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Y2S2-Anatomy-GI > Anatomy of the liver > Flashcards

Anatomy of the liver Flashcards

1
Q

What are the regions that are occupied by the liver?

A

1) Right hypochondrium

2) Epigastrium

3) Part of the left hypochondrium

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2
Q

What are the surfaces of the liver?

A
  • Diaphragmatic surface

1) Anterior

2) Right lateral surface

3) Superior

  • Visceral surface

4) Inferior

5) Posterior

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3
Q

Which surfaces of the liver form the diaphragmatic surface?

A

1) Superior

2) Anterior

3) Right lateral surface

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4
Q

What are the surfaces of the liver that form the visceral surface of the liver?

A

1) Posterior surface

2) Inferior surface

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5
Q

What is the falciform ligament?

A
  • Sickle shape fold
  • Formed by the reflection of the peritoneum of the anterior abdominal wall into the liver
  • It apex lies at the umbilicus
  • It base lies at the superior and anterior sarce of the liver
  • It upper surface is attached to the diaphragm and the anterior abdominal wall
  • It divides the liver into a large right lobe and smaller left lobe
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6
Q

What are the attachments of the falciform ligament?

A

1) Superiorly: Diaphragm

2) Anteriorly: Anterior abdominal wall

3) Posteriorly: anterior surface of the liver

4) Inferiorly: It is attached to the ligament of teres (where we can find the para-umbilical veins)

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7
Q

What is the liver?

A

It is the largest gland, occupying the whole of the right hypochondrium and a great part of the epigastrium, and it extends into the left hypochondrium

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8
Q

What is the shape of the liver?

A
  • It is a wedge-shaped organ, resembling a 4-sided pyramidal, where the apex is directed towards the left
  • It has five surfaces:

1) Superior
2) Inferior
3) Posterior
4) Anterior
5) Lateral right

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9
Q

What are the lobes of the liver?

A

Right and left lobe

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10
Q

What divides the liver into a right and left segment anteriorly and superiorly?

A

The falciform ligament

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11
Q

What divides the liver into a right and left segment inferiorly?

A

The fissure of ligamentum teres

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12
Q

What divides the liver into a right and left segment posteriorly?

A

Ligamentum venosum

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13
Q

What are the ligaments that divide the liver into the right and left lobes?

A

1) Anteriorly & superiorly:

  • Falciform ligament

2) Posteriorly:

  • Ligamentum venosum

3) Inferiorly:

  • Ligamentum teres
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14
Q

Describe the structure of the right lobe

A
  • Forms 5/6 of the liver, acquiring two additional lobes:

1) Cuadate lobe

  • Found at the posterior surface between the groove of the IVC and the fissure of the ligamentum venosum

2) Quadrate lobe

  • Found at the inferior surface between the fossa of the gallbladder and the fissure of ligamentum teres
  • FYI: The left lobe is much smaller, forming only 1/6 part of the liver
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15
Q

Describe the right lateral surface of the liver

A
  • It forms the base of the wedge-shaped liver
  • It is quadrilateral and convex
  • It is related to the diaphragm, which separates it from:

1) Right 7th-11th ribs in the midaxillary line

2) Right lung

3) Right pleura

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16
Q

Describe the anterior surface of the liver

A
  • It is triangular in shape and slightly convex
  • It is related to the xiphoid process and the anterior abdominal wall in the median plane and to the diaphragm on each side
  • Above the diaphragm, it is related to the pleura and the base of the lungs
  • You can see the attachment of the falciform ligament in it
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17
Q

Describe the superior surface of the liver

A
  • Marked by the cardiac impression in the middle
  • It is related to the diaphragm which separates it from:

1) Pericardium and heart in the middle

2) Pleura and lung on each side

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18
Q

Describe the posterior surface of the liver

A
  • Triangular and marked in the middle by the vertebral impression
  • It shows the following features in its right side:

1) Esophageal impression

2) Fissure of ligamentum venosum

3) Cuadate lobe of the liver

4) Groove for the IVC

5) Bare area of the liver

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18
Q

Describe the borders of the bare area of the liver

A
  • It is triangular in shape
  • Lined by the:

1) Superiorly: Upper layer of the coronary ligament

2) Inferiorly: Lower layer of the coronary ligament

3) The apex of the triangle is formed by the right triangular ligament, which is formed from the union of the upper and lower coronary ligaments

4) Base: IVC

  • FYI: Part of the suprarenal gland is in the bare area
18
Q

Describe the inferior surface of the liver

A
  • The surface that faces the viscera (AKA: Visceral surface)
  • It shows several impressions (from left to right):

1) Gastric impression

2) Omental tuberosity

3) Ligamentum teres

4) Quadrate lobe of the liver

5) Fossa of the gall bladder

6) Duodenal impression (2nd part)

7) Colic impression

8) Renal impression

9) Suprarenal impression

19
Q

Describe the boundaries of the quadrate lobe

A

1) Right side: Fossa of the gall bladder

2) Left side: Fissure of ligamentum teres

3) Anteriorly/Inferiorly: The inferior border of the liver

4) Posteriorly: Porta hepatis

20
Q

What are the relations of the quadrate lobe?

A

1) Transverse colon

2) Pyloris of the stomach & first part of the duodenum

3) Lesser omentum

21
Q

What is the porta hepatis?

A

It is the covering of the structures that enters the liver (the hila of the liver)

22
Q

What are the contents of the porta hepatis?

