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THE HEP ATOBILARY SYSTEM Rohan O’HareMAIN COMPONENTS LIVER – GROSSANATOMY • Largest visceral organ • Occupies right hypochondrium + epigastrium LIVER - SURFACES Superior view Posterior view LIVER -LIGAMENTS • Falciform – Connects liver to anterior abdominal wall • Ligamentum teres is a remnant of left umbilical vein • Coronary – Connects liver to diaphragm • Demarcates bare area • Triangular – Union of coronary ligaments • Connects liver to diaphragm • Lesser omentum – Connects to lesser curvature (hepatogastric) and duodenum (hepatoduodenal) • Hepatoduodenal ligament encircles porta hepatisPRINGLE’S MANOEUVRE LIVER –VASCULATURE • Dual blood supply • Hepatic artery proper (25%) • Hepatic portal vein (75%) • Venous drainage through hepatic veins • Bile produced through hepatic duct • Local lymph nodes IMPORTANT POINTS • Porta hepatis • Right + left hepatic arteries • Hepatic duct • Right + left hepatic portal veins • Calot’s triangle contains: • Cystic artery • Right hepatic arteryPORTAL HYPERTENSION Causes: • Pre-hepatic • Thrombosis of portal vein • Congenital stenosis • Hepatic • Cirrhosis • Schistosomiasis • Post-hepatic • Hepatic vein outflow obstruction (eg Budd-Chiari syndrome) • Inferior vena cava obstructionLIVER - MICROANATOMY LIVER - HISTOLOGY Cells: • Hepatocytes • Stellate cells • Kupffer cells PANCREAS – GROSSANATOMY • Epigastric region • Posterior to stomach • Surrounded by duodenum • Medial to spleen • Retroperitoneal (mostly)PANCREAS – GROSSANATOMY PANCREAS –VASCULATURE • Mostly supplied by branches of splenic artery • Pancreatica arteria magna • Head supplied by pancreaticoduodenal arteries • Superior from gastroduodenal • Inferior from superior mesentericPANCREAS - MICROANATOMYPANCREATIC CANCERIMPORTANT STRUCTURES BILIARYTREE Fundus • Gallbladder – Simple columnar Body Infundibulum • Biliary tree – Simple cuboidal Neck Hartmann’s pouchGALLSTONES MCQ:1 What is Morrison’s pouch? a) Sub-phrenic space b) Hepato-renal recess c) Lesser sac d) Right paracolic gutter MCQ:1 What is Morrison’s pouch? a) Sub-phrenic space b) Hepato-renal recess c) Lesser sac d) Right paracolic gutter MCQ:2 Which of the following can be found within Calot’s triangle? a) Hepatic duct b) Left hepatic artery c) Cystic artery d) Hepatic portal vein MCQ:2 Which of the following can be found within Calot’s triangle? a) Hepatic duct b) Left hepatic artery c) Cystic artery d) Hepatic portal vein MCQ:3 The splenic and superior mesenteric portal veins form the hepatic portal vein behind which structure: a) Neck of the pancreas b) Hepatoduodenal ligament c) Splenic notch d) Right kidney MCQ:3 The splenic and superior mesenteric portal veins form the hepatic portal vein behind which structure: a) Neck of the pancreas b) Hepatoduodenal ligament c) Splenic notch d) Right kidney MCQ 4 Which is the correct hierarchy of the luminal pancreas a) Acinar cell > intercalated duct > intralobular duct > interlobular duct > pancreatic duct b) Acinar cell > canaliculi > intralobular duct > interlobular duct > pancreatic duct c) Alpha cell > intralobular duct > intercalated duct > interlobular duct > pancreatic duct d) Acinar cell > intralobular duct > intercalated duct > interlobular duct > pancreatic duct MCQ 4 Which is the correct hierarchy of the luminal pancreas a) Acinar cell > intercalated duct > intralobular duct > interlobular duct > pancreatic duct b) Acinar cell > canaliculi > intralobular duct > interlobular duct > pancreatic duct c) Alpha cell > intralobular duct > intercalated duct > interlobular duct > pancreatic duct d) Acinar cell > intralobular duct > intercalated duct > interlobular duct > pancreatic duct MCQ 5 What is positive clinical finding for cholecystitis (inflammation of the gallbladder)? a) Trousseau’s sign b) Rovsing’s sign c) Cullen’s sign d) Murphy’s sign MCQ 5 What is positive clinical finding for cholecystitis (inflammation of the gallbladder)? a) Trousseau’s sign b) Rovsing’s sign c) Cullen’s sign d) Murphy’s sign ANY QS? 2363395o@student.gla.ac.uk