4 Liver Flashcards
Q: Where does the liver lie? protection? What is it connected to? function?
A: upper right quadrant of the abdomen (protected by ribcage)
gall bladder (stores bile from liver) and (when stimulated) squirts it into the duodenum
Q: What are the 3 overarching functions of the liver?
A: Metabolic and catabolic functions: synthesis and utilization of carbohydrates, lipids and proteins.
Secretory and excretory functions: synthesis and secretion of bile and waste products
Detoxification and immunological functions: breakdown of ingested pathogens and processing of drugs
Q: What are the 3 roles of bile? Produced by? Flow?
A: Emulsification and absorption of fat: to increase surface area for lipase activity
Cholesterol homeostasis: excreting excess as needed
Toxin excretion: endogenous (e.g. bilirubin) and exogenous (e.g. drugs)
- produced by hepatocytes
- flow along caniculus to bile duct (opposite direction to blood flow)
Q: How can the liver be separated in terms of lobes? Anterior. Posterior. Diagram.
A: -2 lobes (shape is a right angled triangle with right angle top left and long side at top)
- right lobe (large part) | left lobe
- separated by falciform ligament- connects it to diaphragm
left lobe | caudate lobe | left hepatic vein | hepatic artery proper | Quadrate lobe (IVA + HPV + common bile duct = hilus) | gall bladder | right lobe
Q: What is the liver blood supply in terms of richness? Dual? Drainage?
A: rich blood supply: 25% of resting cardiac output
dual blood supply: 20% arterial blood from hepatic artery (L and R branches)- from heart
80% venous blood draining from the gut through the hepatic portal vein
blood from the liver drains into the inferior vena cava via the hepatic vein
Q: How can the liver be separated in terms of segments Central? Peripheral? Drainage? Damage? Which segment is usually slip into subsegments?
A: discrete segments (8), with their own anatomical borders
- centrally: portal vein, hepatic artery and bile duct
- peripherally: hepatic vein (drainage)
subsequently hepatic veins drain into the left, middle and right hepatic veins before joining the vena cava
Because of this, it is quite possible to have severe damage in one part of the liver without affecting other parts
IV is usually split into upper (a) and lower (b) subsegments
Q: Draw a diagram showing how the liver segments are numbered? Include 4 veins.
A: numbered clockwise (from front view where right lobe is on left)
right hepatic vein, portal vein, middle hepatic vein, left hepatic vein
Q: What is a structural unit of liver tissue? shape? Diagram.
A: hepatic lobule- roughly hexagonal
each corner consists of a portal triad that links with 3 adjacent lobules
at the centre of each lobule is a central vein which collects blood draining from the hepatic sinusoids to return it to the systemic venous system via the hepatic veins
within the lobule are rows of hepatocytes with each hepatocyte having a sinusoid- facing side and a canaliculi- facing side
Q: What does the portal triad consist of?
A: 3 vessels/conduits
- branch of hepatic portal vein: coming in with mixed venous blood directly from gastrointestinal organs and spleen
- branch of hepatic artery: brings oxygen rich blood to help support hepatocyte activity (high energy demand)
- bile duct: bile that is produced by hepatocytes drains into tiny canals called bile canlculi which eventually coalesce with the bile ducts located around the lobule perimeter
Q: What is the role of hepatocytes? (4) What supports activity? What do they synthesise?
A: -process nutrients
- detoxify blood
- excrete waste substances before the blood returns to circulation
- drug metabolism
oxygen rich blood to help support hepatocyte activity (high energy demand)
- albumin
- clotting products/factors
- bile salts
Q: Which cells are in the liver? (5) Diagram for arrangement.
A: -hepatocytes (80%)= large with pale and rounded nuclei
- kupffer= fixed phagocytes=liver macrophages
- cholangiocytes= bile duct epithelial cells
- endothelial cells= line blood vessels and sinusoids
- hepatic stellate cells= vitamin A storage-> can be activated to a fribrogenic myofibroblastic phenotype
bile canaliculi (no cilia on this side of hepatocytes) hepatocytes space of dissie quiescent stellate cell (between hep and endo) endothelial cells kupffer sinusoid endothelial again
Q: What’s the arrangement of hepatocytes? blood movement? Shape? What percentage of liver mass?
A: in lots of cords (sheets) radiating from central vein
diffuses down through sheets towards central vein
cuboidal
80%
Q: What is an hepatic acinus?
A: functional unit of liver tissue that is harder to define anatomically than a hepatic lobule
consists of 2 adjacent 1/6 lobules that share 2 portal triads and extend as far as central veins
Q: What is the 3 zone model? Refers to?
A: refers to hepatic acinus
due to the arrangement and the way blood is received from the hepatic portal vein and artery (the 2 1/6th lobules have in common) and drains into the outer parts of each 1/6th lobule being the hepatic vein
hepatocytes towards to the outside of the lobules receive ‘early exposure’ to blood contents which includes good components eg O2 and bad eg toxins
3 | 2 | 1 | 1 | 2 | 3
where 1 receives high oxygen and high toxins
3 receives low oxygen and low toxin risk
2 is medium for both
Q: What are hepatic sinusoids? Key features? (3) What occurs to blood as it passes through?
A: specialised capillaries different from systemic ones
- wider than normal allowing slower blood flow
- no basement membrane
- have fenestrations- gaps between endothelial cells in wall= makes them leaky
-> leakage of plasma and plasma borne substances eg lipids from the vessel to enter extravascular space between sinusoids and liver cells-> this gap is the space of disse
Q: What are kupffer cells? Where? Shape? What percentage of liver cell population? Function? (3)
A: -sinusoidal macrophages (internal wall of sinusoids)
- attached to endothelial cells
- stellate shaped
- 15% of liver cell population
- eliminate and detoxify substances arriving into liver from portal circulation (inc phagocytosing)
- these immunological cells also release cytokines that are able to activate hepatic stellate cells in the space of disse