Development of Liver Pancreas and Spleen. the Liver Is Endodermal in Origin
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Te2, Part Iii
TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS -
Accessory Organs of the Gastrointestinal Tract ـــ ھــــــــ دي
.د ـــ ھــــــــدي ـــــــن Accessory Organs of the Gastrointestinal Tract Liver The liver is the largest gland in the body and lies mainly in the right upper quadrant of the abdomen (occupies most of the right hypochondrium and upper epigastrium and extends into the left hypochondrium ) where it is protected by the thoracic cage (lies deep to ribs 7-11 on the right side) and diaphragm and crosses the midline toward the left nipple. The liver may be divided into a large right lobe and a small left lobe by the attachment of the peritoneum of the falciform ligament . The right lobe is further divided into a quadrate lobe and a caudate lobe by the presence of the gallbladder, the fissure for the ligamentum teres, the inferior vena cava, and the fissure for the ligamentum venosum. Experiments have shown that, in fact, the quadrate and caudate lobes are a functional part of the left lobe of the liver. The porta hepatis, or hilum of the liver, is found on the posteroinferior surface and lies between the caudate and quadrate lobes . The upper part of the free edge of the lesser omentum is attached to its margins. In it lie the right and left hepatic ducts, the right and left branches of the hepatic artery, the portal vein, and sympathetic and parasympathetic nerve fibers . A few hepatic lymph nodes lie here; they drain the liver and gallbladder and send their efferent vessels to the celiac lymph nodes. The liver is completely surrounded by a fibrous capsule but only partially covered by peritoneum. -
LIVER “MICRO”-VESICULAR STEATOSIS Obesity Diabetes Toxic
Chapter 18 & BILIARY TRACT DUCT SYSTEM N O FIBROUS TISSUE PORTAL “TRIAD” CENTRAL VEIN PATTERNS OF HEPATIC INJURY • Degeneration: – Balooning, “feathery” degeneration, fat, pigment • Inflammation: Viral or Toxic – Regeneration – Fibrosis • Neoplasia: 99% metastatic, 1% primary BALOONING DEGENERATION “FEATHERY” DEGENERATION FATTY LIVER “MICRO”-VESICULAR STEATOSIS Obesity Diabetes Toxic “MACRO”-VESICULAR STEATOSIS “Golden” pigment stained with Prussian Blue stain to make it blue. Hemosiderin? Bile? Melanin? APOPTOSIS INFLAMMATION •PORTAL TRIADS (early) •SINUSOIDS (more severe) MILD “TRIADITIS” More severe portal infiltrates with sinusoidal infiltrates also Hepatic Regeneration • The LIVER is classically cited as the most “REGENERATIVE” of all the organs! FIBROSIS • FIBROSIS is the end stage of MOST chronic liver diseases, and is ONE (of TWO) absolute criteria needed for the diagnosis of cirrhosis. • What is the other? • PORTAL-to-PORTAL (bridging) FIBROSIS • The “normal” hexagonal “ARCHITECTURE” is replaced by NODULES • Liver • Alcoholic • Biliary (Primary or Secondary) • Laennec’s • Advanced (kind of a “redundant” adjective) • Post-necrotic • Micronodular • Macronodular ALL CIRRHOSIS IS: •IRREVERSIBLE • The end stage of ALL chronic liver disease, often many years, often several months • Associated with a HUGE degree of nodular regeneration, and therefore represents a significant “risk” for primary liver neoplasm, i.e., “Hepatoma”, aka, Hepatocellular Carcinoma BLIND MAN’s LIVER Blind Man’s Diagnosis N O FIBROUS TISSUE IRREGULAR NODULES -
Vascular Architecture in Anomalous Right-Sided Ligamentum Teres: Three-Dimensional Analyses in 35 Patients
DOI:10.1111/j.1477-2574.2011.00398.x HPB ORIGINAL ARTICLE Vascular architecture in anomalous right-sided ligamentum teres: three-dimensional analyses in 35 patients Junichi Shindoh1, Masaaki Akahane2, Shoichi Satou1, Taku Aoki1, Yoshifumi Beck1, Kiyoshi Hasegawa1, Yasuhiko Sugawara1, Kuni Ohtomo2 & Norihiro Kokudo1 1Hepato-biliary-pancreatic Surgery Division, Department of Surgery and 2Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan Abstracthpb_398 32..41 Background: Right-sided ligamentum teres (RSLT) is a congenital anomaly that is sometimes encoun- tered during hepatobiliary surgeries. However, a valid protocol for describing the segmental anatomy of livers with RSLT has not been established, and confusions or anatomic misunderstandings have been a major problem. Methods: The vascular architecture and morphological characteristics were investigated in 35 livers with RSLT using three-dimensional (3D) simulations. Results: Couinaud's four sectors and three hepatic veins were clearly distinguished in the liver with RSLT using 3D simulations. The ligamentum teres was connected with the right paramedian portal pedicle, and the long axis of the cystic fossa was always observed on the left of the ligamentum teres in all 35 livers. However, when the main portal scissura was visualized using 3D simulation, the gallbladder was always located on the border of either side of the hemilivers, and the malposition of the gallbladder was not confirmed. Conclusions: Although the right-sided components of the livers are well developed as a result of the right-dominant distribution of the feeding vessels in livers with RSLT, the basic segmental structure defined by the four sectors and the three hepatic veins are as well preserved as those in the typical liver anatomy. -
