7. Liver

Question 1

peritoneal organ positioned in the right upper quadrant of the abdomen. It is the largest visceral structure in the abdominal cavity, and the largest gland in the human body.

Answer 1

liver

Question 2

performs a wide range of functions, such as synthesis of bile, glycogen storage and clotting factor production.

Answer 2

liver

Question 3

anterosuperior surface of the liver.

Answer 3

Diaphragmatic surface

Question 4

posteroinferior surface of the liver.

Answer 4

visceral surface

Question 5

not covered by visceral peritoneum, and is in direct contact with the diaphragm itself (known as the ‘bare area’ of the liver

Answer 5

posterior aspect of the diaphragmatic surface

Question 6

It lies in contact with the right kidney, right adrenal gland, right colic flexure, transverse colon, first part of the duodenum, gallbladder, oesophagus and the stomach.

Answer 6

visceral surface of the liver

Question 7

ligaments of the liver

Answer 7

• falciform ligament
• coronary ligament (anterior and posterior folds)
• triangular ligament (left and right)
• lesser omentum

Question 8

this sickle-shaped ligament attaches the anterior surface of the liver to the anterior abdominal wall and forms a natural anatomical division between the left and right lobes of the liver.

Answer 8

falciform ligament

Question 9

a remnant of the umbilical vein.

Answer 9

ligamentum teres

Question 10

The free edge of this ligament contains the ligamentum teres, a remnant of the umbilical vein.

Answer 10

falciform ligament

Question 11

attaches the superior surface of the liver to the inferior surface of the diaphragm and demarcates the bare area of the liver

Answer 11

Coronary ligament

Question 12

its anterior and posterior folds unite to form the triangular ligaments on the right and left lobes of the liver.

Answer 12

coronary ligament

Question 13

formed by the union of the anterior and posterior layers of the coronary ligament at the apex of the liver and attaches the left lobe of the liver to the diaphragm.

Answer 13

left triangular ligament

Question 14

this ligament is adjacent to the bare area and attaches the right lobe of the liver to the diaphragm.

Answer 14

right triangular ligament

Question 15

Attaches the liver to the lesser curvature of the stomach and first part of the duodenum

Answer 15

lesser omentum

Question 16

lesser omentum consists of the

Answer 16

It consists of the hepatoduodenal ligament (extends from the duodenum to the liver) and the hepatogastric ligament (extends from the stomach to the liver).

Question 17

surrounds the portal triad.

Answer 17

hepatoduodenal ligament

Question 18

In addition to supporting ligaments, the posterior surface of the liver is secured to the inferior vena cava by

Answer 18

hepatic veins and fibrous tissue

Question 19

are anatomical spaces between the liver and surrounding structures. They are of clinical importance as infection may collect in these areas, forming an abscess.

Answer 19

hepatic recesses

Question 20

spaces located between the diaphragm and the anterior and superior aspects of the liver.

Answer 20

subphrenic spaces

Question 21

subphrenic spaces are divided into

Answer 21

right and left by the falciform ligament.

Question 22

hepatic recesses

Answer 22

subphrenic spaces
subhepatic space
Morison’s pouch

Question 23

a subdivision of the supracolic compartment (above the transverse mesocolon), this peritoneal space is located between the inferior surface of the liver and the transverse colon.

Answer 23

subhepatic space

Question 24

a potential space between the visceral surface of the liver and the right kidney.

Answer 24

Morison’s pouch

Question 25

This is the deepest part of the peritoneal cavity when supine (lying flat), therefore pathological abdominal fluid such as blood or ascites is most likely to collect in this region in a bedridden patient.

Answer 25

Morison’s pouch

Question 26

The liver is covered by a fibrous layer, known as

Answer 26

Glisson’s capsule

Question 27

two further ‘accessory’ lobes that arise from the right lobe, and are located on the visceral surface of liver:

Answer 27

caudate lobe | quadrate lobe

Question 28

this accessory lobe is located on the upper aspect of the visceral surface. It lies between the inferior vena cava and a fossa produced by the ligamentum venosum (a remnant of the fetal ductus venosus)

Answer 28

caudate lobe

Question 29

this accessory lobe is located on the lower aspect of the visceral surface. It lies between the gallbladder and a fossa produced by the ligamentum teres (a remnant of the fetal umbilical vein).

