c l i n i c a l f o l i o s : n a r r a t i v e





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Right Upper Quadrant Anatomy: 7

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The celiac trunk most often (85%) has three branches, the splenic, left gastric and common hepatic arteries. The most common variation is a separate origin of the left gastric with a hepatosplenic trunk. The hepatic artery arises from the celiac 95% of the time and from the superior mesenteric artery 5% of the time, either alone or with one of the other celiac branches. The hepatic artery ascends to the hilus of the liver on the anteromedial surface of the portal vein.     

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Right Upper Quadrant Anatomy: 8

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The hepatic ducts from the right and left lobes unite at the liver hilus to form the common hepatic duct. The junction point is intrahepatic 10% of the time. The right hepatic ducts from the anterior and posterior segments (see segmental anatomy) of the right lobe unite close to the common hepatic duct and the most common variation is a trifurcation without forming a right hepatic duct. The identification of right segmental ducts is the tricky part of cholangiogram interpretation in checking for retained stones. The most helpful landmark for confirming that both anterior and posterior right segmental ducts are visualized is the fact that the anterior duct's division into superior and inferior branches is usually more medial than the posterior duct bifurcation.

More important from the point of view of identifying anatomy and avoiding and diagnosing bile duct injury is a knowledge of the many variations of bile duct drainage (see biliary variation). The left hepatic duct is formed by the union of lateral and medial left segmental ducts and lies on the anterolateral side of the portal vein. The portal triad of bile duct, portal vein and hepatic artery lie in the edge of the hepatoduodenal ligament forming the anterior border of the (epiploic) foramen of Winslow. The length of the common hepatic duct is defined by the junction point of the cystic duct. Below the cystic duct is the short supraduodenal portion of the common bile duct. The remainder of the common duct runs within the head of the pancreas. 

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Right Upper Quadrant Anatomy: 9

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The pancreas drapes across the upper part of the great vessels with the head and tail lying on renal fascia to the right and left respectively. The superior mesenteric vein passes across the uncinate process and beneath the neck of the pancreas where it unites with the splenic vein to form the portal vein. The splenic vein lies in a groove in the posterior upper border of the pancreas and receives many small branches into its pancreatic surface. The splenic artery is usually quite tortuous and lies above the upper border of the tail of the gland.     

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This page was last modified on 3/1/1999.