Podcast
Questions and Answers
A clinician palpates a patient's liver during a routine examination. Which instruction is most appropriate to give the patient to facilitate effective palpation?
A clinician palpates a patient's liver during a routine examination. Which instruction is most appropriate to give the patient to facilitate effective palpation?
- Exhale deeply and hold your breath.
- Breathe normally throughout the examination.
- Take a deep breath and hold it. (correct)
- Cough gently while I apply pressure.
The liver is located in which abdominal quadrant?
The liver is located in which abdominal quadrant?
- Left upper quadrant
- Right upper quadrant (correct)
- Left lower quadrant
- Right lower quadrant
Which anatomical structure provides the most direct protection to the liver?
Which anatomical structure provides the most direct protection to the liver?
- The peritoneum
- The greater omentum
- The thoracic cage and diaphragm (correct)
- The rectus abdominis muscle
During a physical examination, a medical student attempts to locate the upper border of the liver. Following the standard anatomical guidelines, which of the following best describes the location of the upper border?
During a physical examination, a medical student attempts to locate the upper border of the liver. Following the standard anatomical guidelines, which of the following best describes the location of the upper border?
A patient reports pain in the right upper quadrant during deep inspiration. Which anatomical structure's movement is most likely causing this discomfort?
A patient reports pain in the right upper quadrant during deep inspiration. Which anatomical structure's movement is most likely causing this discomfort?
The liver extends into which of the following regions?
The liver extends into which of the following regions?
Regarding the anatomical location of the liver, it crosses midline to which of the following?
Regarding the anatomical location of the liver, it crosses midline to which of the following?
Estimate the liver's mass as a percentage of total adult body weight.
Estimate the liver's mass as a percentage of total adult body weight.
Which of the following structures is NOT directly connected to the liver's visceral surface?
Which of the following structures is NOT directly connected to the liver's visceral surface?
The 'H' shape on the visceral surface of the liver is formed by sagittal fissures connected by which structure?
The 'H' shape on the visceral surface of the liver is formed by sagittal fissures connected by which structure?
Which of the following accurately describes the location of the left triangular ligament?
Which of the following accurately describes the location of the left triangular ligament?
The round ligament of the liver is a remnant of which fetal structure?
The round ligament of the liver is a remnant of which fetal structure?
Which structure is NOT a border of the quadrate lobe?
Which structure is NOT a border of the quadrate lobe?
The hepatorenal recess (Morison's pouch) is a potential site for fluid collection because of its location between the visceral surface of the liver and which other structures?
The hepatorenal recess (Morison's pouch) is a potential site for fluid collection because of its location between the visceral surface of the liver and which other structures?
Which of the following best describes the falciform ligament's attachments?
Which of the following best describes the falciform ligament's attachments?
Which of the following structures is a remnant of the fetal ductus venosus?
Which of the following structures is a remnant of the fetal ductus venosus?
A surgeon needs to divide the liver into its functional right and left lobes. Which anatomical landmark should they primarily consider?
A surgeon needs to divide the liver into its functional right and left lobes. Which anatomical landmark should they primarily consider?
Which of the following best describes the location and relationship of the coronary ligament to the bare area of the liver?
Which of the following best describes the location and relationship of the coronary ligament to the bare area of the liver?
Which anatomical lobe contains both the quadrate and caudate lobes?
Which anatomical lobe contains both the quadrate and caudate lobes?
The subphrenic recess is a superior extension of which of the following?
The subphrenic recess is a superior extension of which of the following?
What is the key difference between anatomical and functional lobes of the liver?
What is the key difference between anatomical and functional lobes of the liver?
In a patient with significant ascites (fluid accumulation in the peritoneal cavity), which recess would be the most likely location for initial fluid collection when the patient is lying supine (on their back)?
In a patient with significant ascites (fluid accumulation in the peritoneal cavity), which recess would be the most likely location for initial fluid collection when the patient is lying supine (on their back)?
During fetal development consider the following: the umbilical vein carries oxygenated blood to the fetus, which is then partially shunted away from the liver via the ductus venosus. After birth, what are the remnants of these two structures, respectively?
