Case

During an abdominal surgical procedure to remove the gallbladder, your index finger is placed into the epiploic foramen. 

Question 1/4 - What is directly anterior to your finger?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

Close, but not quite. The region anterior to your finger is the hepatoduodenal ligament. The common bile duct is in that ligament, but usually slightly anterior and a little lateral of another structure closer to your finger.

Close, but not quite. The common hepatic duct is the segment of the biliary tree between the left/right hepatic ducts and the branch of the cystic duct. This is usually short and close to the liver itself. Additionally, while the common hepatic duct is within the hepatoduodenal ligament (which is anterior to your finger) the common hepatic duct is anterior to another structure within the ligament closer to your finger.

Correct!  The region directly anterior to your finger is the hepatoduodenal ligament containing the portal triad (portal vein, biliary duct, and hepatic artery).

Within the portal triad, the portal vein is the most posterior structure (i.e. directly anterior to the finger). The biliary duct is anterior to the portal vein and a little to the right. The common hepatic artery is anterior to the portal vein and a little to the left.

 

Incorrect. The hepatic veins drain the liver into the inferior vena cava. There is typically a left, right, and middle hepatic vein linking to the inferior vena cave as it passes against liver.  Thus, this location is in the liver, not near the epiploic foramen.

Incorrect. The common hepatic artery is a direct branch from the celiac trunk heading to the right towards the hepatoduodenal ligament which is anterior to your finger. The common hepatic artery branches to provide the proper hepatic artery which is traveling superiorly in the hepatoduodenal ligament to the liver (although that artery is anterior and to the right within the ligament, so not directly anterior to your finger).

 Thus, the common hepatic artery is not within the hepatoduodenal ligament and not anterior to your finger.

Incorrect. The gastroduodenal artery is one of the branches from the common hepatic artery (which made it's way to the right from the celiac trunk).  The gastroduodenal artery turns inferiorly to supply the stomach, duodenum, and pancreas. Thus, the gastroduodenal artery is too inferior to be where your finger is placed.