Porta Hepatis) - Bile Ducts, Portal Vein, Hepatic Arteries
10 Al-Mohtaseb Faisal Nimri Shada gharaibeh The Liver continued The superior surface of the liver You can see * The right and left lobes. * Cut edge of the Falciform ligament. * The coronary ligament, continues on both sides as: * The left triangular ligament * The right triangular ligament * Between the edges of the coronary ligament is the Bare area of the liver (where there is no peritoneum covering the liver). * Groove for the inferior vena cava and the 3 hepatic veins that drain in it. * Cut edge of the Falciform ligament. * Caudate lobe of the liver more or less wrapping around the groove of the inferior vena cava * Fundus of gall bladder * Ligamentum teres → Relations of the superior surface • Diaphragm (the diaphragm is above the liver and is related to the anterior, superior and posterior surfaces of the liver but the visceral surface of the liver doesn’t have relations with the diaphragm). The diaphragm separates the Pleura & lung and the Pericardium & heart from the liver. 1 | P a g e → Relations of the liver anteriorly • Diaphragm • Rt & Lt pleura and lung (separated from the liver by the diaphragm) • Costal cartilage • Xiphoid process • Anterior abdominal wall → Relations of the liver posteriorly • Diaphragm • Rt. Kidney • Supra renal gland • Transverse colon (hepatic flexure) • Duodenum • Gall bladder • I.V.C • Esophagus • Fundus of stomach (pay attention to the impressions in the picture they are important) → lobes of the liver • Right Lobe • Left lobe • Quadrate lobe • Caudate lobe (the quadrate and caudate lobes are similar -
Abdomen and Superficial Structures Including Introductory Pediatric and Musculoskeletal
National Education Curriculum Specialty Curricula Abdomen and Superficial Structures Including Introductory Pediatric and Musculoskeletal Abdomen and Superficial Structures Including Introductory Pediatric and Musculoskeletal Table of Contents Section I: Biliary ........................................................................................................................................................ 3 Section II: Liver ....................................................................................................................................................... 19 Section III: Pancreas ............................................................................................................................................... 35 Section IV: Renal and Lower Urinary Tract ........................................................................................................ 43 Section V: Spleen ..................................................................................................................................................... 67 Section VI: Adrenal ................................................................................................................................................. 75 Section VII: Abdominal Vasculature ..................................................................................................................... 81 Section VIII: Gastrointestinal Tract (GI) .............................................................................................................. 91 -
Normal Anatomy Jeopardy 1
Liver Gallbladder Kidneys Pancreas Spleen 1pt 1 pt 1 pt 1pt 1 pt 2 pt 2 pt 2pt 2pt 2 pt 3 pt 3 pt 3 pt 3 pt 3 pt 4 pt 4 pt 4pt 4 pt 4pt 5pt 5 pt 5 pt 5 pt 5 pt Liver Pt. 1 The liver has how many true lobes? Answer 3 lobes Liver Pt. 2 The liver receives blood from what vascular structure(s)? Answer Portal Veins Liver Pt. 3 What three fossas mark the inferior and posterior surfaces of the right lobe? Answer Porta hepatis Gallbladder Inferior Vena Cava Liver Pt. 4 What is the size range for a normal liver? Answer 13 – 17 cms Liver Pt. 5 What is the normal anatomic variant of the liver, where the right lobe can be extended as far as the iliac crest? Answer Reidel’s Lobe Gallbladder Pt. 1 What type of Serum Bilirubin is considered conjugated? Answer Direct (Serum Bilirubin) Gallbladder Pt. 2 What is the normal variant in which part of the fundus of the gallbladder is bent back on itself? Answer Phrygian Cap Gallbladder Pt. 3 What landmark should the sonographer look for on a sagittal scan to find the gallbladder? Answer Main Lobar Fissure Gallbladder Pt. 4 What is the name of the tiny valves found within the cystic duct? Answer Heister’s Valve Gallbladder Pt. 5 The proximal portion of the biliary duct is the ? Answer Common Hepatic Duct Kidneys Pt. 1 The kidneys are located in the? Answer Retroperitoneum Kidneys Pt. 2 The normal diameter of the adult kidney is? Answer 4 – 6 cms Kidneys Pt. -
Falciform Ligament
