Notes in G37 Liver, Gallbladder, and Pancreas

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Published	11/02/2024	The largest gland of the body is the {{c1::liver}}. It is coincidentally also the largest {{c1::organ}} and the only {{c1::organ}} capable of {{c1::si…
Published	11/02/2024	The liver functions in:{{c1::exocrine secretion (bile)endocrine secretion (ie GFs)glycogen storagesynthesis of fibrinogen and other essential proteins…
Published	11/02/2024	The diaphragmatic surface of the liver is entirely covered by {{c1::visceral peritoneum}} with the exception of the {{c1::bare area}} which contacts t…
Published	11/02/2024	The {{c2::inferior border}} of the liver is a sharp margin that separates the {{c1::diaphragmatic}} and {{c1::visceral}} surfaces of the liver.
Published	11/02/2024	The diaphragmatic surface of the liver is oriented {{c1::anteriorly}}, {{c1::superiorly}}, and somewhat {{c1::posteriorly}}. It is associated with the…
Published	11/02/2024	The visceral surface of the liver is oriented {{c1::postero-inferoly}}. It is {{c1::entirely::partially/entirely}} covered by visceral peritoneum.&nbs…
Published	11/02/2024	The {{c1::porta hepatis}} is the transverse fissure that transmits the hepatic arteries, ducts, and portal vein as well as nerves and lymphatics.
Published	11/02/2024	The bed of the gallbladder in the liver is known as the {{c1::cytsic fossa}}. It is located in the {{c1::right sagittal}} fissure.
Published	11/02/2024	In addition to the cystic fossa, also located in the right sagittal fissue of the liver is the {{c1::groove for the IVC}}.
Published	11/02/2024	The left sagittal fissure of the liver contains the {{c1::ligamentum teres hepatis}} and {{c1::ligamentum venosusm}}.
Published	11/02/2024	The sagittal fissures of the liver can be found along {{c1::the lateral margins}} of the {{c1::porta hepatis}}.
Published	11/02/2024	The hepatic attachment of the heptaogastric ligament is within {{c1::the fissure of the ligamentum venosum}}.
Published	11/02/2024	The hepatic portion of the hepatoduodenal ligament is formed at the {{c1::porta hepatis}}.
Published	11/02/2024	The portal triad is found within the {{c1::hepatoduodenal ligament}} and contains {{c1::the hepatic portal vein (posterior), the proper hepatic artery…
Published	11/02/2024	The falciform ligament arises from {{c1::the ventral mesentery::development}}.
Published	11/02/2024	The {{c1::coronary ligaments}} of the liver are {{c2::peritoneal reflections of the diaphragmatic surface of the liver to the inferior thoracoabdomina…
Published	11/02/2024	The coronary ligaments of the liver can be found {{c1::surrounding the margins of the bare area}}.
Published	11/02/2024	The anatomical lobes of the liver are defined by {{c1::the right/left sagittal fissures (and their contents) and the porta hepatis}}.
Published	11/02/2024	The largest anatomical lobe of the liver is the {{c1::right}} lobe.
Published	11/02/2024	The {{c2::quadrate}} lobe of the liver is the {{c1::inferior and anterior}} lobe.
Published	11/02/2024	The {{c1::caudate}} lobe of the liver is the {{c2::inferior}}, {{c2::posterior}} lobe.
Published	11/02/2024	In addition to anatomical lobes, the liver can be divided into {{c1:: right and left hepatobiliary/functional}} lobes.
Published	11/02/2024	The right hepatobiliary lobe is the lobe supplied by the {{c1::right hepatic}} artery and the {{c1::right branch of the hepatic portal}} vein. It is d…
Published	11/02/2024	The right hepatobiliary lobe of the liver is composed of {{c1::parts of the right and caudate}} anatomical lobes.
Published	11/02/2024	The left hepatobiliary lobe is supplied by the {{c1::left hepatic}} artery and the {{c1::left branch of the hepatic portal}} vein. It is drained by th…
Published	11/02/2024	The left hepatobiliary lobe consists of the {{c1::left, quadrate, and portions of the right and caudate}} anatomical lobes.
Published	11/02/2024	Hepatobiliary divisions and segments are subdivisions of {{c1::hepatobiliary}} lobes defined by {{c1::further branching of the biliary tree}}.
Published	11/02/2024	Each hepatobiliary lobe is divided {{c1::vertically}} into {{c1::2}} divisions with {{c1::3}} of the {{c1::4}} divisions dividing {{c1::horizontally&n…
Published	11/02/2024	Hepatobiliary (functional) lobe {{c2::divisions}} are divided {{c1::vertically}}, {{c2::segments}} are divided {{c1::horizontally}}.
