Week 5- foregut 2

Question 1

Describe the lobes that make up the liver?

Answer 1

You have 4 lobes- right, left, caudate and quadrate.

The caudate lobe is superior and posterior whereas the quadrate lobe is posterior but inferior.

Question 2

Which ligament on the liver is a remnant of an embryological component?

Answer 2

The ligamentum teres is a remnant of the umbilical vein.

Question 3

Which two ligaments run on the superior surface of the liver?
What do they join to form?

Answer 3

The right and left triangular ligaments.

Join together to form the falciform ligament.

Question 4

What is continuous with the falciform ligament inferiorly?

Answer 4

Continuous with the ligamentum teres (it thickens here).

Question 5

Which vein runs alongside the caudate lobe?

Answer 5

The inferior vena cava.

Question 6

What is the porta hepatis?

What does it contain?

Answer 6

Sort of like the lung hilum in the sense that its where the vessels enter/exit the liver.
The porta hepatis contains the portal vein, the left and right hepatic arteries and the right and left hepatic ducts (also lymph nodes and nerves).

Question 7

What forms the boundaries of the porta hepatis?

Answer 7

The lesser omentum.

Question 8

What sits on the posterior surface of the liver?

Answer 8

Oesophagus, stomach, duodenum, right colic flexure, right kidney, supra-renal gland, gall bladder.

Question 9

What peritoneal lining covers the liver? What is the area not covered by this called?

Answer 9

Covered by visceral peritoneum.

Bare area is the area superiorly on the right lobe that isn’t covered by visceral peritoneum.

Question 10

How are the right and left triangular ligaments and the falciform ligament formed?

Answer 10

The peritoneum folds back on itself to form a double layer which is these ligaments.

Question 11

Where does the falciform ligament pass from and to?

Answer 11

Formed by the joint of the right and left triangular ligaments in the groove between the right and left lobes of the liver. Attaches at the umbilicus.

Question 12

What does the right layer of the falciform ligament form?

Answer 12

It creates the coronary ligament.

Question 13

What does the left layer of the falciform ligament form?

Answer 13

The left triangular ligament.

Question 14

Where does the liver obtain its blood supply from?

Answer 14

30% from hepatic arteries- oxygen rich, nutrient deficient.

70% from portal vein- nutrient rich, oxygen deficient

Question 15

When in the liver, where does the arterial and venous blood get sent too?

Answer 15

Goes through liver sinusoids to their central vein.

The central veins then drain into the right and left hepatic veins and then into the IVC.

Question 16

Where does lymph from the liver drain too?

Answer 16

It drains to the nodes at the porta hepatis then to the coeliac nodes.

Question 17

Where is pain from the liver referred too?

Answer 17

To the epigastric region or small amount via the diaphragm to the right shoulder.

Question 18

Where is bile stored and concentrated?

Answer 18

Gall bladder.

Question 19

Describe the bile drainage of the liver?

Answer 19

Right and left bile ducts join. The cystic duct then connects to form the common bile duct. The pancreatic duct joins at the ampulla of vater. They can then be secreted into the duodenum by the sphincter of Oddi.

Question 20

How long is the bile duct and where does it end?

Answer 20

Bile duct is 8cm long and ends by piercing the medial wall of the 2nd part of the duodenum.

Question 21

Describe the structure of the gall bladder?

Answer 21

It has a neck, a body and a fundus (this part hangs below the liver)

Question 22

What sort of peritoneum covers the gall bladder?

Answer 22

Visceral peritoneum.

Question 23

What causes the gallbladder to release bile?

Answer 23

If there is fat in the duodenum, a hormone called cholecystokinin is released causing the gall bladder to contract. This causes the smooth muscle in the sphincter to relax allowing bile into the duodenum.

Question 24

Describe the blood supply to the gallbladder?

Answer 24

Arterial- cystic artery from the right hepatic artery.

Vein-cystic vein which drains into portal vein.

Question 25

Where does lymph from the gallbladder drain to?

Answer 25

It drains to the cystic nodes then to hepatic then to coeliac nodes.

Question 26

Where do nerves to the gallbladder come from? Also where is pain referred to?

Answer 26

Coeliac plexus

Pain referred to epigastric region.

Question 27

What are gallstones?

Answer 27

Crystalline bodies made from bile salts.

Question 28

What are the two types of gallstones you can get? What colour are they?

Answer 28

Cholesterol- green or yellow/white

Pigment stones- bilirubin and calcium salts- usually small and dark.

Question 29

Describe the structure of the pancreas?

Answer 29

It has a head that fits in with the curvature of the duodenum. Has an uncinate process.
A neck
And a body.
And a tail

Question 30

Where does the tail of the pancreas lie?

What does it lie in contact with?

Answer 30

In the lineorenal ligament.

Lies in contact with the hilum of the spleen.