4. Liver and Biliary System Flashcards
Name the endocrine function of the liver
Secretion of bile
Name the endocrine functions of the liver
Metabolism of digestion products (carbs, proteins)
Storage and release of glucose
Detox (synthesis, conjugation, transformation)
What part of the liver is in direct contact with the diaphragm? What otherwise separates liver and diaphragm?
Posterior liver: direct contact
Anterior superior: right and left subphrenic recesses separated by falciform ligament
The visceral surface of the liver is covered with peritoneum, except for…
The porta hepatis
The fossa for the gallbladder
What is located between the right visceral surface of the liver and the right kidney?
The suprarenal gland in the hepatorenal recess (pouch of Morrison)
The hepatorenal recess communicates anteriorly with the _______.
This recess is significant because:
Right subphrenic space.
It’s the deepest, lowest, most gravity-dependent portion of the peritoneal cavity in a supine position.
Normally only potential spaces. Only widen with fluid/gas buildup
Name the four anatomic lobes of the liver. Which one’s the biggest?
Right anatomic (largest), left anatomic, caudate (visceral surface between vena cava and ligamentum venosum), quadrate (between the gallbladder and the fissure for the ligamentum teres)
Name the two functional lobes of the liver and their constituents.
Right functional: right anatomic & 1/2 of caudate
Left functional: left anatomic, quadrate, & 1/2 of caudate
Name the hepatic veins and how they divide the liver
Right hepatic vein: divides the right lobe into anterior and posterior segments
Middle hepatic vein: divides the liver into right and left lobes
Left hepatic vein divides the left lobe into a medial and lateral part
Portal vein divides the liver into upper and lower segments
What are the two vessels that bring oxygenated blood to the liver? Describe the pathway of each of these vessels.
Proper hepatic artery (HA): aorta->common hepatic->HA-> to R & L hepatic a. 25% of liver blood supply
Hepatic portal vein (PV): 75% of liver blood, from union of SMV and splenic v. at level of L2, enters lesser omentum with the rest of the portal triad
What 3 things make up the portal triad?
A branch off the hepatic artery
A branch off the portal vein
A bile duct
Metastatic tumors usually end up in what part of the liver. How do they get there?
Tumors that travel from the IMV or splenic vein end up in the left lobe.
Tumors that travel from the SMV end up in the right lobe.
Describe how deoxygenated blood leaves the liver
Central veins within the substance of the liver -> right, middle & left hepatic veins
What is the result of blockage in hepatic veins? How will blood get back to the IVC instead? What are the consequences of this blockage? How is this treated?
Portal hypertension.
Portal-caval anastamoses.
Passive venous congestion: splenic enlargement.
Blood bypasses liver: no detox, hepatic encephalopathy
Treatment: portal-caval (IVC) shunt
Name the portal-caval anastamosis at the level of the esophagus:
Left gastric vein (portal system) & azygos/hemiazygos vein (caval system). Clinical sign: esophageal varices.
Name the portal-caval anastamosis at the level of the rectum:
Superior rectal vein (portal system) & middle and inferior rectal veins (caval system). Clinical sign: hemorrhoids.
Name the portal-caval anastamosis at the level of the umbilicus:
Paraumbilical veins (portal system) & epigastric veins (caval system). Clinical sign: caput medusae.
Name the portal-caval anastamosis at the level of the secondary retroperitoneal structures:
Visceral veins (portal system) & parietal veins (caval system).
What are the 3 parts of the gall bladder?
Fundus, body, neck
The neck of the gallbladder makes an S-shaped bend and joins the ____
Cystic duct via a spiral valve
What does the gallbladder respond to?
Foods high in fat
Where does the gallbladder empty into?
The second part of the duodenum
Term meaning gallstones in the gallbladder
Cholelithiasis
Gallbladder inflammation
Cholecystitis
Gallbladder infection
Cholangitis
Path followed by bile to the duodenum after it has left the liver
Extrahepatic Biliary System/bile duct
What two structures merge to form the bile duct?
Cystic duct from gallbladder & common hepatic duct
Where does one find the bile duct? Along with what else?
In the hepatoduodenal ligament with the other two parts of the hepatic triad: portal vein and hepatic artery
Term for gallstones obstructing ducts in the biliary tract (particularly the common bile duct). And what does this cause?
Choledocholithiasis. Causes jaundice.
Name the Biliary system sphincters
Sphincter of the bile duct
Sphincter of the pancreatic duct
Hepatopancreatic sphincter (of Oddi) [controls flow into duodenum, closes for backup, concentration of bile]
Surgical removal of the gallbladder. What’s it called and what do you have to visualize before you do?
Cholecystectomy. Cystohepatic Triangle (of Calot) structures: cystic duct(infero-laterally), common hepatic duct (medially), and liver (superiorly)
What is Murphy’s sign and what is it indicative of?
Increase in pain while palpating RUQ
Indicative of cholecystitis
What’s the main cause of cholecystitis?
Gall stones blocking shit
What does Courvoisier’s Law/Sign state?
Individual with jaundice and an enlarged, non-tender gallbladder probs has a tumor, not a stone obstructing shit
What innervates the gallbladder and where might one get referred pain?
Celiac plexus (sympathetics)
Vagus (parasympathetics)
Right phrenic (sensory)
Referred pain to rt shoulder
