38. GA - Stomach, Liver, & Gallbladder

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Questions and Answers

What is the primary function of the liver in terms of metabolism?

Storage of lipids for energy management

Production of glucose from non-carbohydrate sources

Synthesis of hemoglobin for red blood cells

Detoxification and intermediary metabolism (correct)

Which nerve primarily provides parasympathetic input to the stomach?

Inferior mesenteric nerve

Phrenic nerve

Vagus nerve (correct)

Greater splanchnic nerve

Where do lymph nodes of the stomach primarily drain?

Jugular lymph nodes

Thoracic duct

Celiac lymph nodes (correct)

Superior mesenteric vein

What effect does sympathetic innervation have on glandular secretion in the stomach?

Inhibits glandular secretion Signup and view all the answers

What is the role of the enteric nervous system?

Controlling smooth muscle contraction independently of central input Signup and view all the answers

What type of input does the greater splanchnic nerve primarily convey?

Preganglionic sympathetic input Signup and view all the answers

Which component is NOT a function of the liver?

Synthesis of insulin Signup and view all the answers

What is the main site for storage of glycogen in the body?

Liver Signup and view all the answers

What is the primary function of the gallbladder?

Concentration and storage of bile Signup and view all the answers

Which structure does the cystic duct join to form the common bile duct?

Common hepatic duct Signup and view all the answers

Where does the venous return of the liver primarily occur?

Via the hepatic veins into the inferior vena cava Signup and view all the answers

What anatomical regions does the fundus of the gallbladder closely relate to?

The 1st part of the duodenum and anterior abdominal wall Signup and view all the answers

Which of the following is part of the portal triad?

Proper hepatic artery Signup and view all the answers

What anatomical feature is described as having a spiral path inside?

Cystic duct Signup and view all the answers

In which position is the bile duct located relative to the portal vein?

Anterior and lateral Signup and view all the answers

How many hepatic veins typically exit the liver?

3 Signup and view all the answers

What is the primary function of the gallbladder as described?

Storage and concentration of bile Signup and view all the answers

What structure is located at the distal end of the bile duct and regulates bile flow?

Bile duct sphincter Signup and view all the answers

Which artery typically supplies blood to the gallbladder?

Cystic artery Signup and view all the answers

What happens to bile when the bile duct sphincter is closed?

Bile concentrates in the gallbladder Signup and view all the answers

Which fibers are responsible for facilitating gallbladder contraction?

Parasympathetic fibers derived from the vagus nerve Signup and view all the answers

Which structure passes posterior to the common hepatic duct as it supplies the gallbladder?

Cystic artery Signup and view all the answers

What is the role of the sympathetic fibers supplied by postganglionic fibers from the celiac ganglion?

To relax the contraction of the gallbladder Signup and view all the answers

What is the cystohepatic triangle defined by?

Common hepatic duct, cystic duct, liver Signup and view all the answers

Where is visceral pain from the gallbladder referred to?

The right thoracic wall and epigastric region Signup and view all the answers

What does the major duodenal papilla represent in the digestive system?

Convergence of bile and pancreatic ducts Signup and view all the answers

What is concentrated by the gallbladder through reabsorption of water?

Bile Signup and view all the answers

Which cervical nerves are associated with visceral pain relay from the gallbladder?

C3, C4, C5 Signup and view all the answers

What condition occurs when a peptic ulcer penetrates through the mucosa and muscle layers?

Penetrating ulcer Signup and view all the answers

Which aspect is critical when discussing the risks associated with a penetrating ulcer of the stomach?

It poses a risk of digestive erosion to the pancreas. Signup and view all the answers

What area corresponds with the referred pain caused by the greater splanchnic nerve?

Right shoulder blade and thoracic wall Signup and view all the answers

What is the predominant site for the occurrence of peptic ulcers in the stomach?

Posterior wall of the mucosa Signup and view all the answers

What is the primary infection that is commonly associated with triggering gastric carcinoma?

