage of pancreas

Veins drains into the splenic and superior mesenteric vein.

Arterial Supply of Gall Bladder

arises from right hepatic artery within the cystohepatic triangle ( of Calot).

Cirrhosis of the liver

characterized by diffuse fibrosis parenchymal nodular regeneration and disturbed hepatic architecture. -Alcoholic liver disease (60-70%), - Hepatitis B and C (10%), - Genetic hemochromatosis (5%).

The body of gallbladder

contacts the visceral surface of liver, transverse colon and superior part of duodenum

The neck of gallbladder

contain pendulous sacculation (Hartmann's pouch). The neck makes an S-shaped bend to join the cystic duct.

The falciform ligament

extends from the anterior abdominal wall.

Hepatorenal recess

fluid from lesser sac or omental bursa

Venous Blood supply to liver

from hepatic portal vein: 75-80% of the blood of the liver. Portal blood is poorly oxygenated (but contain 40% more oxygen then systemic venous blood), but the nutrient-rich, because portal venous blood is coming from the gastrointestinal tract.

Arterial blood supply to liver

from the Hepatic artery proper. 20-25% of the blood of the liver, blood is oxygenated. The hepatic artery proper divides into right and left hepatic arteries at the porta hepatis.

The coronary and Triangular ligaments

hold the liver to the diaphragm.

Ligamentum venosum

is the obliterated ductus venosus of the fetus. This vessel shunts blood from portal vein to inferior vena cava in fetus.

Ligamentum teres hepatis or round ligament of liver-

is the obliterated umbilical vein

fundus of gallbladder

projects from inferior border of liver at the tip of the right 9th costal cartilage in the Mid clavicular line.

The porta hepatis

provides passage of portal triad (bile duct, hepatic artery and portal vein)

Subphrenic Recesses

separated into right and left recess by the falcifornm ligament.

Biliary obstruction-

stones of appropriate size may enter the duct system and lodge at points of narrowing.

Spleen Support

the Gastrosplenic and spenoral ligaments

Accessory pancreatic duct

usually it communicates with the main pancreatic duct. Some cases it opens separately into minor duodenal papilla.

Billiary referred pain

within the upper quadrants and epigastric region of the abdomen.