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Questions and Answers
What is the sympathetic innervation of the liver primarily supplied by?
Where is the referred pain located for the parenchyma of the liver?
What type of innervation provides the gallbladder with stimulation for contraction?
Which anatomical area does the pancreas refer pain to when inflamed?
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What procedure is used to remove obstructing gallstones within the biliary tree?
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What may cause splenomegaly during normal physiological functioning?
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What nerve supply is dominant in the spleen?
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What type of pain is associated with the diaphragmatic surface of the liver?
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What is the primary function of the gallbladder?
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Which part of the pancreas lies within the C-shaped concavity of the duodenum?
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What is the approximate length of the cystic duct?
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Which artery supplies blood to the gallbladder?
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What type of duct joins the bile duct in the lower part of the pancreas?
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Where does the splenic vein drain into?
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What is the main lymphatic drainage of the pancreas?
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Which structure runs supraduodenal, retroduodenal, infraduodenal, and then intraduodenal?
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What is the key function of the spleen?
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Which ligament is attached to the greater curvature of the stomach?
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What is the primary function of the liver related to blood?
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Which ligament attaches the liver to the anterior abdominal wall?
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Which lobe of the liver is the largest?
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What is the significance of the porta hepatis?
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Which of the following structures is NOT associated with the visceral surface of the liver?
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What divides the liver into functional segments?
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Which of the following ligaments separates the left and right lobes of the liver?
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Which organ is primarily located in the right hypochondrium and epigastric region?
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Which of the following is the remnant of the ductus venosus?
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The lymphatic drainage of the liver generally exits through which nodes?
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What clinical significance does the bare area of the liver have?
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Which lobe of the liver is functionally associated with the left lobe?
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Which ligament attaches the liver to the stomach?
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What is the anatomical relationship of the hepatic ducts to the portal vein at the porta hepatis?
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Study Notes
Liver
- Largest visceral organ in the body.
- Situated primarily in the right hypochondrium and epigastric region, extending to the left hypochondrium.
- Has two surfaces: diaphragmatic (anterior, superior, and posterior) and visceral (inferior).
- Responsible for metabolism, synthesis of bile and prothrombin, excretion, glycogen storage, and protection via antibody formation.
Diaphragmatic Surface
- Smooth and domed.
- Lies against the inferior surface of the diaphragm.
- Associated with subphrenic and hepatorenal recesses.
- Subphrenic recess separates the liver from the diaphragm, divided into left and right areas by the falciform ligament.
- Hepatorenal recess is a part of the peritoneal cavity on the right side, between the liver and right kidney and suprarenal gland.
- Both recesses are continuous anteriorly.
Visceral Surface
- Covered with visceral peritoneum, except in the fossa for the gallbladder and at the porta hepatis (gateway to the liver).
- Contains several related structures:
- Oesophagus
- Right anterior part of the stomach
- Superior part of the duodenum
- Lesser omentum
- Gallbladder
- Right colic flexure
- Right transverse colon
- Right kidney
- Right suprarenal gland
Porta Hepatis
- Deep transverse fissure between the quadrate and caudate lobes.
- Point of entry for hepatic arteries and the portal vein.
- Point of exit for hepatic ducts.
- Attachment site for the lesser omentum.
- Hepatic ducts lie anterior to the portal vein, with hepatic arteries typically between them.
Falciform Ligament
- Attaches the liver to the anterior abdominal wall.
- On the posterior surface, it divides the liver into right and left lobes.
- Contains the ligamentum venosum and ligamentum teres.
- Ligamentum venosum is on the posterior surface of the liver, bordering the caudate lobe on the superior margin, and is a remnant of the ductus venosus.
- Ligamentum teres (round ligament of the liver) is also on the posterior surface, found in the interlobar notch, bordering the quadrate lobe on the inferior margin, and is a remnant of the umbilical vein.
Ligaments
- Other ligaments associated with the liver:
- Hepatogastric ligament: between the liver and stomach.
- Hepatoduodenal ligament: between the liver and duodenum.
- Right and left triangular ligaments: attach the liver to the diaphragm.
- Anterior and posterior coronary ligaments: attach the liver to the diaphragm.
- They enclose the bare area of the liver (area not covered by peritoneum).
Bare Area
- Part of the liver free from peritoneum.
- Anterior boundary: indicated by the anterior coronary ligament.
- Posterior boundary: indicated by the posterior coronary ligament.
- Coronary ligaments come together laterally to form the right and left triangular ligaments.
