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Anatomy: Clinical Anatomy - Liver, Gallbladder & Pancreas

Anatomy and Physiology25 CardsCreated about 2 months ago

These flashcards outline the 11 key functions of the liver, including bile production, detoxification, storage of nutrients, synthesis of plasma proteins and clotting factors, and fetal hematopoiesis. They also describe the liver’s anatomical features, such as its size, lobes (with special emphasis on the caudate lobe), associated ligaments (e.g., falciform), and important peritoneal spaces (subhepatic space, hepatorenal recess). Clinical relevance includes the bare area and peritonitis, with drainage implications.

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Functions of liver: (11 functions)

  • produce & secrete bile (emulsifies fat) - produces bile pigments (bilirubin&biliverdin) = breaks down hemoglobin - detox & blood filtration - stores carbs (glycogen ->glucose) - produce/store lipids (triglycerides) - plasma protein synthesis (albumin&globulin) - produce blood coagulates (coagulation factors I, II, V, VII, IX, X, XI) - produce anticoagulants (heparin, protein C, protein S, antithrombin) - reservoir for blood&platelets - stores calcium, vitamin B12, iron, copper - fetus = produce RBC

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Key Terms

Term
Definition

Functions of liver: (11 functions)

  • produce & secrete bile (emulsifies fat) - produces bile pigments (bilirubin&biliverdin) = breaks down hemoglobin - detox & bloo...

Largest visceral organ. Largest gland in human body?

Liver - weight=1500g (2.5% adult body weight) - right hypochondrium, epigastrium, part of left hypochondrium

Which lobe is considered a “third liver”?

CAUDATE LOBE - independent vascularization (vessels from both portal triad bundles) - drained by 1 or 2 small hepatic vv. (directly to IVC)

Falciform ligament

Liver –> anterior abdominal wall - separates subphrenic recesses (R/L)

Subhepatic space

Portion of subcolic compartment of peritoneal cavity immediately inferior to liver

Hepatorenal recess (Morison pouch)

Posteriosuperior extension of subhepatic space (b/t right kidney & right visceral surface of liver) - fluid draining from omental bursa drain h...

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Anatomy: Clinical Anatomy - Liver, Gallbladder & Pancreas
TermDefinition

Functions of liver: (11 functions)

  • produce & secrete bile (emulsifies fat) - produces bile pigments (bilirubin&biliverdin) = breaks down hemoglobin - detox & blood filtration - stores carbs (glycogen ->glucose) - produce/store lipids (triglycerides) - plasma protein synthesis (albumin&globulin) - produce blood coagulates (coagulation factors I, II, V, VII, IX, X, XI) - produce anticoagulants (heparin, protein C, protein S, antithrombin) - reservoir for blood&platelets - stores calcium, vitamin B12, iron, copper - fetus = produce RBC

Largest visceral organ. Largest gland in human body?

Liver - weight=1500g (2.5% adult body weight) - right hypochondrium, epigastrium, part of left hypochondrium

Which lobe is considered a “third liver”?

CAUDATE LOBE - independent vascularization (vessels from both portal triad bundles) - drained by 1 or 2 small hepatic vv. (directly to IVC)

Falciform ligament

Liver –> anterior abdominal wall - separates subphrenic recesses (R/L)

Subhepatic space

Portion of subcolic compartment of peritoneal cavity immediately inferior to liver

Hepatorenal recess (Morison pouch)

Posteriosuperior extension of subhepatic space (b/t right kidney & right visceral surface of liver) - fluid draining from omental bursa drain here - communicates anteriorly with right subphrenic recess

Peritonitis

Inflammation of peritoneal cavity - subphrenic recess = common site for pus - RIGHT subphrenic abscesses more common - drained via incision @12th rib or inferior; or subcostal incision inferior/peerless to R. costal margin

Bare area of liver?

Posterior: reflection of diaphragm peritoneum as anterior (upper) & posterior (lower) layers of CORONARY LIGAMENT - ports hepata + fossa for gallbladder also = no peritoneum

Areas of liver (impressions):

  1. Gastric & pyloric (R side anterior aspect of stomach) 2. Duodenal (superior duodenum) 3. Fossa for gallbladder 4. Colic (R colic flexure + R transverse colon) 5. Renal & suprarenal (R kidney + suprarenal gland)

Dual Blood Supply

Dominant venous supply + lesser arterial supply


Portal vein

  • Superior mesenteric v + splenic v. - ascends anterior to IVC

Cirrhosis of liver

Liver cells progressively destroyed and replaced by fatty/ fibrous tissue - impedes liver circulation - chronic alcoholism, Hep B,C,D, poison ingestion - causes portal hypertension

Portal-systemic anastomoses:

  1. Submucosal esophageal vv./ azygos 2. Inferior & middle rectal vv. (hemorrhoids) 3. Paraumbilical vv./ small epigastric vv. (capital medusae) 4. Retroperitoneal viscera

Liver Biopsy

  1. Percutaneously by needle; right 8th or 9th intercostal space in the right midaxillary line; ultra-sound or computed tomography (CT) scan guidance - patient holds breath in full expiration to reduce costodiaphragmatic recess (lessen chance of damaging lung) 2. Transjugular liver biopsy; catheter into the right internal jugular vein, guiding through the superior vena cava, IVC, and right hepatic vein. - biopsy needle is inserted through catheter

Gallbladder

  • stores + concentrates bile - releases it intermittently when fat enters the duodenum - bile emulsifies the fat = easy absorption

which hormone (produced by the duodenal mucosa) causes contraction of gallbladder ?

cholecystokinin

what is the abnormal conical pouch that may be present in the neck of the gallblader?

Hartmann’s pouch (also = ampulla of gallbladder)

Where do gallstones commonly collect?

in the infundibulum

What could occur that would allow gallstones to enter the duodenum?

If a peptic duodenal ulcer ruptures = false passage may form between GB infundibulum + superior part of duodenum “cholecystenteric fistula”


“Cholelithiasis” Name 3 main types of gallstones:

  1. Cholesterol stones (crystalline cholesterol monohydrate) –yellow; in Western countries 2. Pigment stones (bilirubin calcium salts) – dark colored; other countries 3. Brown Stones – biliary infections (parasites or bacteria)

gallstone ileus

gallstone entering small intestine becomes trapped at ileocecal valve = bowel obstruction


Functions of Pancreas:

- exocrine secretion: pancreatic juice (from acinar cells) enters duodenum

  • endocrine secretions: insulin, glucagon, somatostatin, etc. (from inlets of Langerhans) enter the blood

Common/acute pancreatitis:

bile fr. bile duct goes retrogradly into pancreas (bile duct possibly blocked by stone)

Identify the structures

(inferior view)

Pancreatic Cancer

  • most cases of extrahepatic obstruction of biliary ducts = cancer of pancreatic head

  • One of the 1st symptoms: jaundice (obstructive jaundice); obstruction = retention of bile pigments + enlargement of the gallbladder + jaundice

  • 90% of people w. pancreatic cancer have ductular adenocarcinoma (glandular origin)

  • Severe pain in the back = common

  • Cancer of neck + body of pancreas may cause portal or IVC obstruction (pancreas overlies these)

  • no clinical symptoms for long period of time (until tumor reaches particular size)

  • Metastasizes to liver & other structures ==> cannot remove all cancerous cells so prognosis is often not good