1. Liver, Pancreas, Spleen and Gall bladder anatomy
Peer support 2014
Alastair Stephens
Jess Gilbert

2. Liver

3. Describe the surface anatomy of the liver.
Lower border follows the right costal margin
not normally palpable
Superior border follows upper limit of diaphragm
5th rib between the MCLs

4. Ligamentum teres within falciform ligament
Label the liver.
Bare Area
Inferior vena cava (IVC)
Ligamentum venosum
Coronary ligament
Right triangular
ligament
Left triangular
ligament
Porta Hepatis
Entry/exit point for portal vein, bile duct, hepatic artery & autonomics
Ligamentum teres within falciform ligament
Gall bladder

5. Name the 4 anatomical lobes of the liver
Left
Right
Caudate
Quadrate
Right
Caudate
Left
Quadrate

6. How many functionally independent segments is the liver divided into?8
What 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 vein
Hepatic artery (30%)
Where does it originate from?
Coeliac trunk
Hepatic
R. hepatic
Left hepatic
Coeliac Trunk
Cystic
Portal vein
Splenic vein
Sup. 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 varices
Peri-umbilical varices (caput medusae)

9. What is the peritoneum between the stomach and the liver called?
Lesser omentum
In liver surgery, why is this clinically relevant?
The Pringle manoeuvre can be performed
The 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.

10. Pancreas

11. Within which region does the pancreas sit?
Epigastric and extends into the left hypochondrium
Via what do pancreatic secretions drain into the second part of the duodenum?
Major duodenal papilla
Which 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 artery
Splenic artery
Inferior pancreaticoduodenal artery

13. Where could fluid collect in pancreatitis?
Lesser sac
Why might pancreatic cancer cause jaundice?
Blocked bile duct

14. Spleen

15. Describe the surface anatomy of the spleen.
Left posterolateral abdominal wall
Related to ribs 9-11
What is the arterial supply to the spleen?
Splenic artery from the coeliac trunk
What 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

17. Gall Bladder

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.

20. Thank you!
Any questions?