HPB anatomy

Liver & biliary tract

  • Surfaces, relations and features of the liver, surface marking - Liver landmarks
  • The liver lobule as an architectural building block: function of the lobule, vessels, sinusoids
  • The named four lobes of the liver: appreciation of their functional division into two halves. Detailed anatomy of lobes and segments not required
  • The shape of the liver: presence of visceral & diaphragmatic surfaces Liver gross anatomy
  • Principal relations of the diaphragmatic surface (eg diaphragm, lungs, pleura). Position of vena cava and other key structures (eg porta hepatis) in relation to the gross structure of the liver. Detailed knowledge of relations not required
  • The hepatic veins & IVC as providers of organ stability - Liver supply
  • Blood supply via hepatic artery (and overview of its divisions) and portal vein: anatomical basis of the potential for one-sided liver infarction.
  • Pattern of venous return
  • Lymphatic drainage pattern and implications for spread of carcinoma
  • Gross structure, surface anatomy and principal relations
  • Course of normal bile flow: location of Hartmann's pouch & implications for stone formation
  • Details of histology, blood supply and lymph drainage not required

Biliary ducts - Bile duct system

  • Pattern of formation of common hepatic duct from tributaries
  • The (common) bile duct as a 3-part tube: principal relations of each part and point of entry into ampulla of Vater
  • Innervation: action of sympathetic & parasympathetic nerves in normal function. Basis of referred pain

Portal vein

  • Appreciation of the five sites of portosystemic anastomosis and the implications of these
  • Appreciation of the vein as being a continuation of the superior mesenteric vein & splenic vein
  • Detailed anatomy of the portal vein NOT required

Pancreas

  • Functional overview: surface markings
  • Palpation of the enlarged spleen: anatomical basis of differentiation of splenomegaly from retroperitoneal masses
  • Details of vasculature/ innervation/ development NOT required