marilyn rose. largest organ of abdomen rt hypochondriac/ and epigastric regions borders:...

Marilyn Rose

Largest organ of abdomen Rt hypochondriac/ and epigastric regions Borders:

Superior/lateral andanterior= Rt diaph

Medial= sto/duodenum,transverse colon.

Inferior= hepatic flex Posterior= Rt Kid

Glisson’s CapsuleCovered in peritoneum

Except: GB fossa, area of IVC and bare area.

Ligamentum teres- divides lt hepatic lobe into medial and lateral segments

Ligamentum venosum- separates the caudate lobe from Lt lobe

Transverse (portal) fissure- horizontal R/L PVS

Main lobar fissure (GB)- divides R/L lobes

Porta Hepatis- inferomedial border of the liver- the site of the MPV/HA and common bile duct.

Fissures of the liver

Lt lobe- most anterior- lt of midline-

separated from Rt by interlobar fissure/ Middle hepatic vein.

Caudate lobeSmallest lobe, on the

inferior/posterior surface, between the IVC and ligamentum venosum

Quadrate lobe-Anterior-inferior surface of

LT lobe between GB and ligamentum teres (remnant fetal umbilical vein, which runs along edge of falciform- The falciform supports/ attaches liver to diaphragm.

1: Right lobe of liver2: Left lobe of liver3: Quadrate lobe of liver4: Round ligament of liver5: Falciform ligament6: Caudate lobe of liver7: Inferior vena cava8: Common bile duct9: Hepatic artery10: Portal vein

Subcapsular Hematoma

Divided into 8 segments by the vascular supply (4=a/b)

Three hepatic veins:MHV- divides liver into

Rt/Lt lobesRHV- divides Rt lobe

into medial and lateral LHV- Lt lobe into

medial and lateral Rt/ Lt Portal veins:

Divides each section transversely

Each segment is functionally independent with its own artery, portal vein and bile duct

Nutrient rich blood from GI tract via the portal veins.

(75-80%)Formed in the

retroperitoneum by the superior mesenteric and splenic veins. (posterior to the neck of

the pancreas)Porta hepatis- the portal

vein branches into the Rt and Lt main portal veins- following the course of the HA’s RPV branches into anterior

and posterior branches LPV courses left and then

turns medially

Portal Hypertension-leads toAscites and splenomegaly

Arterial blood (20-25%) from common hepatic artery

Common hepatic artery arises from the celiac, entering the liver ANTERIOR to the portal vein.

The common hepatic artery arises from the celiac and branches into the Rt gastric and gastroduodenal arteries and continues ast eh proper heaptic towards the porta hepatis.

Prior to entering the liver it divides into the LT/RT hepatic arteries; which bring blood to each lobe.

Right Hepatic VeinLargest- drains

segments 5, 6 and 7

Left Hepatic VeinSmallest – drains

segments 2,3Middle Hepatic Vein

Interlobar fissure- drains segments 4,5 and 8

The three veins converge and enter the IVC just below the diaphragm

Gallbladder and bile ductsDrain the liver and store bile

until transported to the duodenum for digestion of fats..

GB lives in the GB fossa- anterioinferior Rt lobe of the liver closest to the main lobar fissure. Reservoir -fundus, body and

neck- cystic duct Rt/Lt= CBD Rt/Lt hepatic ducts unite at the

porta hepatis to form the common hepatic duct (CHD), the CHD joins the cystic duct and forms the CBD.

CBD continues posterior to the pancreatic head and enters the duodenum along with the main pancreatic duct (Duct of Wirsung) at the Ampulla of Vater ( the muscle at the opening is called the sphincter of Oddi.

ERCPMRCP

Ultrasound

ERCP-Cholangiocarcinoma

Retroperitoneal, long, narrow- un-encapsulated

Posterior to the stomach/ between duodenum and splenic hilum Head- located at the second portion

of the duodenum about L2-L3, anterior to IVC and renal veins Landmarks:

CBD Rt posterior and GDA on the anterior aspect

Uncinate process- between SMV and IVC

Neck- portal splenic confluence main landmark- posterior to the

neck Body- largest, anterior to AO and

SMA with the splenic vein running along the posterior surface

Tail- extends to the LT anterior pararenal space and LT kidney

Endocrine (insulin) and Exocrine (digestive enzymes) Enzymes= amylase, lipase and

peptidases and sodium bicarbonate

MRI -ABDOMEN

Largest lymph organRed pulp= bloodWhite pulp= lymphoid tissue

and white blood cellsIntraperitoneal organ- covered

in peritoneum Posterior to stomach in the LUQBehind the 9-11th ribsBorders-

medial- Lt kidney, splenic flexure, pancreatic tail

Posterior- diaphragm, pleura, Lt lung, ribs

Attached to > curvature of sto and Lt kid by theGastrosplenic and lienorenal

ligaments

SAGITTAL

TRANSVERSE

Splenic Rupture