During fetal development consider the following: the umbilical vein carries oxygenated blood to the fetus, which is then partially shunted away from the liver via the ductus venosus. After birth, what are the remnants of these two structures, respectively?
What is the functional significance of the caudate and quadrate lobes, despite their anatomical location?
What is the functional significance of the caudate and quadrate lobes, despite their anatomical location?
Which structural relationship is crucial for understanding the liver's venous drainage?
Which structural relationship is crucial for understanding the liver's venous drainage?
How does the coronary ligament contribute to the liver's anatomical positioning and stabilization?
How does the coronary ligament contribute to the liver's anatomical positioning and stabilization?
What is the role of the left triangular ligament in relation to the liver's structure?
What is the role of the left triangular ligament in relation to the liver's structure?
Which anatomical feature is located on the visceral surface of the liver between the groove for the inferior vena cava (IVC) and the fissure for the ligamentum venosum?
Which anatomical feature is located on the visceral surface of the liver between the groove for the inferior vena cava (IVC) and the fissure for the ligamentum venosum?
The functional right lobe of the liver is divided into sections by an oblique line running from the midpoint of the right lobe to the groove of the:
The functional right lobe of the liver is divided into sections by an oblique line running from the midpoint of the right lobe to the groove of the:
Which hepatic segments are contained within the right anterior section of the functional right lobe?
Which hepatic segments are contained within the right anterior section of the functional right lobe?
What is the key characteristic of the communication between the right and left hepatic arteries/ducts, and the right and left hepatic portal veins?
What is the key characteristic of the communication between the right and left hepatic arteries/ducts, and the right and left hepatic portal veins?
The Cantlie line, used to divide the liver into functional lobes, runs from the gallbladder to the:
The Cantlie line, used to divide the liver into functional lobes, runs from the gallbladder to the:
Which of the following best describes the approximate contribution of the hepatic artery to the liver's total blood supply?
Which of the following best describes the approximate contribution of the hepatic artery to the liver's total blood supply?
The hepatic portal vein is formed by the confluence of which two veins?
The hepatic portal vein is formed by the confluence of which two veins?
Which structures constitute the portal triad?
Which structures constitute the portal triad?
Prior to entering the liver, the proper hepatic artery bifurcates into which branches?
Prior to entering the liver, the proper hepatic artery bifurcates into which branches?
What accurately describes hepatic portal vein's function regarding nutrient transport?
What accurately describes hepatic portal vein's function regarding nutrient transport?
The splenic-mesenteric confluence describes the point where the splenic vein converges with which other vessel?
The splenic-mesenteric confluence describes the point where the splenic vein converges with which other vessel?
Hepatic veins drain blood from the liver to which major vessel?
Hepatic veins drain blood from the liver to which major vessel?
The lack of valves in the hepatic veins has which significant clinical implication?
The lack of valves in the hepatic veins has which significant clinical implication?
What are the potential consequences of impaired blood flow through the hepatic veins?
What are the potential consequences of impaired blood flow through the hepatic veins?
The common hepatic artery gives rise to which two terminal branches?
The common hepatic artery gives rise to which two terminal branches?
Why is the hepatic portal vein not considered a true vein?
Why is the hepatic portal vein not considered a true vein?
Why are liver abscesses and metastatic liver cancer relatively common occurrences?
Why are liver abscesses and metastatic liver cancer relatively common occurrences?
A surgeon is about to perform a procedure involving the superior mesenteric vein (SMV). Which of the following structures is the surgeon LEAST likely to encounter directly anterior to the SMV during the procedure?
A surgeon is about to perform a procedure involving the superior mesenteric vein (SMV). Which of the following structures is the surgeon LEAST likely to encounter directly anterior to the SMV during the procedure?
A patient is diagnosed with a tumor obstructing the splenic vein near its junction with the superior mesenteric vein. Which of the following organs will experience impaired venous drainage as a direct result of this obstruction?
A patient is diagnosed with a tumor obstructing the splenic vein near its junction with the superior mesenteric vein. Which of the following organs will experience impaired venous drainage as a direct result of this obstruction?
