sheet6بعد النجاح الباهر الذي حققته
و بعد تزايد الطلب من كثير من الطلبة على تكرار التجربة فقد عزمنا و بسم الله نبدأ
Accessory digestive glands:
(1) LIVER:
- It is the largest gland in the body.
- It is located in the:
* Right hypochondriac region.
* Epigastric region.
* May extend to left hypochondriac region.
- It weighs about 1.5 kg.
- In newborn it represents about 10% of weight because it produces RBCs.
- In adults it weighs about 2% of their weight.
- Before birth and until the 3rd month we depend on liver in the production process of RBCs and that is why it represents 10% of newborn weight.
- It is completely an intraperitoneal organ except for 3 areas.
#Divisions:
(1) LIVER:
- It is the largest gland in the body.
- It is located in the:
* Right hypochondriac region.
* Epigastric region.
* May extend to left hypochondriac region.
- It weighs about 1.5 kg.
- In newborn it represents about 10% of weight because it produces RBCs.
- In adults it weighs about 2% of their weight.
- Before birth and until the 3rd month we depend on liver in the production process of RBCs and that is why it represents 10% of newborn weight.
- It is completely an intraperitoneal organ except for 3 areas.
#Divisions:
- Divided into: - Right lobe (large)
- Left lobe (small)
by falciform ligament (c-shaped) "الرباط المنجلي" which is a double layer of Peritoneum between anterior abdominal wall and liver.
- At the free margin of falciform ligament there located ligamentum teres (الرباط الدائري) which was containing umbilical vein.
#Shape:
* From anterior view it is triangular in shape with:
- Superior border.
- Right border.
- Inferior border.
To look nearly like “La Vache qui rit” .
* The inferior border divides the liver into 2 surfaces:
1- Diaphragmatic surface: which is large and convex.
2- Visceral surface: which is concave.
* Below visceral surface we have the right kidney, that is why the right kidney is lower in position than left one, and right lung is higher than the left one due to the large mass of the liver.
-At visceral surface there is an H-shaped area formed by the following:
* right limb of the “H” formed by:
- inferior vena cava (superior).
- Gallbladder (inferior).
* left limb formed by:
- inferior fissure (for ligamentum teres).
- superior fissure (for ligamentum venosus).
* cross bar formed by:
- porta hepatis (the umbilicus of the liver) which contains the hepatic duct, hepatic artery, portal vein. (the duct is anterior / the artery is itermedial / the vein is posterior)
- Since the liver at the visceral surface has an H-shaped area it is divided into 4 lobes:
(1) Right lobe.
(2) Left lobe.
(3) Caudate lobe:
Boundaries:
- inferior: porta hepatis.
- superior: superior border.
- right: inferior vena cava.
- left: fissure for ligamentum venosum.
(4) Quadrate:
Boundries:
- inferior: inferior border.
- superior: porta hepatis.
- right: gallbladder.
- left: ligamentum teres.
- Functionally quadrate + cudate lobes are parts of the left lobe according to arterial supply, venous drainage and bile secretion.
#Arterial and venous supply of the liver:
1- Hepatic artery (branch from celiac artery) brings about 20% of blood to the liver itself.
2- Portal vein brings about 80% of deoxygenated blood from digestive tract for filtration and detoxication.
#The liver is completely intraperitoneal except for 3 retroperetorial parts:
1- Port hepatis.
2- Between Gallbladder and right lobe of the liver.
3- Bare area of the liver at superior border between liver and diaphragm. (important in cancer and from there the disease can go to the posterior mediastinum.
#Pain from liver is usually felt in right side, epigastric region.
- You should differentiate between pain from stomach and the pain from liver:
If the pain is coming from right side and going up towards the right lung >> then the problem is in the right lobe. (left lung > left lobe)
#Function:
· Main function of the liver is filtration.
· Other important functions:
1- Pile formation and secretion (for fat digestion)
2- RBCs’ formation in the embryo and the first three months after birth.
3- Detoxification (e.g. after drinking alcohol)
4- Storage of glycogen.
5- Important in blood clotting. (if we have a patient with تليف الكبد then the healing of the bleeding will be not easy)
(2) GALLBLADDER:
- Elongated pear-shaped sac.
- Close to the visceral surface of the right lobe of the liver.
- Normal capacity: 30 ml.
- Function: Storage and concentration of bile for about 10 times.
- Parts:
1) Fundus:
- Projects beyond inferior border of the liver.
- Completely intraperitoneal.
- Located below the tip of the right 9th rib.
- If the patient has a pain in the tip of the right 9th rib region then we should think of inflammation of Gallbladder which is called (colisitisis)
2) Body:
- The largest part.
- concentration area.
3) Neck.
4) Cystic duct
(قناة الحويصلة) which unites
with common hepatic
duct to form the common bile duct. (cystic duct + common hepatic duct = common bile duct)
- Arterial supply of Gallbladder is through a branch of celiac artery.
اخيرا و ليس اخرا اود ان اهنئ جميع زملائي بالدفعة بمناسبة انتهاء الفصل الثاني من السنة الاولى فلم يبق الكثير (هانت كلهم 16 فصل:D)
و اتمنى للجميع التوفيق في امتحاناتهم و دراسة ممتعة للجميع :) ولو اردت ذكر جميع الاخيار(او الشطار) لاحتجت الى مئات الجدران و لكني اذكر من تذكرت (فأحلى تحية لكل الشباب
وبما انها الsheet
قبل الاخيرة فحبيت اتذكر اكبر قدر ممكن و اخص بالذكر:
Razan 3moosh (w hay awal wa7adeh betmoni :P) , YAZAN 3TOOM , 3bdelra7man 3attili , Far7an Elkooz , Martin Qaqish , 3’aleb 5erfan , Wa2el 6o8an, Yasmine Elsukhon , Aseel Zein Eddin , 7amzeh Sarayra , Raya 7alawani , M7mmd 3arabeyyat , Zaid 8endeel , Elham El8dah , Dina 3mmari , Bandar Maslamani ,Ayoub 3ennabi, M7mmd Maslamani , Muna Talal , Samar Taqatqa , Fadi Halaseh , M7mmd Abu 5alaf , M7mmd Shawaf Qtaishat , Hammam Ryalat , Sami 3abdeen , A7mad 3abed , 3omar Abu Gamar , Rami Salameh , Ayman D3ja , Yazeed 8ayseyyeh , Osama , 7amzeh Jassar , Ma2moon Sha3ban , A7mad Abu 7alaweh , Yazeed Elnaif , 5aled 7ajir , Mo2ayyad Kettaneh , Yousef Kettaneh , Feras Elnemer , Walid El8adiri , Yazan Radaydeh , 3omar Radaydeh , Dana 6walbeh , A7mad 7ara7sheh , 3omar Ellowzi , Bashar Elrama7i , Bashar Sharma , 7amzeh Sbai7 , 3bdallah Tayyem , M7mmd Elmomani , Shatha El3attili , Amr El5alili , Tamara Darweesh , M7mmd Fadel , Zakareyya , Bilal Abu Dhaim , M7mmd Abu Haneyyeh , Waseem Samara , Shaker Barham , A7mad Elshalabi , Ala2 Jabri , Noorhan , 3amer 7ajjaj , Zain El3abedeen , Nemer Sha5sheer , Nidal Matani , 3eesa 3a8eel , M7mmd 8awasmi , Majd 5ader , Amal 7osban , 3omar Dodin , Zaid Shmaisani , 7anna Bar3’oot, Mus6afa Abu Ra7meh & for all Jubilians :D
best wishes;
A7mad El3eesa
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