It is largest gland in body, soft & pliable . Location: RT hypochondrium just beneath diaphragm which separates from the liver from thoracic cavity. Surfaces of liver: Superioanterior surface (diaphragmatic): its a convex upper surface of liver is molded to domes of diaphragm. Posteroinferior (visceral) :its irregular in shape molded to adjacent viscera 1)Large RT lobe & small LT lobe form by attachment of peritoneum of falciform ligament . 2)RT lobe is further subdivided into a quadrate lobe & caudate lobe by presence of gallbladder , ligamentum teres, inferior vena cava & ligamentum venosum . It found on visceral surface & lies between caudate & quadrate lobes . It containes : RT & LT hepatic ducts. RT& LT branches of hepatic artery. Portal vein. Sympathetic & parasympathetic nerve fibers . Hepatic lymph nodes. Peritoneal relation: Falciform Ligament: which is two-layered fold of peritoneum ascends from umbilicus to liver. It contain ligamentum teres ( remains of umbilical vein). Falciform ligament passes on to anterior & then superior surfaces of liver& then splits into two layers. The right upper layer forms coronary ligament. left upper layer of falciform ligament forms left triangular ligament . The right extremity of coronary ligament is known as right triangular ligament. ligamentum venosum ( remains of the ductus venosus) a fibrous band is attached to left branch of portal vein and inferior vena cava. lesser omentum arises from lesser curvature of stomach till edges of porta hepatis. It be noted that the peritoneal layers forming the coronary ligament are widely separated leaving an area of liver devoid of peritoneum. Diaphragm. RT & LT costal margins. RT & LT pleura . Lower margins of both lungs. Xiphoid process. -
The Biliary System
Abdominal Ultrasound Chapter 3 THE BILIARY SYSTEM Niko Mayr Become an expert by learning the most important clinical skills at www.medmastery.com. The Biliary System MASTERING ULTRASOUND ANATOMY Left bile duct Right bile duct Gallbladder Common bile duct Cystic duct Retroperitoneum Bile fluid is produced by the gallbladder, gathers in corner of the periphery of the liver lobule, while the bile ducts, and is transported to the liver hilum, the center of the lobule contains a branch of the where it flows down through the common bile duct hepatic vein. into the duodenum. Blood flows into the liver through the hepatic artery The basic underlying architecture of the liver is the and the portal vein where it enters the capillary liver lobule, which is organized as a hexagon. space between hepatocytes. Blood exits the organ via the right, middle, and left hepatic veins, which The portal triad, or triad of glisson, contains a gather to form a star shape (the hepatic venous branch of the portal vein, a hepatic artery branch, star), when entering the inferior vena cava on the and a bile duct. Portal triads can be found at every dorsocranial surface of the liver. Liver lobule Hepatic artery (branch) Portal triad Central vein Bile duct Portal vein (branch) 1 Become an expert by learning the most important clinical skills at www.medmastery.com. Mickey Mouse sign When viewed in cross section on ultrasound, the with mouse ears (hepatic artery and bile duct) and portal triad—portal vein, hepatic artery branch, and so is called the Mickey Mouse sign. -
Two Congenital Anomalies in One: an Ectopic Gallbladder with Phrygian Cap Deformity
Hindawi Publishing Corporation Case Reports in Radiology Volume 2014, Article ID 246476, 4 pages http://dx.doi.org/10.1155/2014/246476 Case Report Two Congenital Anomalies in One: An Ectopic Gallbladder with Phrygian Cap Deformity Vasileios Rafailidis,1 Sotirios Varelas,2 Naoum Kotsidis,2 and Dimitrios Rafailidis2 1 Department of Radiology, General Hospital of Katerini, 6 Km Katerini-Arona, 60100 Katerini, Greece 2 Department of Radiology, “Gennimatas G.” General Hospital of Thessaloniki, Ethn. Aminis 41, 54635 Thessaloniki, Greece Correspondence should be addressed to Vasileios Rafailidis; [email protected] Received 3 December 2013; Accepted 30 January 2014; Published 4 March 2014 Academic Editors: L. Lampmann, O. Strohm, and A. Vade Copyright © 2014 Vasileios Rafailidis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The gallbladder is affected by a large number of congenital anomalies, which may affect its location, number, size, or form. Some of these malformations are very rare and may lead to misdiagnosis. An ectopic gallbladder can be misinterpreted as agenesis of the organ or as a cystic hepatic mass when intrahepatic. Given the frequency and the wide acceptance of the ultrasonographic examination of the biliary tract, radiologists should be aware of these malformations. In some cases, ultrasonographic diagnosis can be difficult. However, the use of Computed Tomography can elucidate such cases. We present the case of a patient whose gallbladder had two combined malformations but caused no symptoms. Namely, the patient had a transverse ectopic gallbladder combined with a “Phrygian cap” deformity. -
Forgotten Ligaments of the Anterior Abdominal Wall: Have You Heard Their Voices?