H. pylori Signup and view all the answers

Which of the following statements is true regarding the liver's ability to regenerate?

The regeneration process involves activation of growth factors. Signup and view all the answers

What condition is characterized by inflammation of the liver, often due to viral infection?

Hepatitis Signup and view all the answers

What is a potential consequence of a rupture in the liver?

Intraperitoneal bleeding Signup and view all the answers

Which of the following conditions usually leads to progressive destruction of hepatocytes?

Cirrhosis Signup and view all the answers

What is the typical 5-year survival rate for patients diagnosed with gastric carcinoma?

10% Signup and view all the answers

What causes jaundice in the body?

Accumulation of bilirubin in the bloodstream Signup and view all the answers

Which of the following accurately describes a hiatus hernia?

Displacement of stomach into the thoracic cavity Signup and view all the answers

Study Notes

Stomach Lymphatic Drainage

Lymph nodes follow the arterial pathways to the stomach and are named by the corresponding artery.
All lymph nodes drain directly into the celiac lymph nodes, which are clustered around the celiac trunk.
The celiac lymph nodes drain into the thoracic duct.

Stomach Innervation

Both Sympathetic and Parasympathetic nervous systems provide motor and secretory input to the stomach.
Parasympathetic input is provided by the vagus nerve (X) primarily by the anterior vagal trunk.
- Increases glandular secretions (Hydrogen ion & pepsinogen), stimulates peristalsis of the stomach and dilates the pyloric sphincter.
Sympathetic innervation is primarily provided post-ganglionic fibers from the celiac ganglion.
- Preganglionic fibers are from the greater splanchnic nerve (TN5-TN9).
- Reduces peristalsis, glandular secretion and constricts the pyloric sphincter.
Pain and stretch sensory fibers use the sympathetic pathway by way of the greater splanchnic nerve to transmit their signals from the stomach to dermatome levels corresponding to T5-T9.
- The cell bodies of these sensory neurons are housed in the dorsal root ganglion at these thoracic levels.
The enteric nervous system is an endogenous neuronal network that travels the full extent of the alimentary tract (esophagus-rectum).
- Regulated by both parasympathetic and sympathetic input, but can function independently to provide low-level glandular secretion and auto-peristalsis.

Liver General Functions

The liver is the largest and most vascularized organ in the body.
Functions as the primary site for detoxification and intermediary metabolism.
Major storage site for glycogen.
Responsible for the synthesis of bile, proteins, and cholesterol.

Liver Blood Supply

Supplied by the hepatic artery, a branch of the common hepatic artery.
The hepatic artery divides into a right and left hepatic artery at the porta hepatis.
The portal vein, proper hepatic artery and the hepatic duct travel together and form the portal triad.

Liver Venous Return

Provided by the hepatic veins.
The hepatic veins (usually 3 of them) exit the liver (on its diaphragmatic surface) directly into the inferior vena cava.

Gallbladder Functions

A smooth muscular sac that’s responsible for the concentration and storage of bile.
Contracts to inject the bile into the 2nd part of the duodenum, via the common bile duct.
Located in the gallbladder fossa on the visceral surface of the liver, between the right and quadrate lobes.
The fundus of the gallbladder is related (rests directly on) to the 1st part of the duodenum.
In direct contact with the anterior abdominal wall (at the costal margin).

Gallbladder Anatomy

Consists of a fundus, body and neck that empties into the cystic duct.
The internal surface of the cystic duct forms a spiral path, which is not a functional valve.

Common Bile Duct Formation

The cystic duct of the gallbladder joins the common hepatic duct of the liver to form the common bile duct.
The bile duct descends within the hepatoduodenal ligament and is positioned anterior to the portal vein, and lateral to the proper hepatic artery.
Passes posterior to the first part of the duodenum, enroute to the descending part of the duodenum where it meets with the main pancreatic duct, prior to entering the descending part of the duodenum on its posterior-medial wall.
At the distal end of the bile duct, there is a smooth muscle valve called the bile duct sphincter, which is normally closed until ingestion of fatty foods.