Following a traumatic injury, a patient is found to have a compromised inferior vena cava (IVC). Which of the following veins would NOT directly drain into the IVC?
Following a traumatic injury, a patient is found to have a compromised inferior vena cava (IVC). Which of the following veins would NOT directly drain into the IVC?
During a surgical procedure, a surgeon identifies the celiac lymph nodes. Which of the following structures would lymph NOT pass through before reaching these nodes?
During a surgical procedure, a surgeon identifies the celiac lymph nodes. Which of the following structures would lymph NOT pass through before reaching these nodes?
Stimulation of the hepatic nervous plexus results in vasoconstriction within the liver. Which nerve fibers are responsible for this?
Stimulation of the hepatic nervous plexus results in vasoconstriction within the liver. Which nerve fibers are responsible for this?
A patient is experiencing difficulty with bile flow into the gallbladder. Which anatomical feature is most likely to be dysfunctional?
A patient is experiencing difficulty with bile flow into the gallbladder. Which anatomical feature is most likely to be dysfunctional?
What is the primary function of the Sphincter of Oddi?
What is the primary function of the Sphincter of Oddi?
A patient presents with jaundice, abdominal pain, and distended abdominal veins radiating from the umbilicus (Caput Medusae). Which of the following conditions is the MOST likely underlying cause?
A patient presents with jaundice, abdominal pain, and distended abdominal veins radiating from the umbilicus (Caput Medusae). Which of the following conditions is the MOST likely underlying cause?
A patient with liver cirrhosis develops esophageal varices due to portal hypertension. This is a direct result of anastomoses between which of the following venous systems?
A patient with liver cirrhosis develops esophageal varices due to portal hypertension. This is a direct result of anastomoses between which of the following venous systems?
A patient with suspected liver disease is scheduled for a liver biopsy. During the procedure, the patient is asked to hold their breath in full expiration. What is the primary reason for this instruction?
A patient with suspected liver disease is scheduled for a liver biopsy. During the procedure, the patient is asked to hold their breath in full expiration. What is the primary reason for this instruction?
Which of the following conditions is LEAST likely to be diagnosed via liver biopsy?
Which of the following conditions is LEAST likely to be diagnosed via liver biopsy?
Following a motor vehicle accident, a patient is found to have a rupture in their inferior vena cava (IVC) within the retroperitoneal space. Which of the following anatomical relationships is most critical to consider to avoid further damage during surgical repair?
Following a motor vehicle accident, a patient is found to have a rupture in their inferior vena cava (IVC) within the retroperitoneal space. Which of the following anatomical relationships is most critical to consider to avoid further damage during surgical repair?
A surgeon is planning to remove a section of the transverse colon. To best understand the venous drainage of this section, the surgeon must have extensive knowledge of the...
A surgeon is planning to remove a section of the transverse colon. To best understand the venous drainage of this section, the surgeon must have extensive knowledge of the...
A patient is diagnosed with cancer that has metastasized to the liver. Given the liver's lymphatic drainage pathways, where would you expect the cancer to spread after the hepatic nodes?
A patient is diagnosed with cancer that has metastasized to the liver. Given the liver's lymphatic drainage pathways, where would you expect the cancer to spread after the hepatic nodes?
Which of the following correctly describes the primary function of the stomach?
Which of the following correctly describes the primary function of the stomach?
How does the position of the stomach typically differ between individuals with a heavier build and those with a slender build?
How does the position of the stomach typically differ between individuals with a heavier build and those with a slender build?
What anatomical landmark indicates the junction between the body and pyloric part of the stomach?
What anatomical landmark indicates the junction between the body and pyloric part of the stomach?
Which structure forms most of the anterior wall of the omental bursa?
Which structure forms most of the anterior wall of the omental bursa?
Which artery directly supplies the lesser curvature of the stomach?
Which artery directly supplies the lesser curvature of the stomach?
Which of the following veins does NOT directly drain into the hepatic portal vein?
Which of the following veins does NOT directly drain into the hepatic portal vein?
If a patient is lying in the supine position, where is the cardiac orifice of the stomach located in relation to the costal cartilage and median plane?