Japanese Journal of Radiology (2019) 37:750–772 https://doi.org/10.1007/s11604-019-00869-5 INVITED REVIEW Four “fne” messages from four kinds of “fne” forgotten ligaments of the anterior abdominal wall: have you heard their voices? Toshihide Yamaoka1 · Kensuke Kurihara1 · Aki Kido2 · Kaori Togashi2 Received: 28 July 2019 / Accepted: 3 September 2019 / Published online: 14 September 2019 © Japan Radiological Society 2019 Abstract On the posterior aspect of the anterior abdominal wall, there are four kinds of “fne” ligaments. They are: the round ligament of the liver, median umbilical ligament (UL), a pair of medial ULs, and a pair of lateral ULs. Four of them (the round liga- ment, median UL, and paired medial ULs) meet at the umbilicus because they originate from the contents of the umbilical cord. The round ligament of the liver originates from the umbilical vein, the medial ULs from the umbilical arteries, and the median UL from the urachus. These structures help radiologists identify right-sided round ligament (RSRL) (a rare, but surgically important normal variant), as well as to diferentiate groin hernias. The ligaments can be involved in infamma- tion; moreover, tumors can arise from them. Unique symptoms such as umbilical discharge and/or location of pathologies relating to their embryology are important in diagnosing their pathologies. In this article, we comprehensively review the anatomy, embryology, and pathology of the “fne” abdominal ligaments and highlight representative cases with emphasis on clinical signifcance. Keywords Hepatic round ligament · Right-sided round ligament · Umbilical ligament · Groin hernia Introduction Anatomy On the posterior wall of the anterior abdominal wall, there Four “fne” ligaments of the posterior aspect of the anterior are forgotten ligaments. -
Frequency of Anatomical Variations and Congenital Anomalies in Pancreatobiliary Tract Through Magnetic Resonance Cholangiopancreatography
Original Article Frequency of Anatomical Variations and Congenital Anomalies in Pancreatobiliary Tract through Magnetic Resonance Cholangiopancreatography Imran Ishaque 1 , Naveed Ali Siddqui 2 , Mahveen 3 , Jay Kreshan 4 , Sara 5 , Amber Ilyas 6 Abstract Objective: To determine the frequency of anatomical variations and congenital anomalies of pancreatobiliary tract in adults through the Magnetic Resonance Cholangiopancreatography (MRCP). Methods: This cross-sectional observational study was done on patients suspected to have pancreatobiliary disease referred to MRI unit. MRCP was performed on a 1.5 Tesla in MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSF-SE tech- nique. Axial and coronal source images and reformatted images were evaluated together for the pos- sibility of any anomaly and variation in pancreatobiliary tract. Analysis was done by SPSS version 20. Results: Total no of 377 patients included in this study. The patients presented with epigastric pain, obstructive jaundice, pancreatitis and post-cholecystectomy epigastric pain and jaundice. MRCP was performed on these patients to examine the pancreatobiliary tract. In this study, 52% were females and 48% were males. The variations and anomalies were found in 24.93 and 75.07% had normal anatomy of pancreatobiliary tract. The most observed frequency was low insertion of cystic duct and least observed frequency was duct of Santorini. High insertion of cystic duct, absent gallbladder and aberrant hepatic ducts were not found in this study. Conclusion: Majority of the patients in this study were found to be free from pancreatobiliary disease. It is important to clarify the anatomy of the pancreatobiliary tract by preoperative evaluation.