Lobes
- The falciform ligament divides the liver into right and left lobes.
- Right lobe: largest, approximately 5/6 of the liver.
- Left lobe: flattened from above downwards, approximately 1/6 of the liver.
- Posteriorly, the fissure for the ligamentum venosum and ligamentum teres divides the liver into two lobes:
- Quadrate lobe: boundaries are the fissure for the ligamentum teres (left) and the fossa for the gallbladder (right). Functionally associated with the left lobe.
- Caudate lobe: boundaries are the fissure for ligamentum venosum (left) and the groove for the inferior vena cava (right). Functionally separate from both the right and left lobes.
Vasculature of the Liver
- Hepatic artery, hepatic portal veins, and hepatic veins.
- Hepatic artery and portal vein ascend in the lesser omentum to the porta hepatis.
- Common hepatic duct and lymphatic vessels descend in the lesser omentum.
- Hepatic veins leave the liver on its posterior surface to drain into the IVC.
- Lymphatic drainage: caval, hepatic, paracardial, and coeliac nodes. Some lymph from the coronary ligaments drain into the thoracic duct directly.
Functional Lobes of the Liver
- Divided into eight functional segments based on the distribution of portal venous branches in the parenchyma.
- Divided into four portal sectors: right anterior, right posterior, left medial, and left lateral.
- Division is due to four main hepatic veins.
- Three hepatic veins lie between segments as intersectoral veins.
- The veins lie in the main fissures which divide the sectors.
- Three minor fissures (umbilical, venous, Rouvieres sulcus) appear as physical clefts on the liver surface.
Gallbladder
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A pear-shaped sac lying between the right and quadrate lobes of the liver.
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Approximately 7-10cm long, 3cm broad, with a capacity of 30-50ml.
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Receives, concentrates, and stores bile from the liver.
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Components:
- Fundus: rounded end, projects from the inferior border of the liver, in the angle between the rectus abdominus and 9th costal cartilage.
- Body: lies against the transverse colon and superior part of the duodenum, continuous with the neck at the right end of the porta hepatis.
- Neck: narrow part with mucosal folds forming a spiral fold which prevents obstruction to the outflow/inflow of bile.
Gallbladder Structures
- Cystic duct: 3-4cm long, begins at the neck of the gallbladder.
- Joins the common hepatic duct at an angle to form the bile duct.
- Mucous membrane forms crescenteric folds.
- Bile duct: Formed by the cystic duct joining the common hepatic duct.
- 8cm long.
- Runs supraduodenal, retroduodenal, infraduodenal, and then intraduodenal.
- Opens into the major duodenal papilla.
Neurovasculature of Gallbladder
- Arterial supply: gallbladder supplied by the cystic artery (branch of the right hepatic artery), bile duct supplied by the posterior superior pancreaticoduodenal artery.
- Venous drainage: cystic veins, portal veins, hepatic veins.
- Lymphatics: cystic node, hepatic node, upper pancreaticosplenic node.
- Nerve supply: cystic plexus of nerves, right phrenic nerves.
Pancreas
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Posterior to the stomach, extending across the posterior abdominal wall between the duodenum and spleen at L1.
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J-shaped, 15-20cm long.
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Retroperitoneal, except for a small part of the tail.
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Structurally:
- Branched acinar gland wrapped in delicate connective tissue.
- Healthy pancreas is yellow, with a soft-to-firm consistency and lobulated surface.
Pancreas Components
- Head: lies within the C-shaped concavity of the duodenum.
- Uncinate process: projects from the lower part of the head, lies posterior to the superior mesenteric vessels.
- Neck: anterior to the superior mesenteric vessels. The splenic and superior mesenteric veins join to form the portal vein posterior to the neck of the pancreas.
- Body: elongated and extends from the neck to the tail of the pancreas.
- Tail: passes between layers of the splenorenal ligament.
Pancreatic Duct
- Begins in the tail of the pancreas, turns inferiorly at the head of the pancreas.
- Joins the bile duct in the lower part of the head.
- Hepatopancreatic ampulla: where the pancreatic and bile ducts join.
- Enters the second part of the duodenum at the major duodenal papilla.
- Sphincter of ampulla (collection of smooth muscles) surrounds the ampulla.
Accessory Pancreatic Duct
- Empties into the minor duodenal papilla, just above the major duodenal papilla.
- Usually communicates with the main pancreatic duct.
Arterial Supply of the Pancreas
- Gastroduodenal artery from the common hepatic artery:
- Anterior superior pancreaticoduodenal artery.
