Liver, gallbladder and bile ducts
Organ supplied · Foregut T5–T9
The hepatic artery provides about a quarter of liver blood flow but half its oxygen and is the only supply of the biliary tree; the cystic artery, usually from the right hepatic within Calot's triangle, supplies the gallbladder.
Traced from the start
- Abdominal aorta
- Coeliac trunk
- Common hepatic artery
- Liver, gallbladder and bile ducts
Detail
- Liver
- Hepatic artery ~25% of flow, portal vein ~75%
- Bile ducts
- Arterial supply only, via marginal arteries at 3 and 9 o'clock on the common bile duct
- Gallbladder
- Cystic artery from the right hepatic in Calot's triangle
- Referred pain
- Epigastrium T5–T9; right shoulder tip if the diaphragmatic peritoneum is irritated (phrenic, C3–C5)
When it goes wrong
Acute cholecystitis: visceral afferents (T5–T9) first, then parietal peritoneal inflammation
Epigastric colic that localises to the right upper quadrant with Murphy's sign; right shoulder tip pain when the diaphragm is involved
Cystic artery (an end artery) thrombosed by inflammation or an impacted neck stone
Gangrenous cholecystitis and perforation, particularly in elderly and diabetic patients
Replaced right hepatic artery from the SMA (~15%) running behind the bile duct and portal vein
At risk during Whipple's procedure and cholecystectomy; injury infarcts the right lobe
Practise this structure
1 question in the bank tagged Arterial Supply.