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4 - Case 5 > Anatomy - Liver > Flashcards

Anatomy - Liver Flashcards

1
Q

Situation of the liver

A
  • under the diaphragm
  • right upper quadrant, most of right hypochondriac region and epigastric
  • Attatched to diaphragm by falciform, coronary and triangular (R and L) ligaments
  • lesser omentum attatches liver to stomach, cont with traingular ligament
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2
Q

What are the surfaces of the liver

A

Diaphragmatic (front)

Visceral (posteroinferior)

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3
Q

What is the visceral surface related to

A
  • abdominal oesophagus
  • fundus and body of stomach
  • lesser omentum
  • gallbladder
  • sup duodenum
  • transverse colon
  • right kidney and its adrenal gland
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4
Q

Lobes of liver

A

based on blood supply and bile drainage there are 2; right and left
separated by falciform ligament
Also have 2 minor caudate (sup) and quadrate (inf) lobes (both mainly in right lobe)

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5
Q

Segments in terms of blood supply

A

8 segments that can be mapped onto the lobes

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6
Q

Blood supply to the liver

A

Very rich blood supply from;
hepatic artery
portal vein

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7
Q

Blood supply; hepatic artery

A

Branch of coeliac trunk
divides into left and right branches to supply left and right lobes
30% of blood supply to liver

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8
Q

Blood supply; portal vein

A

Carries venous blood rich with products of digestion from the GI tract, stomach, spleen and pancreas
70% of blood supply to liver
Divides into left and right for the separate lobes

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9
Q

How is the hepatic portal vein formed

A

From the union of the superior mesenteric vein and the splenic vein

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10
Q

Venous drainage

A

Via hepatic vein

Central vein from each lobule drains into interlobular vein, which then drains into the hepatic vein

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11
Q

Lymph drainage of liver; deep vessels

A

Deep vessels come together at porta hepatis and end in the hepatic lymph nodes scattered along the hepatic vessels
These drain into the coeliac lymph nodes to drain into thoracic duct
SOME deep lymph vessels follow hepatic veins through diaphragm and end in phrenic lymph nodes

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12
Q

Lymph drainage; superficial vessels

A

Follow same drainage as the deep but also can darin into mediastinal lymph nodes

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13
Q

Nerve supply to liver

A

Recieves both parasymp and symp innervation.
Nerve fibres reach lier via hepatic plexus, derived from coeliac plexusAlso recieves para from right phrenic nerve and R and L vagi
Hepatic nerves follow blood supply and enter at porta hepatis

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14
Q

What is the porta hepatis

A 
Deep fissure on visceral surface (inf) 
contains
- hepatic artery
- portal vein
- hepatic nerve plexus
- hepatic ducts (out)
- lymph vessels
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15
Q

Describing structural units of liver; classic lobule

A

Each lobule is a hexagon with central vein in the centre and a portal triad at each of its corners (6)

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16
Q

What is a portal triad

A

consists of

  • a branch of hepatic artery
  • a brach of portal vein
  • a bile duct
17
Q

Describing structural units of liver; portal lobule

A

Views the liver as being made up of a series of triangles with portal triad at the centre and a central vein at each corner (3)

Emphasises EXOCRINE function

18
Q

Describing structural units of liver; acinus

A

Elliptical (circular) unit with portal triad at centre and central vein at each pole (2)

Emphasises ENDOCRINE function

19
Q

Three zones of acinus

A

More accurate descipt of functional unit of liver as reflects gradient of metabolic activity

  • periportal zone (zone 1)
  • midzone (zone 2)
  • centrilobular zone (zone 3)
20
Q

Periportal zone

A 
Most oxygenated blood found here
centre around portal triad
adjacent to portal canal
recieves most blood from hepatic artery and portal vein
most susceptible to damge from toxins 
most metabolic activity happens here
21
Q

Centrilobular zone

A

Furthest away from portal triad
closest to central vein
most susceptible to ischaemic damage (eg. heart failure)

22
Q

Types of cell present in liver

A

Hepatocytes
Kupffer cells
Haematopoietic cells
Perisinusoidal cells

23
Q

Hepatocytes

A

Arranged in ‘cords’ (lines) that radiate out from the central vein.
Large, eosinophilic cells with round nuclei. More than half are tetraploid (4x no of normal chromosomes)
Network of capillaries (sinusoids) between them

24
Q

Kupffer cells

A

Part of the monocyte-macrophage system
phagocytose old erythrocytes and other cell debris from circulation
Line the sinusoids capillaries

25
Q

Perisinusoidal space (of Disse)

A

In between hepatocytes nad sinusoidal endothlial cells
Contains perisinusoidal cells (stellate cells) which secrete collagen, provbiding supportive mesh
This contributes to fibrosis in liver damage

26
Q

Microvilli

A

At sinusoidal surface, the hepatocytes have short microvilli which extend into perisinusoidal space
Between the bases of the microvilli lie coated pits for endocytosis
These microvilli increase surface area for transfer of digestive products, nutrients, oxygen

27
Q

Bile canaliculi

A

Formed by groove between surfaces of adjacent hepatocytes lines. Sealed by zonulae occuludentes, preventing bile leakage into intercellular spaces
Canaliculi form rings around hepatocyte lines and approach bile ducts by opening into canals of Hering

28
Q

Portal canal

A

Consists of portal triad surrounded by connective tissue
Small space (space of mall) between this connective tissue and surrounding hepatoytes
lymph thought to originate here

29
Q

Limiting plate

A

Hepatocytes of periportal zone
Makes protective layer of cells which are the first to be exposed to toxins in blood.
Damage in this plate can lead to cirrhosis

30
Q

Main functions of the liver

A
  • metabolism of carbohydrates, protein and fat
  • bile production
  • storage of vitamins, mineral, glycogen
  • biotransformation
  • detoxification and protection (via filtration of portal blood)
31
Q

Functional differences between the acinus zones

A
  • periportal hepatocytes take up bile under normal conditions, but under bile overload this is taken up also by the centrilobar zone
  • centrilobar hepatocytes contain enzymes for esterification, periportal ones rich in oxidative enzymes
32
Q

Carbohydrate metabolism

A

c

4 - Case 5 (1 decks)

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