7. Liver Flashcards
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.
liver
performs a wide range of functions, such as synthesis of bile, glycogen storage and clotting factor production.
liver
anterosuperior surface of the liver.
Diaphragmatic surface
posteroinferior surface of the liver.
visceral surface
not covered by visceral peritoneum, and is in direct contact with the diaphragm itself (known as the ‘bare area’ of the liver
posterior aspect of the diaphragmatic surface
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.
visceral surface of the liver
ligaments of the liver
- falciform ligament
- coronary ligament (anterior and posterior folds)
- triangular ligament (left and right)
- lesser omentum
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.
falciform ligament
a remnant of the umbilical vein.
ligamentum teres
The free edge of this ligament contains the ligamentum teres, a remnant of the umbilical vein.
falciform ligament
attaches the superior surface of the liver to the inferior surface of the diaphragm and demarcates the bare area of the liver
Coronary ligament
its anterior and posterior folds unite to form the triangular ligaments on the right and left lobes of the liver.
coronary ligament
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.
left triangular ligament
this ligament is adjacent to the bare area and attaches the right lobe of the liver to the diaphragm.
right triangular ligament
Attaches the liver to the lesser curvature of the stomach and first part of the duodenum
lesser omentum
lesser omentum consists of the
It consists of the hepatoduodenal ligament (extends from the duodenum to the liver) and the hepatogastric ligament (extends from the stomach to the liver).
surrounds the portal triad.
hepatoduodenal ligament
In addition to supporting ligaments, the posterior surface of the liver is secured to the inferior vena cava by
hepatic veins and fibrous tissue
are anatomical spaces between the liver and surrounding structures. They are of clinical importance as infection may collect in these areas, forming an abscess.
hepatic recesses
spaces located between the diaphragm and the anterior and superior aspects of the liver.
subphrenic spaces
subphrenic spaces are divided into
right and left by the falciform ligament.
hepatic recesses
subphrenic spaces
subhepatic space
Morison’s pouch
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.
subhepatic space
a potential space between the visceral surface of the liver and the right kidney.
Morison’s pouch
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.
Morison’s pouch
The liver is covered by a fibrous layer, known as
Glisson’s capsule
two further ‘accessory’ lobes that arise from the right lobe, and are located on the visceral surface of liver:
caudate lobe
quadrate lobe
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)
caudate lobe
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).
quadrate lobe
Separating the caudate and quadrate lobes is a deep, transverse fissure – known as the
porta hepatis
It transmits all the vessels, nerves and ducts entering or leaving the liver with the exception of the hepatic veins.
porta hepatis
Microscopically, the cells of the liver (known as hepatocytes) are arranged into
lobules
Each anatomical lobule is hexagonal-shaped and is drained by a
central vein
At the periphery of the hexagon (lobule) are three structures collectively known as the
portal triad
potral triad:
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.
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lymphatic vessels and vagus nerve (parasympathetic) fibres.
Liver
dual blood supply
Hepatic artery proper (25%)
Hepatic portal vein (75%)
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.
Hepatic portal vein (75%)
supplies the non-parenchymal structures of the liver with arterial blood. It is derived from the coeliac trunk.
Hepatic artery proper (25%)
Venous drainage of the liver
central veins -> collecting veins -> hepatic veins -> inferior vena cava
nerve supply of the liver
hepatic plexus, which contains sympathetic (coeliac plexus) and parasympathetic (vagus nerve) nerve fibres
Glisson’s capsule, the fibrous covering of the liver, is innervated by branches of the
lower intercostal nerves
Distension of the glisson’s capsule results in a
sharp, well localised pain
The lymphatic vessels of the anterior aspect of the liver drain into
Anterior: hepatic lymph nodes
-> colic lymph nodes -> cisterna chyli
Posterior -> phrenic and posterior mediastinal nodes -> right lymphatic and thoracic ducts
procedure used to obtain a sample of liver tissue. A needle is inserted through the skin to access the liver.
percutaneous liver biopsy
pecutaneous liver biopsy is indicated in
- Abnormal LFTs of unknown cause.
- Liver malignancy
- Hepatitis C – Assessment for severity of liver fibrosis and disease progression.
- Other liver conditions (such as Hereditary Haemochromatosis and Autoimmune Hepatitis).
- Following liver transplantation.
remnant of ductus venosus; between left lobe and caudate lobe
ligamentum venosum
remnant of umbilical vein; between left lobe and quadrate lobe
ligamentum teres/ round ligament
adult derivatives of umbilical artery
medial umbilical ligament
adult derivative of urachus
median umbilical ligament
adult derivative of foramen ovale
fossa ovalis
adult derivative of ductus arteriosus
ligamentum arteriosum
classifc liver lobule is
hexagonal
1central vein
6 portal triad at sides
zones of liver acinus
Zone 1,2,3
zone closest to the portal tract and receives the most O2
zone 1
farthest zone and receives the least O2, most susceptible to ischemic injury
zone 3
liver acinus is based on
blood flow
portal lobule is based on
bile flow
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
liver acinus
caudate and quadrate is in this lobe
right lobe
caudate lobe is in this segment
I
quadrate lobe is in this segment
IV
hemorrhage from the liver can be controlled by
clamping the hepatoduodenal ligament (contains the hepatic artery and portal vein) - pringle maneuver
liver biopsy usually done at this site
right 10 ICS MAL
