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TOPIC OUTLINE
I.
II.
III.
Liver
A. Surface Anatomy
B. Ligaments
C. Fissures
D. Lobes
E. Surfaces
F. Vascular Supply
G. Lymphatics
H. Nerve Supply
I. Perhepatic Spaces
J. Clinical Correlation Editing the Header
and Footer
Gallbladder
A. Parts
B. Vascular Supply
C. Lymphatics
D. Nerve Supply
E. Referred Pain
Stomach
A. Parts
B. Curvatures and Orifices
C. Interior of the Stomach
D. Surfaces
E. Vascular Supply
F. Lymphatics
G. Nerve Supply
H. Clinical Correlation
I. LIVER
Largest gland in the body (2nd largest single organ
next to skin)
Enclosed by a tight fibrous capsule of strong
connective tissue called Glissons capsule
Weight: male 1400-1800g; female 1200-1400g
o 2.5% of adult body weight
o 5% of the total fetal weight because it also a
hematopoetic organ
Location: right upper quadrant (RUQ) of the
abdomen; specifically, in the right hypochondrium,
epigastric
and
part
of
the
left
hypochondrium area
Pyramidal in shape, base found at the right and apex
towards the left
Surrounded by peritoneum except on the bare area
of the posterior aspect of the liver, which is in contact
with the diaphragm
Deep to ribs 7-11 on the right side and crosses the
midline toward the left nipple
Protected anteriorly by the lower rib cages, and
posteriorly by the muscles and bones of the
abdominal wall
Function: glycogen storage, bile secretion (yellowbrown or orange- green fluid that aids in the
emulsification of fat) + other metabolic activities
All nutrients (except fat) absorbed from the digestive
tract are initially conveyed to the liver by the portal
venous system
Figure 2. Ligaments
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1. FALCIFORM LIGAMENT
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2. CORONARY LIGAMENT
Upper Layer (Superior Layer): reflected from the
superior surface on to the inferior surface of
diaphragm
In the anterior view, you can only see the liver divided
into two by the falciform ligament: the left lobe and
the right lobe
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LESSER OMENTUM
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Subphrenic recesses
o Superior extension of the peritoneal cavity
(greater sac)
o Between the diaphragm and the anterior and
superior aspects of the diaphragmatic surface of
the liver
o Separated into the right and left recesses by
the falciform ligament
2. POSTEROSUPERIOR
Suprarenal impression
Subhepatic space
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a.
Arterial Supply
Has double blood supply from the hepatic artery (2025%) and the hepatic portal vein (70-80%)
Hepatic artery
o
Branch of the celiac trunk
o
May be divided into the common hepatic artery
from the celiac trunk to the origin of the
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b. Venous drainage
G. LYMPHATICS
The liver is a major lymph-producing organ. Between to
of the lymph entering the thoracic duct comes from the
liver
Superficial lymphatics in the subperitoneal fibrous capsule
of the liver (Glissons capsule), which forms its outer
surface, and as deep lymphatics in the connective tissue,
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H. NERVE SUPPLY
Contains both sympathetic and parasympathetic
fibers via the
hepatic plexus (largest derivative of the celiac
plexus)
Receives filaments from the L and R vagus and R
phrenic nerves
Nerve fibers accompany the vessels and biliary ducts
of the portal triad for vasoconstriction (other functions
are unclear)
Hepatic plexus
o
Largest derivative of the celiac plexus
o
Accompanies the hepatic artery and portal vein
and their branches enters liver through porta
hepatic
Consists of sympathetic fibers from the
celiac plexus and parasympathetic fibers from the
anterior and posterior vagal trunks
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I. PERIHEPATIC SPACES
Spaces between diaphragm, transverse colon and
transverse mesocolon
o
Suprahepatic: between diaphragm and liver.
o
Infrahepatic: between visceral surface of liver
and transverse colon/mesocolon.
