31.5 Liver and Gallbladder Anatomy Quiz

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Questions and Answers

What is the primary focus of the learning outcomes regarding the liver and biliary system?

Discuss the pharmacology of liver medications

Describe the anatomy and clinical relevance of the liver and biliary system (correct)

Conduct liver function tests

Identify the liver on histological slides

Which of the following structures is NOT specifically mentioned as part of the biliary system anatomy?

Hepatic artery (correct)

Common bile duct

Gallbladder

Major duodenal papilla

What is a porto-systemic anastomosis primarily described as?

An obstruction in the bile duct leading to gallbladder disease

A connection between the portal venous system and systemic veins (correct)

The catheterization of the hepatic artery

An increased pressure in the hepatic artery

What structures join to form the hepatopancreatic ampulla (of Vater)?

Common bile duct and main pancreatic duct Signup and view all the answers

Which book is recommended for anatomical reference regarding the liver?

Abrahams' Clinical Atlas of Human Anatomy Signup and view all the answers

What does the learning outcomes suggest is necessary to describe regarding the major duodenal papilla?

Its anatomical structure and connections Signup and view all the answers

Where does the common bile duct open into the duodenum?

Major duodenal papilla Signup and view all the answers

In relation to the hepatic artery and portal vein, where does the common bile duct course?

Right of the hepatic artery and anterior to the portal vein Signup and view all the answers

What surrounds the major duodenal papilla where the common bile duct opens?

Sphincter of Oddi Signup and view all the answers

Which duct is described as anterior to the hepatic portal vein?

Common bile duct Signup and view all the answers

Which veins are responsible for draining the neck of the gallbladder directly into the portal vein?

Cystic veins Signup and view all the answers

What anatomical structure forms the hepatic portal vein?

Superior mesenteric vein and splenic vein Signup and view all the answers

What is the consequence of increased portal pressure?

Caput medusae Signup and view all the answers

What does the blood from the portal vein do after passing through the liver?

Goes back to systemic circulation via hepatic veins Signup and view all the answers

Which veins play a role in porto-caval anastomosis?

Oesophageal veins and left gastric vein Signup and view all the answers

Which of the following statements about the hepatic portal vein is true?

It carries nutrient-rich blood from the digestive organs. Signup and view all the answers

What vein drains the gallbladder's fundus and body directly into the liver?

Cystic vein Signup and view all the answers

Which veins are involved in the anastomosis that can result in caput medusae?

Epigastric veins and para-umbilical veins Signup and view all the answers

Which nerves provide parasympathetic innervation to the gallbladder?

Parasympathetic from the vagus Signup and view all the answers

What is a common symptom associated with cholecystitis?

Coca cola urine Signup and view all the answers

Which of the following conditions is associated with portal hypertension?

Cirrhosis Signup and view all the answers

What hormone stimulates the contraction of the gallbladder?

Cholecystokinin (CCK) Signup and view all the answers

Which imaging technique is used for assessing the biliary and pancreatic ducts?

Endoscopic retrograde cholangiopancreatogram (ERCP) Signup and view all the answers

Which nerve plexus is the source of sympathetic innervation to the hepatic area?

Celiac plexus Signup and view all the answers

Which clinical condition is characterized by abnormal dilation of blood vessels in the esophagus?

Oesophageal varices Signup and view all the answers

What major structure does the cystic duct connect with the common bile duct?

Gallbladder Signup and view all the answers

What does the quadrate lobe lie between according to its anatomical position?

The fissure for ligamentum teres and the fossa for the gallbladder Signup and view all the answers

Which lobes of the liver are categorized as functional lobes?

Left and right halves Signup and view all the answers

Which structure is part of the portal triad entering the liver at the porta hepatis?

Right hepatic duct Signup and view all the answers

Where does the fundus of the gallbladder project anatomically?

Lower border of the right lobe Signup and view all the answers

What is the typical capacity of the gallbladder?

~50mL Signup and view all the answers

What anatomical landmark is used to determine Murphy’s point?

Intersection of the right rectus abdominis and costal margin Signup and view all the answers

What are the hepatic segments based on?

Biliary drainage and blood supply Signup and view all the answers

Which of the following is NOT a part of the gallbladder's anatomy?

