MONASH Structured Gross & Clinical Anatomy Practical Tasks

Malaysia
MED 2031 ABDOMEN IV:
YEAR 2 LIVER, BILIARY TRACT & PANCREAS

Practical Activities: each activity is referenced with an appropriate

Model/Chart/Plastinated Specimen (P) or Digital application resource:
An@tomedia (ANM), Grants (GDA); MAPEL DIGITAL REPOSITORY. Please use
them as well as text books and Anatomy atlases.

Part A
1. VISCERA: LIVER (Torso, models JS 8, K24, J8/2, P3-1,P30-1,P56-1);
MAPEL DIGITAL REPOSITORY - LIVER
1.1. Hold the Liver in the anatomical position.
1.2. Identify the 4 anatomical lobes
Perform a virtual dissection in 4 D Anatomy (http://4danatomy.com/modules )
of the Liver by dissecting at the levels of 1, 2 & 3 : Visceral surface of
liver with pancreaticoduodenal unit
1.3. Identify the falciform ligament.
1.3.1.What is the significance of the embryological structure it contains in
its free edge?. GDA-Grants atlas-2.49A
1.4. Trace and review the pathway of blood from umbilicus to right atrium in the
fetus.

1.5. How are the functional lobes of the liver defined? GDA-Grants atlas-2.53B
1.5.1.From the model, identify the vascular segments of the liver and give its
importance GDA-Grants atlas-2.53A, 2.53C

1.6. Identify the peritoneal and bare areas of the liver. GDA-Grants atlas-2.49B
1.6.1.List the major hepatic ligaments. ANM Abd System 18

1.7. Identify the hepatic fissures. GDA-Grants atlas-2.50A

1.7.1.What is located deep in these fissures? GDA-Grants atlas-2.50B
1.7.2.What is their embryological origin and the function of these structures
in the fetus?
1.7.3.Schematically draw to show how these ligaments are all derived from
the ventral mesogastrium during development of the liver.

1.8. Identify the visceral surface impressions GDA-Grants atlas-2.51B

1.9. Identify the caudate process of the liver.

1.9.1.What is its significance? (i.e. what is it the superior boundary of?)

2. VESSELS
2.1. Identify the porta hepatis (of the liver) GDA-Grants atlas-2.35A,2.54B

2.2. Describe the structures found here and their relationship GDA-Grants
atlas-2.36
2.3. Identify the branches of the common hepatic artery.GDA-Grants atlas-
2.55A
2.3.1.Identify the branches of the hepatic artery proper.
2.4. Identify the blood supply to the gall bladder. GDA-Grants atlas-2.55A

2.5. What proportion of blood to the liver is supplied by the portal and system
vessels respectively?

2.6. Identify the portal vein and its formative tributaries ANM Abd System 31;
GDA-Grants atlas-2.60

Prepared by A/P Dr. A Sen & A/P Dr. L.Selvaratnam/ 2018 Page 1
MONASH Structured Gross & Clinical Anatomy Practical Tasks
Malaysia
MED 2031 ABDOMEN IV:
YEAR 2 LIVER, BILIARY TRACT & PANCREAS

3. VISCERA: GALL BLADDER & BILIARY TRACT (MODEL 6090.2,

6090.23)
3.1. Identify the parts of the gall bladder ANM Abd System 20

3.2. What is the Hartmann’s pouch? ANM Abd System 20

3.2.1.Describe the sphincter in the gall bladder neck.

3.3. Draw a schematic diagram describing the biliary tree/pathway of bile from
hepatocyte to duodenum. GDA-Grants atlas-2.37

3.4. Identify the boundaries of the Calot’s triangle

4. VISCERA: PANCREAS (MODEL 6090.14, JS 11,6090.24, P28-2, P28-

1); MAPEL DIGITAL REPOSITORY - DUODENUM PANCREAS SPLEEN
4.1. Identify and describe its position, location and its vertebral level.
ANM Abd System 21
4.2. Identify each of the parts of the pancreas. GDA-Grants atlas-2.32
4.2.1.What is its functions (general)? Where these functional tissues are
mainly situated?

4.2.2.With the aid of a diagram identify one important relation of each part.
GDA-Grants atlas-2.33A

4.3. Describe the anatomy of the pancreatic duct.

5. VISCERA: SPLEEN (TORSO, MODEL JS 11, 6000.16, JS2/1, P 48-1,

P31-1, P48-2, P32-1) MAPEL DIGITAL REPOSITORY - SPLEEN

5.1. Hold the spleen in Anatomical position.Identify the surfaces and borders of
the spleen ANM Abd System 33
5.1.1.What is the axis of the spleen and which ribs are related to it?

5.1.2.Identify the splenic notches. GDA-Grants atlas-2.29

5.1.3.What is their embryological significance?

5.2. Identify the splenic ligaments. GDA-Grants atlas-2.23B

5.2.1.Where are they attached and give its embryological origins
5.2.2.What do they contain?

5.3. What is contained in the hilum of the spleen? GDA-Grants atlas-2.21B

5.3.1.How are the hilar structures related? GDA-Grants atlas-2.25
5.3.2.How does the capsule affect splenic trauma?

6. NERVES
6.1. What is the segmental nerve supply to the gall bladder?
6.1.1.Where can intrinsic (visceral) pain be referred GDA-Clin Orient Anat-
2.28

6.2. How is the flow of bile increased? What is the main cause?

6.3. What is the nerve supply of the pancreas?

6.3.1.How is pancreatic secretion generally controlled?

