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