Quadrate lobe Signup and view all the answers

Where does the gallbladder lie in relation to the quadrate lobe?

Adjacent to it Signup and view all the answers

What is Pringle’s Manoeuvre associated with?

Liver surgery Signup and view all the answers

Which structure is primarily responsible for draining blood into the liver from the digestive tract?

Hepatic portal vein Signup and view all the answers

What anatomical feature is commonly referred to as Hartman's pouch?

Neck of the gallbladder Signup and view all the answers

Where does the common bile duct typically open into the duodenum?

Hepatopancreatic ampulla Signup and view all the answers

Which artery supplies oxygenated blood to the liver?

Hepatic artery proper Signup and view all the answers

What is the main substance drained by the hepatic portal vein?

Nutrient-rich, deoxygenated blood Signup and view all the answers

What leads to the development of alternative blood pathways in liver cirrhosis?

Obstructed blood flow to the liver Signup and view all the answers

Which anatomical site is NOT associated with venous enlargement in the context of liver cirrhosis?

Pulmonary veins Signup and view all the answers

Which pathway is a portal system related to the development of varices in liver cirrhosis?

Superior rectal vein to inferior mesenteric vein Signup and view all the answers

Which condition is likely to cause anastomosis between systemic and portal veins?

Liver cirrhosis Signup and view all the answers

What is the consequence of venous enlargement at the gastroesophageal junction?

Esophageal varices formation Signup and view all the answers

What is the main pathway for drainage of lymph from the gallbladder?

Gallbladder drains to celiac nodes via cystic node Signup and view all the answers

Which lymph nodes do the superficial lymphatics from the posterior diaphragmatic surfaces ultimately drain into?

Phrenic lymph nodes Signup and view all the answers

Which structure accompanies the hepatic artery and portal vein within the hepatic nerve plexus?

Celiac plexus Signup and view all the answers

Which statement accurately describes the innervation of the gallbladder?

Parasympathetic innervation is provided by the vagus nerve Signup and view all the answers

What is the fate of lymph drained from hepatic lymph nodes?

Drains into cisterna chyli and then through the thoracic duct Signup and view all the answers

From where do the superficial lymphatics of the anterior diaphragmatic surfaces primarily drain?

Porta hepatis Signup and view all the answers

Which nodes act as an intermediary between gallbladder lymphatics and the thoracic duct?

Coeliac lymph nodes Signup and view all the answers

What is a key characteristic of parasympathetic fibers to the gallbladder?

They synapse at ganglia near the organs Signup and view all the answers

What divides the functional lobes of the liver into eight segments?

Biliary drainage and blood supply Signup and view all the answers

Which anatomical feature is used to locate the fundus of the gallbladder?

Lower border of the liver Signup and view all the answers

Which duct connects the gallbladder with the common hepatic duct?

Cystic duct Signup and view all the answers

What is the anatomical location of the quadrate lobe relative to the liver?

Between the ligamentum teres and the gallbladder fossa Signup and view all the answers

What is the role of Pringle’s Manoeuvre during surgery?

To control bleeding from the liver Signup and view all the answers

Which lobe of the liver is categorized as an independent functional unit based on bile drainage?

Caudate lobe Signup and view all the answers

How much bile can the gallbladder typically store?

50 mL Signup and view all the answers

Where is Murphy’s point located in relation to the ribcage?

At the level of the transpyloric plane on the right ribcage Signup and view all the answers

What anatomical location does the gallbladder occupy?

In the gallbladder fossa on the visceral surface of the liver Signup and view all the answers

Which ligament connects the liver to the anterior abdominal wall?

Falciform ligament Signup and view all the answers

What is the primary feature that divides the liver into right and left lobes?

Falciform ligament Signup and view all the answers

Which ligament is located at the free margin of the liver?

Round ligament of the liver Signup and view all the answers

Which structure forms the barrier between the caudate lobe and the fossa for the inferior vena cava (IVC)?

Fissure for ligamentum venosum Signup and view all the answers

Which of the following ligaments is associated with the diaphragm?

Coronary ligament Signup and view all the answers

What anatomical feature creates the right sagittal fissure on the liver's visceral surface?

Fossa for the gallbladder Signup and view all the answers

Which ligament forms the left sagittal fissure on the liver?