If a patient is lying in the supine position, where is the cardiac orifice of the stomach located in relation to the costal cartilage and median plane?
Which anatomical feature of the stomach is responsible for controlling the discharge of stomach contents into the duodenum?
Which anatomical feature of the stomach is responsible for controlling the discharge of stomach contents into the duodenum?
A surgeon is operating on a patient and needs to locate the transpyloric plane. Which anatomical landmarks can they use to identify this plane?
A surgeon is operating on a patient and needs to locate the transpyloric plane. Which anatomical landmarks can they use to identify this plane?
What is the significance of the gastric canal within the stomach's interior?
What is the significance of the gastric canal within the stomach's interior?
A patient complains of acid reflux. Based on the text, which body type and corresponding stomach position might predispose them to this condition?
A patient complains of acid reflux. Based on the text, which body type and corresponding stomach position might predispose them to this condition?
During a surgical procedure, a doctor needs to identify the fundus of the stomach. Which of the following descriptions accurately describes the fundus's location?
During a surgical procedure, a doctor needs to identify the fundus of the stomach. Which of the following descriptions accurately describes the fundus's location?
A patient has a blockage in the splenic vein. Which of the following veins might be affected, potentially leading to impaired drainage from the stomach?
A patient has a blockage in the splenic vein. Which of the following veins might be affected, potentially leading to impaired drainage from the stomach?
After a large meal, the gastric folds (gastric rugae) inside the stomach are MOST likely to appear how?
After a large meal, the gastric folds (gastric rugae) inside the stomach are MOST likely to appear how?
Which set of structures form the 'bed of the stomach' when a person is lying in a supine position?
Which set of structures form the 'bed of the stomach' when a person is lying in a supine position?
The Pringle maneuver involves clamping the hepatoduodenal ligament to control bleeding during liver trauma. Which structures are NOT directly within the hepatoduodenal ligament that is clamped?
The Pringle maneuver involves clamping the hepatoduodenal ligament to control bleeding during liver trauma. Which structures are NOT directly within the hepatoduodenal ligament that is clamped?
If a gallstone obstructs the cystic duct, what is the most likely immediate consequence?
If a gallstone obstructs the cystic duct, what is the most likely immediate consequence?
Which of the following accurately describes the location of the gallbladder's fundus?
Which of the following accurately describes the location of the gallbladder's fundus?
What is the primary function of the spiral valves within the cystic duct?
What is the primary function of the spiral valves within the cystic duct?
A patient presents with jaundice and elevated liver enzymes. Imaging reveals a gallstone obstructing the common bile duct. Which condition best explains these findings?
A patient presents with jaundice and elevated liver enzymes. Imaging reveals a gallstone obstructing the common bile duct. Which condition best explains these findings?
Following a high-fat meal, which of the following events would most immediately occur in a healthy individual?
Following a high-fat meal, which of the following events would most immediately occur in a healthy individual?
Which of the following statements best describes the role of bile in digestion?
Which of the following statements best describes the role of bile in digestion?
If the cystic artery is accidentally ligated during a cholecystectomy, which part of the gallbladder would be most immediately affected?
If the cystic artery is accidentally ligated during a cholecystectomy, which part of the gallbladder would be most immediately affected?
What is the most likely composition of a yellow gallstone?
What is the most likely composition of a yellow gallstone?
Damage to the R phrenic nerve during surgery near the gallbladder could result in what symptom?
Damage to the R phrenic nerve during surgery near the gallbladder could result in what symptom?
A surgeon is identifying the boundaries of the cystohepatic triangle (of Calot) during a cholecystectomy. Which of the following structures form this triangle?
A surgeon is identifying the boundaries of the cystohepatic triangle (of Calot) during a cholecystectomy. Which of the following structures form this triangle?
How does parasympathetic stimulation affect the gallbladder and the hepatopancreatic ampulla (Ampulla of Vater)?
How does parasympathetic stimulation affect the gallbladder and the hepatopancreatic ampulla (Ampulla of Vater)?
Which of the following statements is most accurate regarding the lymphatic drainage of the gallbladder?
