4. Liver and Biliary System

Question 0

Name the endocrine function of the liver

Answer 0

Secretion of bile

Question 1

Name the endocrine functions of the liver

Answer 1

Metabolism of digestion products (carbs, proteins)
Storage and release of glucose
Detox (synthesis, conjugation, transformation)

Question 2

What part of the liver is in direct contact with the diaphragm? What otherwise separates liver and diaphragm?

Answer 2

Posterior liver: direct contact

Anterior superior: right and left subphrenic recesses separated by falciform ligament

Question 3

The visceral surface of the liver is covered with peritoneum, except for…

Answer 3

The porta hepatis

The fossa for the gallbladder

Question 4

What is located between the right visceral surface of the liver and the right kidney?

Answer 4

The suprarenal gland in the hepatorenal recess (pouch of Morrison)

Question 5

The hepatorenal recess communicates anteriorly with the _______.

This recess is significant because:

Answer 5

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

Question 6

Name the four anatomic lobes of the liver. Which one’s the biggest?

Answer 6

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)

Question 7

Name the two functional lobes of the liver and their constituents.

Answer 7

Right functional: right anatomic & 1/2 of caudate

Left functional: left anatomic, quadrate, & 1/2 of caudate

Question 9

Name the hepatic veins and how they divide the liver

Answer 9

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

Question 10

What are the two vessels that bring oxygenated blood to the liver? Describe the pathway of each of these vessels.

Answer 10

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

Question 11

What 3 things make up the portal triad?

Answer 11

A branch off the hepatic artery
A branch off the portal vein
A bile duct

Question 12

Metastatic tumors usually end up in what part of the liver. How do they get there?

Answer 12

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.

Question 13

Describe how deoxygenated blood leaves the liver

Answer 13

Central veins within the substance of the liver -> right, middle & left hepatic veins

Question 14

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?

Answer 14

Portal hypertension.
Portal-caval anastamoses.
Passive venous congestion: splenic enlargement.
Blood bypasses liver: no detox, hepatic encephalopathy
Treatment: portal-caval (IVC) shunt

Question 15

Name the portal-caval anastamosis at the level of the esophagus:

Answer 15

Left gastric vein (portal system) & azygos/hemiazygos vein (caval system). Clinical sign: esophageal varices.

Question 16

Name the portal-caval anastamosis at the level of the rectum:

Answer 16

Superior rectal vein (portal system) & middle and inferior rectal veins (caval system). Clinical sign: hemorrhoids.

Question 17

Name the portal-caval anastamosis at the level of the umbilicus:

Answer 17

Paraumbilical veins (portal system) & epigastric veins (caval system). Clinical sign: caput medusae.

Question 18

Name the portal-caval anastamosis at the level of the secondary retroperitoneal structures:

Answer 18

Visceral veins (portal system) & parietal veins (caval system).

Question 19

What are the 3 parts of the gall bladder?

Answer 19

Fundus, body, neck

Question 20

The neck of the gallbladder makes an S-shaped bend and joins the ____

Answer 20

Cystic duct via a spiral valve

Question 21

What does the gallbladder respond to?

Answer 21

Foods high in fat

Question 22

Where does the gallbladder empty into?

Answer 22

The second part of the duodenum

Question 23

Term meaning gallstones in the gallbladder

Answer 23

Cholelithiasis

Question 24

Gallbladder inflammation

Answer 24

Cholecystitis

Question 25

Gallbladder infection

Answer 25

Cholangitis

Question 26

Path followed by bile to the duodenum after it has left the liver

Answer 26

Extrahepatic Biliary System/bile duct

Question 27

What two structures merge to form the bile duct?

Answer 27

Cystic duct from gallbladder & common hepatic duct

Question 28

Where does one find the bile duct? Along with what else?

Answer 28

In the hepatoduodenal ligament with the other two parts of the hepatic triad: portal vein and hepatic artery

Question 29

Term for gallstones obstructing ducts in the biliary tract (particularly the common bile duct). And what does this cause?

Answer 29

Choledocholithiasis. Causes jaundice.

Question 30

Name the Biliary system sphincters

Answer 30

Sphincter of the bile duct
Sphincter of the pancreatic duct
Hepatopancreatic sphincter (of Oddi) [controls flow into duodenum, closes for backup, concentration of bile]

Question 31

Surgical removal of the gallbladder. What’s it called and what do you have to visualize before you do?

Answer 31

Cholecystectomy.
Cystohepatic Triangle (of Calot) structures: cystic duct(infero-laterally), common hepatic duct (medially), and liver (superiorly)

Question 32

What is Murphy’s sign and what is it indicative of?

Answer 32

Increase in pain while palpating RUQ

Indicative of cholecystitis

Question 33

What’s the main cause of cholecystitis?

Answer 33

Gall stones blocking shit

Question 34

What does Courvoisier’s Law/Sign state?

Answer 34

Individual with jaundice and an enlarged, non-tender gallbladder probs has a tumor, not a stone obstructing shit

Question 35

What innervates the gallbladder and where might one get referred pain?

Answer 35

Celiac plexus (sympathetics)
Vagus (parasympathetics)
Right phrenic (sensory)
Referred pain to rt shoulder