Published	11/02/2024	The fourth hepatobiliary division (ie the one without a natural segmentation) and the {{c1::caudate}} lobe are considered separate segments. In total,…
Published	11/02/2024	What is clinically relevant about hepatobiliary segments?{{c1::They are the smallest, self-contained functional units of the liver and are divisional.…
Published	11/02/2024	The majority of the liver's oxygen comes from the {{c1::proper hepatic}} artery. However, this artery only accounts for {{c1::20% of the liver's total…
Published	11/02/2024	The majority of the liver's blood supply is from the {{c1::hepatic portal vein}}.
Published	11/02/2024	The hepatic portal vein connects the capillary beds of the {{c1::GI tract}} and {{c1::liver sinusoids}}.
Published	11/02/2024	The portal vein primarily conveys {{c1::substances absorbed by the intestines}} and {{c1::unconjugated bilirubin from splenic RBC breakdown}}.
Published	11/02/2024	Arterial and venous blood mix in the liver {{c1::sinusoids}}. These {{c1::sinusoids}} eventually drain into {{c1::one of three hepatic veins - right, …
Published	11/02/2024	Tributaries of the hepatic veins are termed {{c1::intersegmental (drain 1/8 segments of the liver)}} veins whereas branches of the portal vein are con…
Published	11/02/2024	The portal system is {{c1::valveless::valved/valveless}}.
Published	11/02/2024	{{c1::Portosystemic/portocaval}} anastomoses are {{c2::regions of overlap between portal and systemic venous return}}.
Published	11/02/2024	Portosystemic anastomoses can be located at {{c1::either end of the GI tract}} and {{c1::wherever GI organs contact the body wall/enter an extraperito…
Published	11/02/2024	The major portosystemic anastomoses are at {{c1::the lower esophagus, the anal canal, the anterior abdominal wall, and the bare area of the liver}}.
Published	11/02/2024	The portosystemic anastomosis of the lower esophagus is composed of {{c1::esophageal tributaries of the azygos system (systemic) and esophageal tribut…
Published	11/02/2024	The anal canal portosystemic anastomosis is composed of an anastomosis of the {{c1::vessels of the internal rectal venous plexus}} within the {{c1::re…
Published	11/02/2024	The anterior abdominal wall portosystemic anastomosis is composed of {{c1::paraumbilical veins}} within the {{c1::falciform ligament}} that anastomose…
Published	11/02/2024	The bare area of the liver portosystemic anastomosis is composed of the anastomoses between {{c1::liver parenchyma}} (portal) and tributaries of {{c1:…
Published	11/02/2024	Portal hypertension (alcholic cirrhosis) is caused by an obstruction of the venous return through the liver and leads to {{c1::elevated pressure in th…
Published	11/02/2024	Clinical features of portal hypertension can be observed in all areas of portosystemic anastamosis. These features manifest as:{{c1::Esophageal varice…
Published	11/02/2024	The liver is innervated by the {{c1::hepatic}} plexus, a division of the {{c1::celiac plexus}}.
Published	11/02/2024	The liver receives sympathetic innervation from {{c1::postganglionic}} fibers of the {{c1::greater splanchnic nn (T5-T9)}} and parasympathetic from {{…
Published	11/02/2024	Visceral sensory innvervation of the liver is conveyed by {{c1::T5-T9::spinal nerve levels}}.
Published	11/02/2024	The majority of the lymph in the thoracic duct is drained from the {{c1::liver}}
Published	11/02/2024	Liver lymph drains into {{c1::the cisterna chyli, phrenic lymph nodes, and the posterior mediastinal lymph nodes::3}}.
Published	11/02/2024	The gallbladder can be observed at the junction of the {{c1::right}} and {{c1::quadrate}} anatomical liver lobes.
Published	11/02/2024	The gallbladder functions to {{c1::store, concentrate, and release bile in response to hormonal signals (ie CCK)}}.
Published	11/02/2024	The anatomical divisions of the gallbladder are {{c1::the fundus, body, neck, and infundibulum}}.
Published	11/02/2024	The cystic infundibulum is a dilation at the junction of the {{c1::neck}} and the {{c1::cystic duct}}. It may or may not be present but is often assoc…
Published	11/02/2024	The mucosa of the cystic duct is arranged into {{c1::spiral folds}} in order to {{c1::maintain ductal patency}}.
Published	11/02/2024	The flow of bile from the liver is as follows:{{c1::Intrahepatic biliary ducts → right/left hepatic ducts draining their respective hepatobiliary lobe…
Published	11/02/2024	The bile duct passes {{c2::posteriorly}} to the {{c1::superior portion of the duodenum}} and {{c1::head of the pancreas}} before joining the terminal …
Published	11/02/2024	The union of the terminal portion of the main pancreatic duct with the bile duct forms the {{c1::hepatopancreatic ampulla (aka the ampulla of Vater)}}…
Published	11/02/2024	The hepatopancreatic ampulla empties into {{c1::the descending/second}} portion of the duodenum at the {{c1::major duodenal papilla}}.