Which of the following statements is most accurate regarding the lymphatic drainage of the gallbladder?
A patient is diagnosed with a condition that results in the insufficient production of bile. What primary effect would this have on the digestive process?
A patient is diagnosed with a condition that results in the insufficient production of bile. What primary effect would this have on the digestive process?
Which portion of the gallbladder communicates bile from the body to the neck?
Which portion of the gallbladder communicates bile from the body to the neck?
Which of the following best describes the lymphatic drainage pattern of the superior two-thirds of the stomach?
Which of the following best describes the lymphatic drainage pattern of the superior two-thirds of the stomach?
A patient is experiencing referred pain originating from the stomach. Which nerve transmits the sensation of pain, fullness, and nausea from the stomach to the central nervous system?
A patient is experiencing referred pain originating from the stomach. Which nerve transmits the sensation of pain, fullness, and nausea from the stomach to the central nervous system?
Following a vagotomy, a patient experiences delayed gastric emptying. Which of the following nerves, when intact, normally functions to relax the pyloric sphincter during gastric emptying?
Following a vagotomy, a patient experiences delayed gastric emptying. Which of the following nerves, when intact, normally functions to relax the pyloric sphincter during gastric emptying?
A surgeon is preparing to perform a highly selective vagotomy. Which nerve branch should the surgeon target to reduce gastric secretion while preserving gastric motility?
A surgeon is preparing to perform a highly selective vagotomy. Which nerve branch should the surgeon target to reduce gastric secretion while preserving gastric motility?
A patient with chronic gastritis is prescribed medication that inhibits gastric acid secretion. Which of the following is a potential long-term consequence of reduced gastric acidity?
A patient with chronic gastritis is prescribed medication that inhibits gastric acid secretion. Which of the following is a potential long-term consequence of reduced gastric acidity?
During a surgical procedure involving the lesser omentum, a surgeon needs to access the epiploic foramen. Which of the following structures serves as the anterior boundary to the epiploic foramen?
During a surgical procedure involving the lesser omentum, a surgeon needs to access the epiploic foramen. Which of the following structures serves as the anterior boundary to the epiploic foramen?
A surgeon is dissecting the hepatoduodenal ligament during a liver transplant and needs to identify the portal vein. Which of the following describes the relative position of the portal vein within this ligament?
A surgeon is dissecting the hepatoduodenal ligament during a liver transplant and needs to identify the portal vein. Which of the following describes the relative position of the portal vein within this ligament?
In a Whipple procedure (pancreaticoduodenectomy), the gastroduodenal artery is ligated. From which artery does the gastroduodenal artery directly arise?
In a Whipple procedure (pancreaticoduodenectomy), the gastroduodenal artery is ligated. From which artery does the gastroduodenal artery directly arise?
During a laparoscopic cholecystectomy, a surgeon identifies the cystic artery within the Triangle of Calot. Which structures form the boundaries of this triangle?
During a laparoscopic cholecystectomy, a surgeon identifies the cystic artery within the Triangle of Calot. Which structures form the boundaries of this triangle?
A patient presents with a blocked cystic duct. Where would the backup of bile most likely occur?
A patient presents with a blocked cystic duct. Where would the backup of bile most likely occur?
During abdominal surgery, the falciform ligament is identified. Which structure is found within the free inferior edge of the falciform ligament?
During abdominal surgery, the falciform ligament is identified. Which structure is found within the free inferior edge of the falciform ligament?
On the visceral surface of the liver, a series of impressions from adjacent organs can be observed. Which impression is LEAST likely to be found on the visceral surface of the liver?
On the visceral surface of the liver, a series of impressions from adjacent organs can be observed. Which impression is LEAST likely to be found on the visceral surface of the liver?
Following a motor vehicle accident, a patient is found to have a ruptured spleen. Which of the following best describes the relationship of the spleen to the greater omentum?
Following a motor vehicle accident, a patient is found to have a ruptured spleen. Which of the following best describes the relationship of the spleen to the greater omentum?
During an upper endoscopy, a patient is found to have inflammation of the stomach lining. Which of the following lifestyle factors is most associated with gastritis?
