Abdomen part 2
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Abdomen Part 2. Marilyn Rose. Liver. 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

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Abdomen Part 2

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Abdomen part 2

Abdomen Part 2

Marilyn Rose


Liver

Liver

  • 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.


Fissures of liver

Fissures of liver

  • 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.


Abdomen part 2

Fissures of the liver


Lobes of the liver

Lobes 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 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


Abdomen part 2

Subcapsular Hematoma


Segments of liver

Segments of Liver

  • 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


Portal system

Portal System

  • 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


End stage liver failure

End Stage Liver Failure

Portal Hypertension-leads to

Ascites and splenomegaly


Hepatic artery

Hepatic Artery

  • 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.


Hepatic veins ivc

Hepatic Veins IVC

  • 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


Biliary system

Biliary System

  • Gallbladder and bile ducts

  • Drain 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.


Biliary system imaging

Biliary System Imaging

ERCP

MRCP

Ultrasound


Abdomen part 2

ERCP-

Cholangiocarcinoma


Pancreas

Pancreas

  • 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


Pancreas1

Pancreas


Abdomen part 2

MRI -ABDOMEN


Spleen

Spleen

SAGITTAL

  • Largest lymph organ

  • Red pulp= blood

  • White pulp= lymphoid tissue and 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


Spleen1

Spleen

Splenic Rupture


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