Published	11/02/2024	The sphincter of the bile duct can be found {{c1::where the duct joins the hepatopancreatic ampulla}}.
Published	11/02/2024	The hepatopancreatic sphincter can be found {{c1::where the hepatopancreatic ampulla opens on the major duodenal papilla}}.
Published	11/02/2024	The sphincter of the bile duct serves to {{c1::regulate bile flow}}. The hepatopancreatic sphincter serves to {{c1::regulate bile/pancreatic excretion…
Published	11/02/2024	The cystic artery often courses {{c1::posterior}} to the {{c2::common hepatic duct}} to reach the cystic duct.
Published	11/02/2024	The cystohepatic triangle is bound by {{c1::the visceral surface of the liverthe cystic duct the common hepatic duct}}It is the common landm…
Published	11/02/2024	Cystic veins drain into {{c1::either the liver sinusoids or the portal vein}}.
Published	11/02/2024	Lymph from the gallbladder and biliary ducts drains into the {{c1::celiac}} lymph nodes.
Published	11/02/2024	The gallbladder is innervated by {{c1::branches of the hepatic plexus (ie vagal trunks and greater splanchnic nn. from the celiac ganglion)}}.
Published	11/02/2024	How is bile from the liver stored in the gallbladder?{{c1::The sphincter of the bile duct is typically closed and diverts it up the cystic duct.}}
Published	11/02/2024	Visceral gallbladder pain (aka biliary {{c1::colic}}) is felt in the {{c1::epigastrium (T5-T9 dermatome)}}.
Published	11/02/2024	Severe inflammation of the parietal peritoneum surrounding the gallbladder may cause pain in the {{c1::right hypochondriac region}} with {{c1::reflexi…
Published	11/02/2024	Biliary colic that results in inflammation of the diaphragmatic peritoneum may refer pain to {{c1::the right neck and shoulder (ie C3-C5 dermatomes fr…
Published	11/02/2024	The progession of pain from cholelisthiases tends to {{c1::begin in the epigastrium, shift to the right hypochondriac region, then potentially refer p…
Published	11/02/2024	The pancreas lies {{c1::transversely}} along the abdominal wall at the level of {{c1::L2}} vertebra(e).
Published	11/02/2024	The pancreas is posterior to the {{c1::stomach::organ}}, anterior to {{c1::the superior mesenteric::aortic branch}} vessels, and lies between the {{c1…
Published	11/02/2024	The head of the pancreas lies within the {{c1::C-loop of the duodenum}} and is in direct contact (posteriorly) with the {{c1::IVC}}, {{c1::right renal…
Published	11/02/2024	The inferomedial projection of the pancreas head is known as the {{c1::uncinate process}}.
Published	11/02/2024	The unicinate process of the pancreas is {{c1::posterior}} to the superior mesenteric vessels and the neck is {{c1::anterior}} to them.
Published	11/02/2024	The neck of the pancreas lies posterior of the {{c1::stomach pylorus}}.
Published	11/02/2024	Posterior of the body of the pancreas are the {{c1::abdominal aorta, left suprarenal gland, left kidney, and renal vessels::4}}.
Published	11/02/2024	The tail of the pancreas is associated with {{c1::the left kidney, splenic hilum, and left colic flexure}}.
Published	11/02/2024	The main pancreatic duct drains the {{c1::tail and body}}.
Published	11/02/2024	The accessory pancreatic duct is not always present but when it is it drains {{c1::the head of the pancreas}}, emptying into {{c1::the minor duodenal …
Published	11/02/2024	The head of the pancreas is supplied by {{c1::anterior/posterior superior pancreaticoduodenal aa. which anastamose with their inferior counterparts fr…
Published	11/02/2024	Pancreatic veins drain into the {{c1::splenic}} vein and lymph vessels into the {{c1::celiac}} lymph nodes.
Published	11/02/2024	The pancreas is sympathetically innervated by {{c1::postganglionic}} nerve fibers from {{c1::the celiac and superior mesenteric plexuses}}. Therefore,…
Published	11/02/2024	Parasympathetic innvervation of the pancreas is from {{c1::a/p vagal trunks from the celiac and superior mesenteric plexuses}}.
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Published	11/02/2024	Anatomically, the gallbladder is {{c3::inferior}} and {{c3::directly adhered}} to the fibrous liver capsule. It projects onto the anterior abdominal w…
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