During an upper endoscopy, a patient is found to have inflammation of the stomach lining. Which of the following lifestyle factors is most associated with gastritis?
A patient presents with epigastric pain that is relieved by eating. An endoscopy reveals gastritis in the stomach. Which of the following best describes the pathophysiology of gastritis?
A patient presents with epigastric pain that is relieved by eating. An endoscopy reveals gastritis in the stomach. Which of the following best describes the pathophysiology of gastritis?
Flashcards
Liver Structure
Liver Structure
The liver has lobes and fissures crucial for its function.
Diaphragmatic Surface
Diaphragmatic Surface
The surface of the liver facing the diaphragm.
Visceral Surface
Visceral Surface
The surface of the liver that faces the internal organs.
Liver Ligaments
Liver Ligaments
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Liver Location
Liver Location
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Liver Blood Supply
Liver Blood Supply
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Palpation Technique
Palpation Technique
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Liver Function
Liver Function
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Functional Right Lobe
Functional Right Lobe
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Right Anterior Section
Right Anterior Section
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Right Posterior Section
Right Posterior Section
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Hepatic Segments
Hepatic Segments
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Cantlie Line
Cantlie Line
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Portal Triad
Portal Triad
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Hepatic Portal Vein
Hepatic Portal Vein
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Hepatic Artery
Hepatic Artery
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Valveless Hepatic Veins
Valveless Hepatic Veins
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Splenic-Mesenteric Confluence
Splenic-Mesenteric Confluence
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Nutrient Transport
Nutrient Transport
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Venous Drainage
Venous Drainage
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Surgical Lobe Removal
Surgical Lobe Removal
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Hepatic Functionality
Hepatic Functionality
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Risk of Hepatic Congestion
Risk of Hepatic Congestion
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Lymphatic Drainage of Stomach
Lymphatic Drainage of Stomach
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Superior 2/3 of Stomach
Superior 2/3 of Stomach
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Gastric Lymph Nodes
Gastric Lymph Nodes
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Pyloric Lymph Nodes
Pyloric Lymph Nodes
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Neural Innervation of Stomach
Neural Innervation of Stomach
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Anterior Vagal Trunk
Anterior Vagal Trunk
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Parasympathetic Function
Parasympathetic Function
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Posterior Vagal Trunk
Posterior Vagal Trunk
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Visceral Afferent Nerves
Visceral Afferent Nerves
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Celiac Plexus
Celiac Plexus
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Gastritis
Gastritis
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Symptoms of Gastritis
Symptoms of Gastritis
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Epiploic Foramen
Epiploic Foramen
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Hepatogastric Ligament
Hepatogastric Ligament
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Common Bile Duct
Common Bile Duct
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Gallbladder Length
Gallbladder Length
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Gallbladder Shape
Gallbladder Shape
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Gallbladder Location
Gallbladder Location
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Gallbladder Functions
Gallbladder Functions
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Cystic Duct
Cystic Duct
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Ampulla of Vater
Ampulla of Vater
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Gallbladder Stones
Gallbladder Stones
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Cholecystitis
Cholecystitis
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Cystic Artery
Cystic Artery
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Gallbladder Nerves
Gallbladder Nerves
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Cholecystectomy
Cholecystectomy
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Types of Gallstones
Types of Gallstones
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Biliary Duct System
Biliary Duct System
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Sphincter of Oddi
Sphincter of Oddi
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Lymphatic Drainage of Gallbladder
Lymphatic Drainage of Gallbladder
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Right Sagittal Fissure
Right Sagittal Fissure
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Left Sagittal Fissure
Left Sagittal Fissure
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Falciform Ligament
Falciform Ligament
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Coronary Ligament
Coronary Ligament
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Round Ligament
Round Ligament