Answer 29

quadrate lobe

Question 30

Separating the caudate and quadrate lobes is a deep, transverse fissure – known as the

Answer 30

porta hepatis

Question 31

It transmits all the vessels, nerves and ducts entering or leaving the liver with the exception of the hepatic veins.

Answer 31

porta hepatis

Question 32

Microscopically, the cells of the liver (known as hepatocytes) are arranged into

Answer 32

lobules

Question 33

Each anatomical lobule is hexagonal-shaped and is drained by a

Answer 33

central vein

Question 34

At the periphery of the hexagon (lobule) are three structures collectively known as the

Answer 34

portal triad

Question 35

potral triad:

Answer 35

Arteriole – a branch of the hepatic artery entering the liver. Venule – a branch of the hepatic portal vein entering the liver. Bile duct – branch of the bile duct leaving the liver. + lymphatic vessels and vagus nerve (parasympathetic) fibres.

Question 36

Liver | dual blood supply

Answer 36

Hepatic artery proper (25%) Hepatic portal vein (75%)

Question 37

supplies the liver with partially deoxygenated blood, carrying nutrients absorbed from the small intestine. This is the dominant blood supply to the liver parenchyma, and allows the liver to perform its gut-related functions, such as detoxification.

Answer 37

Hepatic portal vein (75%)

Question 38

supplies the non-parenchymal structures of the liver with arterial blood. It is derived from the coeliac trunk.

Answer 38

Hepatic artery proper (25%)

Question 39

Venous drainage of the liver

Answer 39

central veins -> collecting veins -> hepatic veins -> inferior vena cava

Question 40

nerve supply of the liver

Answer 40

hepatic plexus, which contains sympathetic (coeliac plexus) and parasympathetic (vagus nerve) nerve fibres

Question 41

Glisson’s capsule, the fibrous covering of the liver, is innervated by branches of the

Answer 41

lower intercostal nerves

Question 42

Distension of the glisson’s capsule results in a

Answer 42

sharp, well localised pain

Question 43

The lymphatic vessels of the anterior aspect of the liver drain into

Answer 43

Anterior: hepatic lymph nodes -> colic lymph nodes -> cisterna chyli Posterior -> phrenic and posterior mediastinal nodes -> right lymphatic and thoracic ducts

Question 44

procedure used to obtain a sample of liver tissue. A needle is inserted through the skin to access the liver.

Answer 44

percutaneous liver biopsy

Question 45

pecutaneous liver biopsy is indicated in

Answer 45

1. Abnormal LFTs of unknown cause. 2. Liver malignancy 3. Hepatitis C – Assessment for severity of liver fibrosis and disease progression. 4. Other liver conditions (such as Hereditary Haemochromatosis and Autoimmune Hepatitis). 5. Following liver transplantation.

Question 46

remnant of ductus venosus; between left lobe and caudate lobe

Answer 46

ligamentum venosum

Question 47

remnant of umbilical vein; between left lobe and quadrate lobe

Answer 47

ligamentum teres/ round ligament

Question 48

adult derivatives of umbilical artery

Answer 48

medial umbilical ligament

Question 49

adult derivative of urachus

Answer 49

median umbilical ligament

Question 50

adult derivative of foramen ovale

Answer 50

fossa ovalis

Question 51

adult derivative of ductus arteriosus

Answer 51

ligamentum arteriosum

Question 52

classifc liver lobule is

Answer 52

hexagonal 1central vein 6 portal triad at sides

Question 53

zones of liver acinus

Answer 53

Zone 1,2,3

Question 54

zone closest to the portal tract and receives the most O2

Answer 54

zone 1

Question 55

farthest zone and receives the least O2, most susceptible to ischemic injury

Answer 55

zone 3

Question 56

liver acinus is based on

Answer 56

blood flow

Question 57

portal lobule is based on

Answer 57

bile flow

Question 58

diamond-shaped area of the liver whose long axis is the straight line between neighboring central veins and whose short axis is the intersecting line between neighboring portal areas

Answer 58

liver acinus

Question 59

caudate and quadrate is in this lobe

Answer 59

right lobe

Question 60

caudate lobe is in this segment

Answer 60

I

Question 61

quadrate lobe is in this segment

Answer 61

IV

Question 62

hemorrhage from the liver can be controlled by

Answer 62

clamping the hepatoduodenal ligament (contains the hepatic artery and portal vein) - pringle maneuver

Question 63

liver biopsy usually done at this site

Answer 63

right 10 ICS MAL