Fissure for ligamentum venosum Signup and view all the answers

Which two ligaments provide attachment of the liver to the superior diaphragm?

Coronary ligament and left triangular ligament Signup and view all the answers

What forms the caudate lobe of the liver?

Fissure for ligamentum venosum and IVC Signup and view all the answers

Which ligament is specifically mentioned as connecting the liver to the duodenum?

Hepatoduodenal ligament Signup and view all the answers

Study Notes

Liver Anatomy

The liver is divided into anatomical lobes (left, right, caudate and quadrate) and functional lobes (left and right halves).
Functional halves are further divided into 8 segments, each with its own biliary drainage and blood supply.
The portal triad consists of the hepatic artery, hepatic portal vein, and common bile duct.
The porta hepatis is the entrance to the liver, where the portal triad, lymphatics, and nerves enter.
Pringle’s Manoeuvre is a surgical technique that involves clamping the hepatoduodenal ligament to control blood flow to the liver.

Gallbladder

The gallbladder is a pear-shaped structure with a fundus, body, and neck.
It lies in the gallbladder fossa on the visceral surface of the right lobe of the liver.
The gallbladder stores and concentrates bile secreted by the liver.
The cystic duct connects the gallbladder to the common bile duct.
The common bile duct joins the main pancreatic duct to form the hepatopancreatic ampulla (of Vater), which opens into the duodenum at the major duodenal papilla.
The sphincter of the ampulla (of Oddi) controls the flow of bile and pancreatic juice into the duodenum.

Venous Drainage

Blood from the hepatic portal vein and hepatic artery passes through the liver.
Hepatic veins return blood to the inferior vena cava (IVC).
The cystic veins drain the neck of the gallbladder directly into the portal vein, while the fundus and body drain directly to the liver (into the hepatic sinusoids).

Porto-Systemic Anastomoses

These connections allow blood to bypass the liver when portal pressure is increased.
The para-umbilical veins anastomose with the small epigastric veins, which can result in caput medusae.
The oesophageal veins (draining into the azygos vein) anastomose with the left gastric vein, which can lead to oesophageal varices.

Nerves

The hepatic nerve plexus is derived from the coeliac plexus and accompanies the hepatic artery and hepatic portal vein.
Nerves to the gallbladder pass along the cystic artery from the celiac nerve plexus.
Cholecystokinin (CCK) stimulates contraction of the gallbladder and bile release.

Clinical Conditions

Portal hypertension can lead to oesophageal varices and caput medusae.
Hepatomegaly is an enlarged liver.
Liver infections, such as abscesses, can be caused by various organisms.
Liver cancer can be primary or metastatic.
Trauma to the liver can be managed using Pringle’s Manoeuvre.
Storage disorders and enzyme deficiencies can affect liver function.
Cirrhosis is a chronic liver disease with irreversible scarring.

Imaging

Endoscopic retrograde cholangiopancreatogram (ERCP) is an imaging technique used to visualize the biliary and pancreatic ducts.
Magnetic resonance cholangiopancreatogram (MRCP) is an imaging technique used to visualize the biliary and pancreatic ducts without using contrast fluid.

Case Study

A 48-year-old female presents with abdominal pain, fever, chills, nausea, vomiting, and jaundice.
Imaging reveals signs consistent with cholecystitis (inflammation of the gallbladder) and cholelithiasis (gallstones).
Gallstones can obstruct the biliary duct system, leading to complications like cholecystitis and pancreatitis.

Lymphatics

Superficial lymphatics from anterior diaphragmatic and visceral surfaces drain into 3-4 nodes at the porta hepatis (hepatic lymph nodes).
Hepatic lymph nodes drain into celiac lymph nodes.
Coeliac lymph nodes drain into cisterna chyli, then to the thoracic duct.
Superficial lymphatics from the posterior diaphragmatic and visceral surfaces drain to phrenic lymph nodes.
Phrenic lymph nodes drain to posterior mediastinal lymph nodes, then to the right thoracic duct.
Gallbladder lymphatics drain to hepatic nodes through a cystic node located at the neck of the gallbladder, finally reaching the coeliac nodes.

Nerves

Hepatic nerve plexus originates from the coeliac plexus and accompanies the hepatic artery and portal vein.
Parasympathetic innervation of the hepatic nerve plexus comes from the vagus nerve.
Nerves to the gallbladder travel alongside the cystic artery from the coeliac nerve plexus.
Parasympathetic innervation of the gallbladder is from the vagus nerve.