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Ligamentum Venosum
Ligamentum Venosum
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Caudate Lobe
Caudate Lobe
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Quadrate Lobe
Quadrate Lobe
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Anatomical Lobes
Anatomical Lobes
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Fissures of the Liver
Fissures of the Liver
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Bare Area of the Liver
Bare Area of the Liver
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Hepatorenal Recess
Hepatorenal Recess
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Open Venous System
Open Venous System
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Superior Mesenteric Vein (SMV)
Superior Mesenteric Vein (SMV)
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Right Gastroepiploic Vein
Right Gastroepiploic Vein
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Pancreaticoduodenal Vein
Pancreaticoduodenal Vein
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Inferior Mesenteric Vein (IMV)
Inferior Mesenteric Vein (IMV)
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Inferior Vena Cava (IVC)
Inferior Vena Cava (IVC)
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Lymphatic Drainage of the Liver
Lymphatic Drainage of the Liver
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Hepatic Nervous Plexus
Hepatic Nervous Plexus
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Biliary Ducts
Biliary Ducts
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Portal Hypertension
Portal Hypertension
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Caput Medusa
Caput Medusa
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Liver Biopsy
Liver Biopsy
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Portal System
Portal System
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Stomach
Stomach
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Chief function of the stomach
Chief function of the stomach
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Parts of the stomach
Parts of the stomach
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Cardia
Cardia
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Fundus
Fundus
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Body of the stomach
Body of the stomach
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Pyloric Part
Pyloric Part
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Lesser Curvature
Lesser Curvature
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Greater Curvature
Greater Curvature
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Gastric Rugae
Gastric Rugae
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Arterial Supply
Arterial Supply
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Lymphatic Drainage
Lymphatic Drainage
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Position of the stomach
Position of the stomach
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Chyme
Chyme
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Left Triangular Ligament
Left Triangular Ligament
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Study Notes
Liver
- Largest gland and visceral organ in the body, weighing approximately 1500g (2.5% of body weight)
- Primarily located in the right upper quadrant, extending into the upper epigastrium and slightly into the left hypochondrium.
- Protected by ribs and diaphragm.
- Lower border: tip of 10th rib to left 5th intercostal space along midclavicular line.
- Upper border: follows line passing through 5th intercostal space on each side.
Liver Surfaces
- Diaphragmatic Surface: Supero-anterior, covered in visceral peritoneum (except bare area), contacts diaphragm.
- Visceral Surface: Postero-inferior, covered in visceral peritoneum (except fossa of gallbladder and porta hepatis), two sagittal fissures form 'H' shape.
Liver Recesses
- Subphrenic Recess: Superior extension of greater sac (left and right, separated by falciform ligament).
- Subhepatic Space: Supracolic compartment inferior to liver.
- Hepatorenal Recess (Morison Pouch): Subhepatic space's posterosuperior extension, between visceral liver, right kidney, and suprarenal gland; common fluid collection site.
Liver Ligaments
- Coronary Ligament: Attaches liver to diaphragm, reflection of peritoneum (anterior and posterior portions).
- Falciform Ligament: Most anterior surface, connects liver to anterior abdominal wall.
- Round Ligament (Ligamentum Teres Hepatis): Inferior end of falciform ligament, remnant of umbilical vein; divides liver into left and right lobes.
- Ligamentum Venosum: Remnant of fetal ductus venosus; connects umbilical vein to IVC- Important division in anatomical and functional liver lobes.
Liver Divisions
- Anatomical Lobes: Externally divided into right (larger) and left lobes by peritoneum reflections and fissures; includes quadrate and caudate lobes.
- Functional Lobes: Divided by Cantlie's line (through gallbladder fundus to IVC) into roughly equal left and right functional lobes with 8 hepatic segments.
Liver Neurovasculature
- Arterial Supply: 20% from hepatic artery (celiac trunk branch), 80% from hepatic portal vein (superior mesenteric and splenic veins).
- Portal Triad (Porta Hepatis): Contains portal vein, hepatic artery, and common hepatic duct; transmits lymphatic vessels, nerves.
- Venous Drainage: Hepatic portal vein (receives nutrients/toxins from GI tract), hepatic veins (drain blood from liver to IVC, no valves).
Liver Lymphatic Drainage
- Drains mainly to hepatic nodes at porta hepatis, then celiac nodes, thoracic duct.
Liver Innervation
- Hepatic nervous plexus (celiac plexus + vagal trunks), sympathetic and parasympathetic fibers; accompanies vessels/ducts; purpose of nerve fibers largely unknown.