Gallbladder Bile Function

Bile produced by the liver is relatively dilute upon entering the hepatic duct and requires concentration by the gallbladder.
The closed bile duct sphincter located at the terminal end of the bile duct allows the flow of the dilute bile to back up into the gallbladder, where it is then concentrated, by re-absorption of water and essential metabolites, by its mucosa.
Upon contraction of the GB, the concentrated bile mixes with the release of pancreatic enzymes, and then pass through the sphincter of hepatopancreatic ampulla , (located in the medial wall of the 2nd part of the duodenum) into the duodenum.
The opening is visible in the medial wall of the duodenal mucosa and appears as a raised mound, usually covered by the circular folds of the duodenal mucosa, and is called the major duodenal papilla.

Gallbladder Blood Supply

Supplied by the cystic artery, which is usually given off by the right hepatic artery.
The cystic artery usually passes posterior to the common hepatic duct, within the hepatoduodenal ligament, in route to the neck of the gallbladder.
This region is of surgical importance and is known as the cystohepatic triangle.

Gallbladder Innervation

Autonomic Innervation:
- Parasympathetic fibers derived from the vagus N (X) participates in facilitating contraction of the gallbladder, along with endocrine release of CCK.
- Sympathetic fibers are supplied by postganglionic fibers from the celiac ganglion which receives preganglionic input from the greater splanchnic nerve. Function to relax the contraction of the gallbladder.
Visceral sensory (pain) of the gallbladder is relayed by via the greater splanchnic nerve and right phrenic nerves.

Gallbladder Pain Referral

Greater splanchnic nerve: Visceral pain is referred to the rt thoracic wall corresponding to dermatomes T7-T9 to an area of skin spanning from the rt spinous process of vertebrae T-7-T9 and projecting around to the epigastric region on the anterior abdominal wall.
Phrenic N.(Cervical N’s C3-5): Visceral pain relayed from the gallbladder is relayed to the right shoulder blade via the right phrenic N.

Stomach Clinical Aspects

Peptic ulcers are usually found on the posterior wall of the mucosal of the stomach.
- If severe, underlying structures associated with the “bed of the stomach” are vulnerable to digestive erosion as well.
- The posterior wall of the stomach rests directly upon the body of the pancreas.
- Digestive erosion of the pancreas via a penetrating ulcer, is a medical emergency and often fatal.
Gastric carcinoma develops from mutated gastric mucosa epithelium and is a highly aggressive form of cancer.
- The most common causative in triggering gastric carcinoma is from an infection resulting from the bacterium hemicobacter pylori.
- Current 5 year survival rate for gastric carcinoma is ~10%.
Hiatus hernia is where a portion of the stomach is pulled through the esophageal hiatus and displaced into the thoracic cavity.

Liver Clinical Aspects

Rupture of the liver results in intraperitoneal bleeding, which can be fatal.
Liver is a major site of metastatic carcinoma.
Cirrhosis results in progressive destruction of hepatocytes, commonly caused by excessive alcohol or drug use.
- Can lead to liver failure.
Hepatitis is defined an inflammation of the liver that is usually caused by viral infection or from chemical toxins.
Jaundice is an elevated level of bile pigment found in the blood stream, causing a yellow appearance in the skin and conjunctiva of the eyes.
- One of the possible causes for this pathology is the blockage of the bile duct system by a gallstone.
- This blockage causes bile to back up into the liver and prevents further processing of the bile pigment (bilirubin) from the blood.
The liver is capable of regeneration.
- Surgical removal of a diseased lobe of the liver signals the healthy liver tissue to regenerate through activation of a series of growth factors.

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Description

Test your understanding of the lymphatic drainage and innervation of the stomach. This quiz covers the pathways involved in both the sympathetic and parasympathetic control, including key structures like the celiac lymph nodes and vagus nerve. Evaluate your knowledge of how these systems interact to regulate stomach function.