Transcript Abdomen Part 2

Marilyn Rose
 Largest organ of abdomen
 Rt hypochondriac/ and epigastric regions
 Borders:
 Superior/lateral and
anterior= Rt diaph
 Medial= sto/duodenum,
transverse colon.
 Inferior= hepatic flex
 Posterior= Rt Kid
 Glisson’s Capsule
 Covered in peritoneum
 Except: GB fossa,
area of IVC and bare
area.
 Ligamentum teres- divides


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lt hepatic lobe into medial
and lateral segments
Ligamentum venosumseparates the caudate lobe
from Lt lobe
Transverse (portal) fissurehorizontal R/L PVS
Main lobar fissure (GB)divides R/L lobes
Porta Hepatisinferomedial 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 lobe
 Smallest 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 liver
2: Left lobe of liver
3: Quadrate lobe of liver
4: Round ligament of liver
5: Falciform ligament
6: Caudate lobe of liver
7: Inferior vena cava
8: Common bile duct
9: Hepatic artery
10: Portal vein
Subcapsular Hematoma
 Divided into 8 segments by
the vascular supply (4=a/b)
 Three hepatic veins:
 MHV- divides liver into
Rt/Lt lobes
 RHV- 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 to
Ascites 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 Vein
 Largest- drains
segments 5, 6 and 7
 Left Hepatic Vein
 Smallest – drains
segments 2,3
 Middle 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 ducts
 Drain the liver and store bile until
transported to the duodenum for
digestion of fats..
 GB lives in the GB fossaanterioinferior 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.
ERCP
MRCP
Ultrasound
ERCPCholangiocarcinoma
 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
SAGITTAL
 Largest lymph organ
 Red pulp= blood
 White pulp= lymphoid tissue and
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


white blood cells
Intraperitoneal organ- covered in
peritoneum
Posterior to stomach in the LUQ
Behind the 9-11th ribs
Borders-
 medial- Lt kidney, splenic flexure,
pancreatic tail
 Posterior- diaphragm, pleura, Lt lung,
ribs
 Attached to > curvature of sto and Lt
kid by the
 Gastrosplenic and lienorenal ligaments
TRANSVERSE
Splenic Rupture