Biliary Ducts
- Right Hepatic Duct: Drains right lobe
- Left Hepatic Duct: Drains left lobe
- Common Hepatic Duct: Forms from union of R & L, outside liver.
- Cystic Duct: Drains gallbladder to common bile duct (spiral valves of Heister).
- Common Bile Duct: Formed by union of common hepatic and cystic ducts; joins pancreatic duct, forming Ampulla of Vater (Sphincter of Oddi).
Liver Clinical Correlates
- Portal Hypertension: Increased pressure in portal system (causes: cirrhosis, clots, schistosomiasis); leads to varicose veins.
- Liver Biopsy: Procedure to diagnose liver disease.
- Pringle Maneuver: Clamping hepatoduodenal ligament during liver trauma.
Gallbladder
- Pear-shaped, 7-10cm, holds 50mL.
- Located in fossa on visceral liver surface.
Gallbladder Parts
- Fundus: Adjacent to anterior abdominal wall, behind 8th costal cartilage.
- Body: Largest, inferior to liver.
- Infundibulum (Hartmann's pouch): Tapering between body and neck.
- Neck: Most proximal/narrow, folds (spiral valves of Heister) allow bidirectional bile flow, connects to cystic duct.
- Cystic Duct: Connects gallbladder to common bile duct.
Gallbladder Neurovasculature
- Arterial Supply: Primarily cystic artery (branch of right hepatic), also from posterior superior pancreaticoduodenal & gastroduodenal arteries.
- Venous Drainage: Cystic vein (from neck & duct), hepatic sinusoids (from fundus & body).
- Lymphatic Drainage: Hepatic and cystic lymph nodes.
- Nerves: Parasympathetic (contraction/sphincter relaxation) and sympathetic (unknown), stimulated by cholecystokinin (CCK).
Gallbladder Clinical Correlates
- Gallstones (cholelithiasis): Hardened deposits (cholesterol/pigment); causes cholecystitis (inflammation).
- Cholecystectomy: Surgical removal of gallbladder.
Stomach
- Expandable digestive organ (2-3L capacity).
- Between esophagus and small intestine.
Stomach Position
- Primarily in RUQ and LUQ epigastric, umbilical, and left hypochondrium regions; moves inferiorly in upright posture.
- Position influenced by body build (heavy: high, transverse; slender: low, vertical):
Stomach Parts
- Cardia: Surrounds cardiac orifice (opening).
- Fundus: Dilated superior part, related to left diaphragm.
- Body: Major part.
- Pyloric Part: Funnel-shaped outflow:
- Pyloric Antrum: Wider part.
- Pyloric Canal: Narrower part.
- Pylorus: Distinct sphincter region.
Stomach Curvatures
- Lesser Curvature: Shorter, concave, right border, includes angular incisure.
- Greater Curvature: Longer, convex, left border.
Stomach Interior
- Gastric Rugae: Folds in mucosa, diminished in full stomach, protect stomach from acid.
- Gastric Canal: Formed by mucosa/muscular layer attachment, drains saliva/food.
Stomach Relations
- Anterior: Diaphragm, left liver lobe, abdominal wall.
- Posterior: Omental bursa, pancreas.
- Inferior/Lateral: Transverse colon.
Stomach Neurovasculature
- Arterial Supply: Celiac trunk branches (gastric, gastro-omental)
- Venous Drainage: Gastric veins → portal/splenic/ superior mesenteric veins.
- Lymphatic Drainage: Gastric, pancreaticosplenic, pyloric, pancreatoduodenal nodes drain based on anatomic position.
- Neural Innervation: Anterior vagal trunk, posterior vagal trunk, sympathetic fibers (celiac plexus), visceral afferents (vagus nerves).
Stomach Clinical Correlates
- Gastritis: Stomach lining inflammation (causes: bacteria/pain relievers/alcohol/stress).
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Description
Explore liver palpation techniques, anatomical location, and protective structures during an examination. The liver’s position in the abdominal quadrants and its relation to other anatomical structures is discussed.