A
  • From anterior to posterior:

1) Two hepatic ducts

2) Hepatic artery

3) Portal vein

23
Describe the blood supply of the liver
- Receives 75% of its blood supply from the portal vein and the rest from the hepatic artery
24
Describe the venous drainage of the liver
- Three large hepatic veins, which emerge from the posterior surface of the liver in the upper part of the groove of the IVC ending into the IVC
25
Describe the route of the hepatic artery
1) Celiac trunk 2) Common hepatic artery (divides into) 2a) Gastroduodenal artery 2b) Proper hepatic artery (which divides into) 2b.1: Right hepatic artery 2b.2: Left hepatic artery
26
Describe the liver engorgement and hepatomegaly
- The liver is soft and highly vascular - It receives a large amount of blood before entering the heart - the IVC and portal vein are valve less - If the liver was temperorary engorged with blood, the fibrous (glisson's) capsule stretches, producing pain in the right hypochondrium (runner's stich)
27
What is meant by the runners' stitch?
It is the pain sensation produced by the stretching of the fibrous (Glisson's capsule) as the liver engorges with blood
28
When the inferior margin of the liver palpable (below the right costal margin)?
When the liver is enlarged (in congestive heart failure, as the liver is engorged with blood)
29
Describe the lymphatic drainage of the liver
1) The lymphatic vessels leave the liver towards the LN in the porta hepatis and then go to the celiac lymph nodes 2) Fewer lymph vessels pass from the bare area of the liver through the diaphragm and into the posterior mediastinal lymph nodes
30
What is the nerve supply of the liver?
Sympathetic and parasympathetic (Vagus) innervation from the celiac plexus
31
How can cancer metastasize in the liver?
- The liver is a common site of metastatic carcinoma from the organs drained by the portal system of the vein - Cancer can also pass to the liver from the thorax due to the communication between the thoracic lymph nodes and the bare area of the liver - The Left Lobe of the liver is affected by hindgut lesions, as blood from the hindgut drains into the portal vein via the inferior mesenteric vein - The Right Lobe of the liver is affected by midgut lesions, as blood from the midgut drains into the portal vein via the superior mesenteric vein
32
How is a liver biopsy done?
- A needle is commonly inserted into the right 10th intercostal space at the midaxillary line - Before doing the procedure, the patient is asked to hold his breath in full expiration, in order to reduce the costodiaphragmatic recess and lessen the possibility of damaging the lung, contaminating the pleural cavity
33
What are some of the liver structures that are not covered by the peritoneum?
1) Fissure of ligamentum teres 2) Fossa of the gall bladder 3) Bare area 4) Porta hepatis
34
Describe the location of the porta hepatis
Found between the ligamentum venosum and ligamentum teres, it contains the (portal vein, proper hepatic artery (continuation of the common hepatic artery), and the hepatic duct)
35
Describe the course of the common hepatic artery
- Common hepatis - proper hepatic artery - The hepatic artery ascends in the right free margin of the lesser omentum, gets into the porta hepatis, and divides into right and left terminal hepatic arteries
36
Describe the formation of the hepatic duct
The right and left hepatic ducts unite to form the common hepatic duct, which will then forms the cystic duct, forming the common bile duct, which descends and opens into the second part of the duodenum
37
How is the portal vein formed?
- Occurs behind the neck of the pancreas at the transpyloric plane - The portal vein is formed by the anastomosis of the splenic and SMV - The portal vein will then ascend behind the first part of the duodenum, behind the gastroduodenal artery and the common bile duct, then ascends in the right free margin of the lesser omentum behind the hepatic artery and the common bile duct, then it enters the porta hepatis then divides into two branches
38
What are the boundaries of the epiploic foramen?
1) Anteriorly: Right free margin of the lesser omentum, which contains the (hepatic artery, common bile duct, and portal vein) 2) Inferiorly: The first part of the duodenum 3) Posteriorly: IVC 4) Superiorly: Caudate process of the liver
39
What are the boundaries of the caudate lobe?
1) Left boundary: Fissure of the ligamentum venosum 2) Right boundary: IVC 3) Superiorly: ligamentum venosum which arches over the caudate lobe 4) Inferior boundary: Porta hepatis - FYI: Caudate lobe is related to the two crura of the diaphragm at the aortic opening
40
What is the omental bursa?
It is an elevated area in the liver known as the tuberomental/omental tuberosity, which is in direct contact with the lesser omentum
41
What are the relations of the inferior surface of the liver? (from left to right)
1) Gastric impression 2) Omental tuberosity 3) Fissure for ligamentum teres 4) Quadrate lobe of the liver 5) Fossa for the gallbladder 6) Duodenal impression 7) Colic impression 8) Renal impression + suprarenal impression
42
What are the peritoneal ligaments of the liver?
1) Left and right triangular ligament 2) Upper and lower layers of the coronary ligament 3) Falciform ligament - (QUESTION: what runs in the lower free margin of the falciform ligament, "the ligamentum teres") 4) Ligamentum teres and ligamentum venosum are ligaments related to the liver but are not peritoneal ligaments
43
All of the liver is covered by peritoneum except?
1) Bare area of the liver 2) Groove for the IVC 3) Fossa for gallbladder 4) Porta hepatis 5) Along the lines of reflection of the peritoneal ligaments

Y2S2-Anatomy-GI (9 decks)

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