27. Liver, Pancreas, Spleen I

A patient suffered fractures to the lower ribs causing one to perforate an organ. What organ is most likely involved in this injury and what type of bleeding can be expected

Liver; sever hemorrhage

Describe cirrhosis of the liver

progressive destruction of hepatocytes which are replaced by fibrous tissue causing the liver to become firm and possible impede blood circulation. Most frequent cause of portal hypertension

In what position would a patient be in, in order for fluid to accumulate in the hepatorenal recess?

Located between the liver and kindey, a patient would have to be supine for fluid to accumulate in the hepatorenal recess.

What ligament is the major landmark for the left and right lobes of the liver?

Falciform ligament

What structure is directly touching the liver in the bare area? What normally separates the liver and this structure?

The bare area is a triangular area devoid of peritoneal covering. In this region alone will the liver be in direct contact with the diaphragm

The epiploic foramen is also known by what other name? What structures does it connect?

Foramen of winslow
It is connection between the greater and lesser sac

What arteries supply the liver? Through what vessel does the liver receive blood to be detoxed

Proper hepatic artery brings oxygenated blood;
Portal vein brings deoxygenated, nutrient filled blood to be filtered

What is the clinical significance of the many segments of the liver?

These segments do not communicate significantly and therefore can be removed (lobectomy) without many issues

When looking at the liver anteriorly, which part of the gall bladder is usually visible from under the right lobe?

The fundus is the lower part of the gall bladder which usually projects around the 8th intercostal cartilage mid-clavicular line

What is the most common site of bile obstruction?

cystic duct

How does acute cholecystits usually present?

Pain in the right upper quadrant which may cause sybdiaphragmatic parietal peritoneum irritation and refferred pain to the right shoulder by the phrenic nerve

What is the landmark for the cystic artery which supplies the gall bladder? What are its borders?

Triangle of Calot
Boundaries:
Liver
Lateral - cystic duct
Medial - common hepatic duct

In what quadrant is the spleen located and what is its function? How does sickle cell anemia affect its function?

Left hypochondrium
Main function: purify the blood and store RBC's
Sickeled cells get stuck in the spleen (because of their shape) and cause the spleen to enlarge. Has a large blood supply and will bleed profusely if ruptured. Solution: remove the spleen.

What is the main purpose of the portal-systemic (porto-caval) anastamosis?

Systems through which the blood bypasses the portal system of the liver. Often due to cirrhosis which blocks entry to the portal system and causes back flow.

Which arteries supply the pancreas?

Superior pancreaticoduodenal artery (banch of gastroduodenal artery which is a branch of the hepatic artery)
Inferior pancreaticoduodenal artery (branch of SMA)
Pancreatic branches (numerous from spenic artery)

In which part of the duodenum does the pacreatic duct join with the bile duct

2nd part of duodenum

What physical presentation is often associated with pacreatic cancer? why?

Obstructive jaudice
bile pigments are being retained and gall bladder is enlarged. This growth could compress the portal vein and lead to portal hypertension