Notes in Liver/Gall Bladder

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Published	01/20/2024	The {{c1::Diaphragmatic}} surface of liver is smooth andlies against the inferior surface of thediaphragm
Published	01/20/2024	Associated with the diaphragmatic surface are the {{c1::subphrenic}} and {{c1::hepatorenal}} recesses.
Published	01/20/2024	Subphrenic recesses divided into right and leftareas by the {{c1::falciform}} ligament (derived fromventral mesogastrium).
Published	01/20/2024	Falciform ligament – its free edge contains {{c1::ligamentum teres hepatis}} (remnant of left umbilical vein)
Published	01/20/2024	The Liver is the largest visceral organ. Located right hypochondrium and epigastric region, extending into left {{c1::hypochondrium, RUQ}} and {{c1::L…
Published	01/20/2024	Visceral surface of the liver is covered with visceral peritoneumexcept in the fossa for the {{c1::gallbladder}} and at the {{c1::porta hepatis}}
Published	01/20/2024	Porta hepatis is the point of entry into the liver for {{c1::hepatic}} arteries and {{c1::portal}} vein, and exit point for {{c1::hepatic ducts}} (fus…
Published	01/20/2024	The Liver is divided into right and left lobes by the falciform ligamentanteriorly and the {{c1::ligamentum venosum}} and fissure for the {{c1::ligame…
Published	01/20/2024	The {{c1::Quadrate}} and {{c1::Caudate}} lobes of the liver are described as arising from the right lobe but functionally are distinct.
Published	01/20/2024	Quadrate lobe is visible on visceral surface of the liverbounded on left by the fissure for {{c1::ligamentum teres}} and on rightby {{c1::fossa for th…
Published	01/20/2024	Caudate lobe is visible on visceral surface of liver.bounded on the left by the fissure for the {{c2::ligamentum venosum}} and on right by the groove …
Published	01/20/2024	Round ligament of the liver:{{c1::Ligamentum teres hepatis}}
Published	01/20/2024	Ligament which connect liver to diaphragm:{{c1::Right and left triangular ligaments}}{{c1::Anterior and posterior coronary ligaments}}
Published	01/20/2024	Ligaments of Liver:{{c1::Falciform ligamentLigamentum teres hepatisLigamentum venosumLesser omentum }}
Published	01/20/2024	Bare area of liver is large triangular area on diaphragmatic surface where there is no {{c1::intervening peritoneum}} between liver and diaphragm; has…
Published	01/20/2024	What capsule surrounds liver?{{c1::Glisson’s}}
Published	01/20/2024	Clinical importance of bare area – site of {{c1::portocaval anastomosis}}, infection can spread form abdominal cavity to thoracic cavity
Published	01/20/2024	Ligamentum venosum is the fibrous remnant of the ductus venosus - connects left branch of {{c1::portal vein}} to the left {{c1::hepatic vein}}
Published	01/20/2024	Blood supply of Liver – very vascular organ, dual blood supply1. {{c1::Portal vein}} – 70-75% blood supply 2. {{c1::Hepatic artery}} – 20-25% blood su…
Published	01/20/2024	Arterial and portal blood mixes within the {{c1::hepatic sinusoids.}}
Published	01/20/2024	Sinusoids ultimately drain into 3 Hepatic veins (R, L, Middle Hepatic) which open directly into {{c1::IVC}}
Published	01/20/2024	{{c1::Transarterial embolization (TAE)}} and {{c1::Transarterial chemoembolization (TACE)}} for hepatocellular carcinoma (HCC) – chemotherapeutic…
Published	01/20/2024	Common hepatic artery divides into the {{c1::gastroduodena}}l arteryand the {{c1::proper hepatic}} artery
Published	01/20/2024	The proper hepatic artery divides into {{c1::right and left hepatic}} arteries
Published	01/20/2024	Right hepatic artery gives rise to the {{c1::cystic}} artery
Published	01/20/2024	The {{c1::proper hepatic}} artery runs in the free edge of the lesseromentum and can be compressed by the Pringle maneuver
Published	01/20/2024	{{c1::Aberrant hepatic}} arteries may not get compressed by Pringlemaneuver!
Published	01/20/2024	Functionally, the right lobe is on its own, while the {{c1::quadrate, caudate, and left lobe}} act as a functional left lobe
Published	01/20/2024	Anatomically the right lobe consists of the {{c1::right lobe, quadrate lobe, & caudate lobe}}
Published	01/20/2024	8 Functional Segments of LiverEach segment has its own {{c1::vascular inflow,outflow and biliary drainage}}
Published	01/20/2024	Portal vein – 8cm longFormed by union of {{c1::superior mesenteric}} vein and {{c1::splenic}} vein
Published	01/20/2024	Anterior to the portal vein are the {{c1::bile duct}} to right andthe {{c1::proper hepatic}} artery to the left
Published	01/20/2024	{{c1::Portal hypertension}} - commonest causecirrhosis of liver, seen in chronic alcoholics
Published	01/20/2024	{{c1::Cirrhosis}} – widespread hepatic fibrosis with nodular regeneration.
Published	01/20/2024	Increased pressure inside portal vein causes {{c1::splenic congestion}}, {{c1::esophageal varices}}, {{c1::hemorrhoids}}, {{c1::caput medusae}}
Published	01/20/2024	{{c1::Portocaval}} shunts and {{c1::TIPS}} can be used to reducepressure in portal vein.
