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The alimentary system > Anatomy of the liver > Flashcards

Anatomy of the liver Flashcards

1
Q

Where is the liver located?

A

Located below diaphragm: mostly the right hypochondrium & epigastrium, but extends into left hypochondrium
Below diaphragm
Right wrt stomach
Above the colon
Overlies gallbladder
Top part of liver in between the 4th and 5th rib on the right hand side. Liver has ribs covering it

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2
Q

State the main functions of the liver

A

detoxification
protein synthesis
production of bile – accessory GI organ
glycogen storage

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3
Q

Describe the intensity of the blood supply of the liver

A

Highly vascularised

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4
Q

Describe the shape and colour of the liver

A

Wedge shaped reddish/brown organ

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5
Q

Describe the structure of the liver

A

Diaphragmatic upper surface blunt, dome shaped/ sharp inferior border
Ant. view – divided into two main lobes: left and right
Post. view – two other lobes: quadrate and caudate
Surface covered by peritoneum except bare area, where it connects with diaphragm
Falciform (ant) and lesser omentum (post) ligaments separate right and left lobes
Porta hepatis divides the quadrate and caudate lobes

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6
Q

List the peritoneal folds

A

Falciform ligament
Round ligament
Coronary ligaments
Lesser omentum

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7
Q

Describe the falciform ligament

A 
Links diaphragm to upper surface liver 
Ligamentum teres (aka round ligament) at lower end
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8
Q

Describe the round ligament

A

Obliterated left umbilical vein

Extends to umbilicus

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9
Q

Describe the coronary ligaments

A

Links diaphragm to liver

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10
Q

Describe the lesser omentum and its function

A 
Links liver to the stomach - From lesser curvature stomach to porta hepatis
Has a free margin (ventral mesentery)
Encloses
	hepatic artery
	portal vein
	bile duct
	lymph vessels
Close to the stomach it also encloses the gastric arteries and veins
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11
Q

What do all the blood supply to the gut have in common?

A

All from the midline at the abdominal aorta

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12
Q

Which artery is derived from the foregut?

A

Coeliac artery/trunk

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13
Q

Which artery is derived from the midgut?

A

Superior mesenteric

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14
Q

Which artery is derived from the hindgut?

A

Inferior mesenteric

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15
Q

Describe the blood supply to the liver

A

Coeliac artery (aka trunk or axis)

  • Left gastric
  • Splenic
  • Hepatic
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16
Q

Which vertebral level does the coeliac artery divide?

A

T12/L1 Level

17
Q

What other structures does the coeliac artery supply?

A

Duodenum

Pancreas

18
Q

Describe the hepatic artery variations

A

Most common cases:
right hepatic artery replaced to the SMA

left hepatic artery replaced to the left gastric artery

trifurcation of the common hepatic artery
	right hepatic artery
	left hepatic artery
	gastroduodenal artery (GDA)
19
Q

Describe the porta hepatis

A 
At hilum of the liver- visceral surface
Deep fissure
Entry/exit point for
- hepatic portal vein
- hepatic artery proper
- common hepatic duct
- nerves and lymphatics
20
Q

What reaches the liver through the hepatic artery?

A

Oxygenated blood

21
Q

What reaches the liver through the portal vein?

A

Deoxygenated blood
Nutrients
Drugs
Toxins

22
Q

What is the portal vein composed of?

A

sup mesenteric + splenic

23
Q

What is a portal triad?

A

According to how the hepatic artery and portal vein subdivide, the liver anatomic lobes are subdivided into segments (Couinaud)

Branches of hepatic artery and portal vein carry blood into sinusoids

Branches of the bile duct accompany those of the hepatic artery and portal vein. All three structures are called portal triad and supply each segment

24
Q

Why is knowledge of coinauds segments important?

A

Knowledge of vascular supply to segments is vital for liver transplants or surgery

25
Q

Describe liver lobules

A 
Each lobe of liver contains several lobules
Functional units of the liver
Hexagon shaped
Contains hepatocytes (60% liver cells)
Portal triads at corners
26
Q

Describe the metabolic functions of hepatocytes

A

Synthesis and release

  • plasma proteins into blood
  • albumin
  • clotting factors complement cascade components
  • Deaminates amino acids – urea into blood
  • Bilirubin to bile pigment
  • Bile salts – emulsification of fats
27
Q

Describe the venous drainage of the liver

A

The ‘mixed’ blood from the two sources (portal and hepatic) in the sinusoids passes through the hepatocytes and into the central vein

The central vein is found at the center of a hepatic lobule

Central veins then drain into the sublobular vein

Sublobular vein then drain into hepatic veins

28
Q

Describe portal systemic anastomosis and why they are important

A

Communications between some branches of the portal and systemic systems

aka portocaval anastomosis

Very important if portal vein blocked or passage via liver meets resistance – portal hypertension

Allow collateral return of blood to heart without which subject would die

29
Q

List some portal systemic anastomosis

A

Abdominal part of oesophagus – left gastric tributaries with oesophageal branches azygos

Anal canal – superior rectal anastomoses with middle and inferior rectal

Umbilicus – paraumbilical veins with epigastric veins

Veins of colon, duodenum, pancreas, liver with renal, lumbar and phrenic

30
Q

What is portal hypertension?

A

Common clinical condition caused by obstruction of portal vein

Pressure rises – hypertension

Anastomoses between portal and systemic means backflow of blood to heart then lungs

Signs include: Varicoses, Caput medusa ; oesophageal varices

31
Q

Describe a portacaval shunt

A

Procedure carried out in attempt of Reduction of hypertension
Divert blood from portal to systemic
Blood diverted from portal to IVC
Portal vein conveys 70% blood to liver
Largely been abandoned since the advent of TIPS (transjugular intrahepatic portosystemic shunting)

32
Q

Describe the pathway and secretion of bile

A

Secreted by hepatocytes into bile canaliculi
Closed sphincter Oddi to duodenum => bile flows to gall bladder to be stored and concentrated
Right and left hepatic ducts – relevant lobes
Emerge from porta – unite to form common hepatic duct

33
Q

How much bile is secreted in an hour?

A

40ml

34
Q

Describe the lymphatic drainage of the liver

A

Liver produces vast amount of lymph

Lymph nodes in porta hepatis

Pass to coeliac nodes

Drain to cisterna chyli

35
Q

Describe the risk of liver trauma

A

Closely related to lower ribs

Fracture ribs / penetrating wounds

High vascularisation => severe haemorrhage

Remove portions due to segmental nature liver and vessels / ducts supplying it
liver biopsies
metastatic spread
cirrhosis

The alimentary system (21 decks)

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