Associated Ligaments

The liver is attached to the anterior abdominal wall by the falciform ligament.
The round ligament of the liver (ligamentum teres), located at the free margin of the falciform ligament, is a remnant of the fetal umbilical vein.
The liver is connected to the stomach by the hepatogastric ligament.
The liver is attached to the duodenum via the hepatoduodenal ligament.
The liver is connected to the diaphragm by the right and left triangular ligaments, as well as the anterior and posterior coronary ligaments.

Anatomical Lobes

The liver is divided into right and left lobes by the falciform ligament.
The visceral surface of the liver has an H-pattern.
- The right sagittal fissure is formed by the fossa for the gallbladder and the inferior vena cava (IVC).
- The left sagittal fissure is created by the fissure for the ligamentum venosum and the fissure for the round ligament (ligamentum teres).
The caudate lobe is located between the fissure for the ligamentum venosum and the fossa for the IVC.
The quadrate lobe is situated between the fissure for the ligamentum teres and the fossa for the gallbladder.

Functional Lobes

The functional lobes divide the liver into left and right halves, further subdivided into eight segments each.
The eight hepatic (or surgical) segments form independent functional units based on biliary drainage and blood supply.

Porta Hepatis

The porta hepatis is the main entrance point to the liver and is where the portal triad enters.
The portal triad consists of:
- Hepatic artery: Carries oxygenated blood from the systemic circulation.
- Hepatic portal vein: Carries deoxygenated blood rich in nutrients from the small intestine.
- Common bile duct: Transports bile from the liver and gallbladder to the duodenum.

Gallbladder

The fundus of the gallbladder projects onto the lower border of the liver and touches the parietal peritoneum of the anterior abdominal wall at the tip of the ninth costal cartilage.
Surface landmark of the gallbladder coincides with the intersection of the lateral border of the right rectus abdominis and the costal margin.
- Murphy's point is located at the level of the transpyloric plane and the right ribcage.
The gallbladder lies in the gallbladder fossa on the visceral surface of the right lobe of the liver, adjacent to the quadrate lobe.
It functions in the storage and concentration of bile secreted by the liver, with a capacity of approximately 50mL.

Common Bile Duct

The common bile duct is formed by the union of the cystic duct from the gallbladder and the common hepatic duct from the liver.
The common bile duct connects the liver and gallbladder to the duodenum, where it merges with the main pancreatic duct, forming the hepatopancreatic ampulla (of Oddi).
The hepatopancreatic ampulla is surrounded by the sphincter of Oddi (also called Glisson's sphincter) which controls the flow of bile and pancreatic juice into the duodenum.

Liver Blood Supply

The liver receives blood from two primary sources:
- Hepatic artery: Provides oxygenated blood from the systemic circulation.
- Hepatic portal vein: Delivers deoxygenated blood rich in nutrients from the digestive tract, specifically the small intestine, spleen, and pancreas.
The hepatic artery branches into the right and left hepatic arteries, each supplying a corresponding hepatic lobe.
The hepatic portal vein is formed by the union of the splenic vein, superior mesenteric vein, and inferior mesenteric vein.
Portal hypertension, caused by liver cirrhosis or other conditions that obstruct blood flow to the liver, leads to:
- Increased pressure in the portal venous system
- Blood-taking alternative pathways, like the gastroesophageal junction, anus, and anterior abdominal wall to relieve the pressure.
- Venous enlargement in these areas (varices).

Pringle's Manoeuvre

Pringle's Manoeuvre involves clamping the hepatoduodenal ligament to temporarily stop blood flow to the liver. This technique is used during surgery to control bleeding and allows for a bloodless field.
The hepatoduodenal ligament is the free margin of the lesser omentum, which contains the portal triad (hepatic artery, portal vein, and common bile duct).
The manoeuvre involves clamping the ligament at the epiploic foramen (of Winslow), the entrance to the omental bursa.

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Description

Test your knowledge on the anatomy of the liver and gallbladder. This quiz covers the liver's lobes, the portal triad, and the structure and function of the gallbladder. Perfect for students studying human anatomy or healthcare professionals.