Published	01/20/2024	Tributaries of portal vein• Right and left {{c1::gastric veins}}• {{c1::Cystic}} vein• {{c1::Paraumbilical}} veins – connected toveins on anterior abd…
Published	01/20/2024	Tributaries of Splenic vein• {{c1::Short gastric}} veins – fundus and leftpart of greater curvature of stomach• {{c1::Left gastro-omental vein}}• {{c1…
Published	01/20/2024	Tributaries of Superior mesenteric vein• {{c1::Right gastro-omental}} vein• {{c1::Anterior and posterior inferiorpancreaticoduodenal}} vein
Published	01/20/2024	Portal is posterior to neck of {{c1::pancreas at L1}}
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Published	01/20/2024	Borders of Epiploic foramenBorders:• Caudate process of liver above• first part of duodenum below• Posteriorly {{c1::Inferior vena cava}}• Anteriorly …
Published	01/20/2024	If bleeding continues after Pringlemaneuver – suspect Injury to {{c1::IVC}} or {{c1::hepaticveins}} or {{c1::aberrant hepatic artery}}
Published	01/20/2024	Nerve supply of Liver hepatic nerve plexus (from celiac plexus), accompanies branches of{{c1::hepatic}} artery and {{c1::portal}} vein
Published	01/20/2024	Sympathetic fibers for liver- postganglionicsympathetic fibers from {{c1::celiac andsuperior mesenteric}} plexus
Published	01/20/2024	Parasympathetic for liver -  fibers from {{c1::anterior and posterior vagal trunks}}
Published	01/20/2024	Lymphaticsdrain to hepatic nodes at {{c1::porta hepatis}}Hepatic nodes → {{c2::celiac}} nodes
Published	01/20/2024	An inferior sacculation (outpouching) ofthe gallbladder infundibulum or neck issometimes present; this is called the{{c1::Hartmann}} pouch
Published	01/20/2024	Gallbladder has an inferior {{c1::peritoneal}} surface and a superior {{c1::hepatic}} surface that is closely applied to gallbladder bed in liver
Published	01/20/2024	{{c1::Cholelithiasis}} - presence of gallstones usually in the gallbladder
Published	01/20/2024	{{c1::Choledocholithiasis}} - presence of gallstones in common bile duct (CBD)
Published	01/20/2024	{{c1::Acute cholecystitis}} – Well-localized pain in the right upper quadrant, usually with rebound tenderness and guarding; positive Murphy sign and …
Published	01/20/2024	{{c1::Positive Murphy sign}} - inspiratory arrest on deep palpation of RUQ during deep inspiration, is highly suggestive of cholecystitis
Published	01/20/2024	{{c1::Chronic cholecystitis}} - repeated attacks of pain (biliary colic) that occur when gallstones periodically block the cystic duct. Unpredictable …
Published	01/20/2024	Pain from chronic cholecystitis is termed {{c1::biliary colic}} occurs when gallstones impact in cystic duct during gallbladder contraction, increasin…
Published	01/20/2024	Occasionally, a large stone may erode through wall of gallbladder into an adjacent viscus (typically duodenum), producing a {{c1::cholecystoenteric fi…
Published	01/20/2024	A stone, if sufficiently large, may obstruct thesmall intestine, usually at the level of theileum, a phenomenon termed {{c1::gallstoneileus.}}
Published	01/20/2024	{{c1::Cholecystitis}} – inflammation of gall bladder
Published	01/20/2024	{{c1::Ascending cholangitis}} (AKA acute cholangitis or cholangitis) – inflammation of bile duct usually caused by bacteria ascending from duodenum
Published	01/20/2024	{{c1::Endoscopic retrogradecholangiopancreatography (ERCP)}} is atechnique that uses a combination of luminalendoscopy and fluoroscopic imaging t…
Published	01/20/2024	{{c1::Percutaneous transhepaticcholangiography (PTC)}} involvestranshepatic insertion of a needle into abile duct, followed by injection ofcontra…
Published	01/20/2024	Hepatobiliary triangle• {{c1::cystic duct}},• {{c1::Common hepatic duct}}• {{c1::Inferior surface of the liver}}
Published	01/20/2024	{{c1::Cystic artery}} runs from righthepatic artery to gallbladder
Published	01/20/2024	{{c1::Cystic lymph node}} often liessuperficial to cystic artery and actsa landmark to locate this artery
Published	01/20/2024	{{c1::Cholecystectomy}}: Cystic arteryshould be divided close to thegallbladder to avoid injury to righthepatic artery
Published	01/20/2024	Lymphatic drainage of the gallbladder goes to {{c1::cystic}} lymph nodes located near the neck of the gallbladder and to {{c1::hepatic}} lymph no…
Published	01/20/2024	Nerves to gallbladder and cystic duct pass along the cysticartery from celiac (nerve) plexus –sympathetic ({{c1::Visceral afferent}} Fibers- Pain)-{{c…
Published	01/20/2024	Sympathetic nerves of Gall Bladder {{c1::Greater splanchnic nerve (T5-9)Lesser splanchnic nerve (T10-11)Least splanchnic nerve (T12)}}
Published	01/20/2024	{{c1::Lumbar splanchnic nerves (L1-3)}} carry preganglionic sympathetic. Fibers end in inferior mesenteric ganglion. The postganglionic fibers su…
Published	01/20/2024	Name the two parasympathetic nerves for gallbladder:{{c1::Vagus nerve}}{{c1::Pelvic splanchnic nerves (S2-4)}}
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