J. CLINICAL CORRELATIONS
LIVER BIOPSY
Alcoholic cirrhosis
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1. FUNDUS
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2. BODY
2. VENOUS DRAINAGE
Helps keep the cystic duct open (to easily divert bile
into GB when the distal end of the bile duct is closed
by the sphincter of the bile duct and/or
hepatopancreatic sphincter, or bile can pass to the
duodenum as the GB contracts
CYSTIC ARTERY
o Commonly arises from the right hepatic artery in
the triangle between the common hepatic duct,
cystic duct, and visceral surface of the liver, the
cystohepatic triangle (of Calot).
o Supplies the gallbladder and cystic duct.
o Divides into two, supplying:
o The free surface of the gallbladder
o The attached surface of the gallbladder
o Can originate from:
o Right and left hepatic arteries
o Common hepatic artery
o Superior mesenteric artery
C. LYMPHATICS
The lymphatic drainage of the GB is to the hepatic
lymph nodes, often through cystic lymph nodes
located near the neck of the GB. Efferent lymphatic
vessels from these nodes pass to the celiac lymph
nodes.
D. NERVE SUPPLY
The nerves follow the path of the cystic artery.
They come from celiac plexus (sympathetic and
visceral afferent [pain] fibers), vagus nerve
(parasympathetic), and right phrenic nerve (sensory).
E. REFERRED PAIN
Irritation in the liver (near the diaphragm) will manifest
as pain in the neck and shoulder region (C3, C4, C5).
Shoulder pain could also mean biliary stones.
Irritation in the gallbladder will manifest as pain in T7
and T9 (until posterior) and infrascapular area.
If the phrenic nerve is irritated, it will cause ipsilateral
pain in the shoulder and neck.
Abdominal pain in the crouching position may suggest
appendicitis.
Cholecystitis is gallbladder inflammation (tenderness
occurs at ipsilateral side of RUQ and shoulder)
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III. STOMACH
Most dilated part of the alimentary canal between the
esophagus and small intestine
Lies in the epigastric, umbilical and left
hypochondriac region
o Hypochondriac region = region on either side of
the abdomen beneath the cartilages of the false
ribs [chondros = cartilage]
It is intraperitoneal and covered by visceral
peritoneum (except where blood vessels run along its
curvature)
Relations to other organs:
o
Anteriorly: related to the diaphragm, left lobe of
liver, anterior abdominal wall
o
Posteriorly: related to the omental bursa and
pancreas; the posterior surface of the stomach
forms most of the anterior wall of omental bursa
A. PARTS
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4. CARDIA
Pyloric antrum
o Part of the pyloric region that is more proximal to
the stomach proper, found near midline position
and begins to ascend as it blends into the pyloric
canal; it is the entryway to the pyloric canal
(Latin, pylorus meaning gatekeeper; antrum
meaning cave)
Pyloric canal
o The more distal part of the stomach proper; it is
located 2-3cm from the pylorus
2018 IA
responsible for many pulmonary and cardiac
symptoms
Clinical correlation:
o
The near proximity of the heart to the stomach is
illustrated by a case where a thorn (tinik) has
been swallowed and had found its way throug the
diaphragm and pericardium into the wall and
cavity of the right ventricle
POSTEROINFERIOR SURFACE
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G. NERVE SUPPLY
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PARASYMPATHETIC NERVE SUPPLY
H. CLINICAL CORRELATION
Initial
aorta
Celiac trunk
Left gastric
Origin
abdominal
Celiac trunk
Splenic
Splenic
artery
posterior to stomach
Posterior gastric
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Left gastro-omental
Splenic
Short gastric
Hepatic
artery
in hilum of
spleen
Celiac trunk
Right gastric
Hepatic artery
Gastroduodenal
Right gastro-omental
Gastroduodena
l artery
Distribution
Stomach
Lesser curvature of
stomach
Greater
curvature
and
posterior
stomach body
Posterior wall and
fundus of stomach
Left portion of greater
curvature of stomach
Fundus of stomach
Stomach
Right
portion
of
lesser curvature of
stomach
Stomach
Right
portion
of
greater curvature of
stomach
Kia: At dahil matatapos na ang anatomy... gusto ko lang iaffirm na super awesome/happy/gwapo(heh)/sipag/bibo
ng anatomates ko!! Thank you Jasmine, Almira, Aldwin,
Julian, and Carlos!! Ang saya matuto at magdissect
kasama kayo. Sa sobrang galing nyo, 2pm pa lang ata
umuuwi na tayo :P Im so blessed and thankful to have
Adre,
Almora,
Anarna
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