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Met2 > Anatomy of the liver > Flashcards

Anatomy of the liver Flashcards

1
Q

Where is the subphrenic recess?

A

between the diaphragm and liver anteriorly (divided longitudinally by the falciform ligament)

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2
Q

Where is the hepatorenal recess?

A

between postero-inferior surface of the liver and superior surface on the kidney (on the right)

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3
Q

What is the hepatorenal recess also known as?

A

Pouch of Morrison –> site for fluid buildup

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4
Q

Describe the different lobes of the liver.

A

There are 4 lobes:

  • right lobe has 2 accessory lobes: main lobe and then the caudate and quadrate lobes
  • caudate lobe: between fissure for ligamentum venosum and groove for IVC
  • left lobe: liver attached to anterior abdominal wall via the falciform ligament (continuation of ligamentum teres)
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5
Q

Name the different ligaments associated with the liver.

A
  • Coronary ligament
  • Left triangular ligament
  • Falciform ligament
  • Ligamentum teres
  • Ligamentum venosum
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6
Q

What are the borders of the bare area?

A
  • anterior + posterior coronary ligaments (meet at right triangular ligament)
  • reflection of peritoneum from diaphragm
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7
Q

Which ligaments connect the liver to the lesser omentum?

A

hepatoduodenal and hepatogastric

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8
Q

What structures enter and leave the porta hepatis?

A

Enter:

  • proper hepatic artery
  • hepatic portal vein

Leave:
- common hepatic duct

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9
Q

What are Couinaud’s segments?

A
  • hepatic artery and portal vein subdivide lobes into 8 segments
  • branches of the hepatic artery and portal vein carry blood into sinusoids of liver lobules –> each segment is independent and has its own blood supply and venous return
  • caudate lobe is segment 1
  • numbering of lobes goes in clockwise direction from top left side after that
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10
Q

What is the Pringle manoeuvre?

A
  • close off structures in the porta hepatis (usually in the case of traumatic injury) to try locate the bleeding
  • if bleeding stops then bleeding is from the portal vein or the hepatic artery
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11
Q

Which arteries supply oxygenated blood to the liver?

A

Common hepatic

25% of all blood flowing through the lvier

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12
Q

Which vein passes through the liver, supplying most of the blood in the liver?

A

Hepatic portal vein

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13
Q

Which veins join to form the hepatic portal vein?

A

inferior mesenteric drains into the splenic vein

splenic and superior mesenteric veins join to form the hepatic portal vein

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14
Q

What structural changes occur to the liver in cirrhosis?

A

replacement of liver tissue by fibrosis, scar tissue and regenerative nodules

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15
Q

What is normal portal pressure and IVC pressure? How is portal pressure gradient calculated?

A

normal portal pressure: 5-10 mmHg
IVC pressure: 2-6 mmHg
portal pressure gradient = difference between vein + IVC

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16
Q

What is the portal pressure gradient in the following?

  1. portal hypertension
  2. oesophageal varices
  3. ascites
A
  1. 6-10 mmHg
  2. > 10 mmHg
  3. > 12 mmHg
17
Q

What complications are associated with portal hypertension?

A

Can lead to splenomegaly

  • liver can become hyperactive
  • result in anaemia, thrombocytopenia, leucopenia
18
Q

Where do oesophageal varices occur?

A

at the anastomosis of the left gastric vein with oesophageal veins at the gastrooesophageal junction

19
Q

How does oesophageal varices usually present?

A

haematemesis (vomiting blood)

20
Q

What causes oesophageal varices and how is it diagnosed and treated?

A

Causes:

  • tumours
  • peptic/gastoduodenal ulcers
  • erosion of oesophagus
  • gastroenteritis

Diagnosis:
- Contrast MRI: bubbly appearance around oesophageal area

Treatment:
- oesophageal banding

21
Q

What is ascites and how is it caused?

A
  • fluid in the peritoneal space
  • causes:
    1. portal hypertension
    2. hypoalbuminaemia (no maintenance of oncotic pressure, fluid leaks into interstitium)
    3. aldosterone related renal sodium retention (blood volume expansion)
22
Q

What is caput medusae?

A

Recanalised umbilical vein within falciform ligament

- paraumbilical veins radiate superiorly to intercostal veins and inferiorly to the inferior epigastric vein

23
Q

How do rectal varices arise?

A

portal hypertension due to the formation of portosystemic shunts
- NOT THE SAME AS HAEMORRHOIDS

24
Q

Describe the recto anal junction ABOVE the pectinate line in terms of:

  1. embryological origin
  2. epithelium
  3. blood supply
  4. venous drainage
  5. lymphatics
  6. nerves
  7. haemorrhoids
A
  1. embryological origin: endoderm
  2. epithelium: columnar
  3. blood supply: superior rectal artery (branch of inf mes)
  4. venous drainage: superior rectal –> inf mesenteric
  5. lymphatics: inf iliac and inf mesenteric nodes
  6. nerves: inf hypogastric plexus (autonomic)
  7. haemorrhoids: internal (NOT painful)
25
Q

Describe the recto anal junction BELOW the pectinate line in terms of:

  1. embryological origin
  2. epithelium
  3. blood supply
  4. venous drainage
  5. lymphatics
  6. nerves
  7. haemorrhoids
A
  1. embryological origin: ectoderm
  2. epithelium: stratified squamous
  3. blood supply: inferior rectal artery (branch of int iliac)
  4. venous drainage: inf rectal –> middle rectal –> int iliac
  5. lymphatics: inguinal nodes
  6. nerves: inf rectal - branches of pudendal (somatic)
  7. haemorrhoids: external (painful)
26
Q

What is the portal venous drainage, systemic venous drainage and S+S of damage of the oesophagus?

A

portal venous drainage: left gastric
systemic venous drainage: azygos and hemiazygos
S+S: oesophageal varices + haematemesis

27
Q

What is the portal venous drainage, systemic venous drainage and S+S of damage of the rectum?

A

portal venous drainage: superior rectal vein
systemic venous drainage: inferior rectal vein
S+S: rectoanal varices

28
Q

What is the portal venous drainage, systemic venous drainage and S+S of damage of the ant abdo wall anastomoses?

A

portal venous drainage: paraumbilical veins
systemic venous drainage: inferior epigastric + intercostal
S+S: caput medusae

29
Q

What is the portal venous drainage, systemic venous drainage and S+S of damage of the retroperitoneal anastomoses?

A

portal venous drainage: duodenal, pancreatic, r + l colic veins
systemic venous drainage: lumbar veins
S+S: retroperitoneal haemorrhage

30
Q

At what rate is bile secreted by the liver?

A

40mL/hour

31
Q

What is the role of the gallbladder?

A

To concentrate and store bile

32
Q

Where is pain referred to in cholecystitis?

A

right flank and scapula

gallbladder herniates into the colon and duodenum

33
Q

What is Murphy’s sign? What pathology would produce a positive sign?

A
  1. performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line
  2. The patient is then instructed to breathe in
    - -> Normally, during inspiration, the abdominal contents are pushed downward
    - -> If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner’s fingers) and winces with a “catch” in breath, the test is considered positive
    * In order for the test to be considered positive, the same manoeuver must not elicit pain when performed on the left side.

Positive sign = probably cholecystitis

Met2 (26 decks)

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