3 Describe the surface anatomy of the liver. Lower border follows the right costal marginnot normally palpableSuperior border follows upper limit of diaphragm5th rib between the MCLs
4 Ligamentum teres within falciform ligament Label the liver.Bare AreaInferior vena cava (IVC)Ligamentum venosumCoronary ligamentRight triangularligamentLeft triangularligamentPorta HepatisEntry/exit point for portal vein, bile duct, hepatic artery & autonomicsLigamentum teres within falciform ligamentGall bladder
5 Name the 4 anatomical lobes of the liver LeftRightCaudateQuadrateRightCaudateLeftQuadrate
6 How many functionally independent segments is the liver divided into? 8What are the benefits of these divisions?Each segment is served by a hepatobiliary division so can function independently.
7 What is the blood supply to the liver from What is the blood supply to the liver from? (What percentage do they contribute?)2 sources:Portal vein (70%)What forms it?Splenic vein and the superior mesenteric veinHepatic artery (30%)Where does it originate from?Coeliac trunkHepaticR. hepaticLeft hepaticCoeliac TrunkCysticPortal veinSplenic veinSup. Mesenteric v.Inf. Mesenteric v.variable position
8 Where else can varices be located? Jonny, a chronic alcoholic, has an endoscopy that reveals oesophageal varices in the lower oesophagus. Name the anatomical location that varices usually occur, and why?Where the portal and systemic veins join (porto-systemic anastomoses).Increased portal venous pressure can cause congestion in the anastamoses leading to dilatation = varices.Where else can varices be located?Ano-rectal varicesPeri-umbilical varices (caput medusae)
9 What is the peritoneum between the stomach and the liver called? Lesser omentumIn liver surgery, why is this clinically relevant?The Pringle manoeuvre can be performedThe free edge can be pinched, which contains the common bile duct, hepatic artery and portal vein. This will cut off the blood supply to the liver.
11 Within which region does the pancreas sit? Epigastric and extends into the left hypochondriumVia what do pancreatic secretions drain into the second part of the duodenum?Major duodenal papillaWhich sphincter guards the entrance of the duct into the duodenum?Hepato-pancreatic sphincter (Sphincter of Oddi)
12 What is the blood supply to the pancreas? Superior pancreaticoduodenal arterySplenic arteryInferior pancreaticoduodenal artery
13 Where could fluid collect in pancreatitis? Lesser sacWhy might pancreatic cancer cause jaundice?Blocked bile duct
15 Describe the surface anatomy of the spleen. Left posterolateral abdominal wallRelated to ribs 9-11What is the arterial supply to the spleen?Splenic artery from the coeliac trunkWhat is the venous drainage from the spleen?Splenic vein to the portal vein
16 Paul has potential splenomegaly, how would you examine his spleen? Start in right iliac fossa and palpate up and across towards left hypochondrium
18 Where can the fundus of the gall bladder normally be palpated? 9th costal cartilage (L1)Why could inserting a needle at this level to access the liver be potentially fatal?Puncture of the gall bladder can cause a biliary peritonitis.
19 What is a likely cause of her right shoulder pain? Why? Sarah presents to your GP surgery complaining of pain in her right shoulder. She elicits a positive Murphy’s sign. What is Murphy’s sign?Place your hand in the right hypochondrium and ask the patient to inspire. The diaphragm and so the liver will descend and if the gall bladder is tender, it will graze your hand causing the patient to flinch. This is a positive Murphy’s sign and indicates gall bladder pathology.What is a likely cause of her right shoulder pain? Why?This is an example of referred pain. The diaphragm is irritated by the gall bladder, which is innervated by the phrenic nerve (C3-5). The skin covering the shoulder is also innervated by C3-4.