6.3.2.Where is intrinsic pancreatic pain referred? GDA-Clin Orient Anat-2.28

Prepared by A/P Dr. A Sen & A/P Dr. L.Selvaratnam/ 2018 Page 2
MONASH Structured Gross & Clinical Anatomy Practical Tasks
Malaysia
MED 2031 ABDOMEN IV:
YEAR 2 LIVER, BILIARY TRACT & PANCREAS

PART B
7. CLINICAL/SURFACE ANATOMY
{Where possible palpate on yourself or on your willing and consenting peers
or models/ plastinated specimens the following}:
Surface marking guide pdf- webdrive}
7.1. Surface mark the following:
• Liver
• Fundus of Gall bladder
• Spleen
• Traube’s space (Surface markings: Superiorly: Left 6th rib;Inferiorly: Left costal margin Laterally:
Anterior axillary line .)
▪ What is its clinical importance?

7.2. How much must the spleen enlarge to be palpable?

7.3. What are the common causes of liver and splenic enlargement?
7.3.1.Demonstrate how you would clinically palpate/examine liver and spleen.

7.4. Explain the anatomical basis of clinical features of cancer of the head of the
pancreas.
7.4.1.What structures are surgically removed in patients with cancer of the head of
the pancreas and why?
7.4.2.Describe the embryological basis for an annular pancreas. GDA-Grants atlas-
2.38B
7.4.3.How does the termination of the pancreatic duct embryologically explain the
dual blood supply of the pancreas? GDA-Grants atlas-2.34B;2.38B

7.5. What is portal hypertension?

7.5.1.Identify all the sites and vessels involved in porta caval anastomosis. GDA-
Grants atlas-2.61A
7.5.2.Describe how may the patient with oesophageal varices present. GDA-Grants
atlas-2.61B

7.6. Identify the Anatomical structures that are involved in Laparoscopic

Cholecystectomy. ANM Imaging 59

7.7. Classify jaundice.

7.7.1.What are the causes and anatomical sites of “surgical/obstructive jaundice”?

7.8. List a few of the common anatomical variations in the biliary tract :
▪ variations in hepatic and cystic arteries: GDA-Grants atlas-2.57A-H
▪ variations in the cystic and hepatic ducts and the Gall bladder GDA-Grants
atlas-2.59 A-G

7.8.1.What is the cause of biliary atresia? Briefly explain the consequences.

Prepared by A/P Dr. A Sen & A/P Dr. L.Selvaratnam/ 2018 Page 3
MONASH Structured Gross & Clinical Anatomy Practical Tasks
Malaysia
MED 2031 ABDOMEN IV:
YEAR 2 LIVER, BILIARY TRACT & PANCREAS
8. RADIOLOGY
{Refer to radiological images in textbooks, Grants Atlas & Clinical Imaging
software, An@tomedia}

Review the following:

8.1. AP radiograph of Abdomen (for liver/spleen where possible)

8.2. Ultrasound of Gall Bladder ANM Abd Imaging 49

8.3. ERCP : Identify the biliary tree. GDA-Grants atlas-2.37C;ANM Abd Imaging
61

8.4. MRI /CT scan of abdomen at L1-L2 level ANM Abd Imaging 33 (Axial
MRI),41 (CT)
8.5. CT scan of abdomen and Biliary Tract (with contrast) ANM Abd Imaging 44;

9. RESOURCES
9.1. Aclands Video: 6.2.16/6.2.17/6.2.18/6.2.19/6.2.20/6.2.21

9.2. Models
9.2.1.Abdomen (T12)
9.2.2.Half torso (AS23-1. AS50/1)
9.2.3.Skeleton with Viscera (SK-2500)
9.2.4.Viscera :Pathology of Pancreas, Duodenum, Liver, Blood Supply of
the Liver (JS5, JS11, 6090.14)

9.3. Computer Aided Learning( CAL)

9.3.1.An@tomedia
http://www.anatomediaonline.com.ezproxy.lib.monash.edu.au/
9.3.2.MAPEL Digital AnatomyPathology Repository
http://59.191.192.195/mapel
• Gross Anatomy (Interactive Display)
• Cross Sections (Interactive Display)
• 3D (Interactive Display)
9.3.3.Grant’s Dynamic Anatomy :http://atlasdha.med.monash.edu.au
9.3.4.Diagnostic Imaging Pathways:
http://www.imagingpathways.health.wa.gov.au/index.php/image-galleries/normal-anatomy
9.3.5.Radiology assistant http://www.radiologyassistant.nl/en/p43facb25c7ba7/click-for-more-
information.html
9.3.6. 4 D Anatomy http://4danatomy.com/modules
• Chest and upper abdomen module
• Visceral surface of liver with pancreaticoduodenal unit
9.4. Surface Anatomy Resources (pdf file)

9.5. Plastinated specimens

9.5.1. Mr Viscera/Mr Muscle
9.5.2. Viscera :
9.5.2.1. liver;
9.5.2.2. combined viscera-liver & portal triad,
9.5.2.3. Pancreas,
9.5.2.4. duodenum,
9.5.2.5. abdominal cavity with diaphragm and liver
9.5.3. Thin sheet plastinated cross section

9.6. Posters of Prosection

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