- Posterior superior pancreaticoduodenal artery.
- Inferior pancreatic artery from the splenic artery:
- Dorsal pancreatic artery.
- Great pancreatic artery.
- Inferior pancreaticoduodenal artery from the superior mesenteric artery:
- Anterior inferior pancreaticoduodenal artery.
- Posterior inferior pancreaticoduodenal artery.
Venous & Lymphatic Drainage of the Pancreas
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Portal vein, superior mesenteric vein, splenic vein.
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Superior and inferior pancreaticoduodenal veins drain the head and uncinate process.
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The splenic vein drains the body and tail.
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Lymphatic drainage is extensive:
- Starts at interlobular septa within the gland.
- Larger lymphatic vessels follow the paths of arteries.
- Tail and body: nodes along the splenic artery.
- Head and neck: pre-aortic nodes.
Spleen
- Develops as part of the vascular system in the dorsal mesentery.
- Located in the left hypochondrium, against the diaphragm at Rib 9 - Rib 10.
- Wedge-shaped organ, between the fundus of the stomach and diaphragm.
- Functions in phagocytosis, haematopoiesis, immune response, and in the storage of red blood cells.
Spleen: Structures
- Splenic hilum: entry point for splenic vessels, the tail of the pancreas is related to this area.
- Anterior end: expanded and reaches the midaxillary line.
- Posterior end: rounded, rests on the upper pole of the left kidney.
- Superior border: notched on the anterior end – splenic notch.
- Inferior border: rounded.
- Impressions on the visceral surface: gastric, renal, colic, pancreatic.
Spleen: Ligaments
- Gastrosplenic ligament: attached to the greater curvature of the stomach, contains short gastric and gastro-omental vessels.
- Splenorenal ligament: attached to the left kidney, contains splenic vessels.
Vasculature of the Spleen
- Arterial supply: splenic artery gives off a left gastro-omental artery.
- Venous drainage: splenic vein, joins the superior mesenteric vein to form the portal vein.
- Lymphatics: pancreaticosplenic nodes.
- Nerve supply: coeliac plexus – sympathetic innervation.
Innervation of Accessory Organs
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Liver: parenchyma supplied by the hepatic plexus (sympathetic: coeliac plexus, parasympathetic: vagus nerve fibres).
- Referred pain: epigastric region for parenchyma, right shoulder for the diaphragmatic surface, and localized ‘somatic’ pain for the fibrous capsule of the liver.
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Spleen: sympathetic: coeliac plexus (sympathetic supply dominant), parasympathetic: vagus nerve.
- Referred pain: epigastric region.
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Gallbladder: sympathetic and sensory fibres: coeliac plexus, parasympathetic fibres: vagus nerve (stimulates contraction of the gallbladder).
- Referred pain: right hypochondriac and epigastric regions, can radiate to the back, inferior to the right scapula.
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Pancreas: sympathetic: extra-pancreatic and intra-pancreatic plexuses of autonomic nerves, parasympathetic: vagal efferents reach the pancreas via hepatic, gastric, and coeliac branches of the vagus nerve.
- Referred pain: localized to the lower thoracic spine (due to inflammation of the pancreas involving the retroperitoneum, which is innervated by somatic nerves).
Clinical Relevance
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ERCP (Endoscopic Retrograde Cholangiopancreatography):
- Can be used to remove obstructing gallstones within the biliary tree.
- Combines endoluminal endoscopy with fluoroscopy to diagnose and treat problems in the biliary and pancreatic ducts.
- An endoscope is put through the oesophagus and stomach into the second part of the duodenum, where the major duodenal papilla is.
- The bile or pancreatic duct is then cannulated and contrast is put into either the bile duct (cholangiogram) or pancreatic duct (pancreatogram).
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Splenomegaly:
- The spleen is an organ of the reticuloendothelial system, involved in haematopoiesis and the immune system.
- Diseases such as leukemia or lymphoma may produce generalized lymphadenopathy and enlargement of the spleen (splenomegaly).
- The spleen enlarges during normal physiological functioning.
- Splenomegaly may also occur due to increased venous pressure due to heart failure, portal hypertension, or splenic vein thrombosis.
- An enlarged spleen is prone to rupture.
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Description
Explore the key features of the liver, the largest visceral organ in the body. This quiz covers its locations, surfaces, and important functions such as metabolism and bile synthesis. Dive into the details of both the diaphragmatic and visceral surfaces, along with their associated recesses.
