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104-theme 2-the liver and regulation of metabolism > anatomy of the liver > Flashcards

anatomy of the liver Flashcards

1
Q

describe the topography of the liver? 5

A
  • Largest gland in the body
  • Wedge-shaped reddish-brown organ
  • Located below the diaphragm: mostly the right hypochondrium and epigastrium, but extends into the left hypochondrium
  • highly vascularised structure
  • pliable to touch and easily lacerated
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2
Q

what are the main functions of the liver? 4

A
  • Detoxification
  • Protein synthesis
  • Production of bile aids lipid digestion
  • Glycogen storage
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3
Q

what are the relations of the liver? 4

A
  • Below diaphragm
  • Right of the stomach
  • Above the colon
  • Overlies gallbladder
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4
Q

describe the gross anatomy of the liver? 6

A
  • Diaphragmatic upper surface blunt, domed shaped/ sharp inferior border
  • Anterior view divided into two main lobes, left and right
  • Posterior view two other lobs: quadrate and caudate
  • Surface is covered by peritoneum except bare area where it touches the diaphragm
  • Falciform (anterior) and lesser omentum (posterior) ligaments separate the right and left lobes
  • Porta hepatis divides the quadrate and caudate lobes
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5
Q

describe the peritoneal folds? 4

A
  • Falciform ligament= links anterior abdominal wall to liver. Ligamentum teres (aka round ligament) at lower end
  • Round ligament= obliterated left umbilical vein extends to umbilicus
  • Coronary ligaments= links diaphragm to the liver
  • Lesser omentum= links liver to stomach
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6
Q

describe the lesser omentum? 4

A
  • From lesser curvature stomach to porta hepatis
  • Has a free margin (ventral mesentery)
  • Encloses the hepatic artery, portal vein, bile duct, lymph vessels
  • Close to the stomach it also encloses the gastric arteries and veins
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7
Q

describe the blood supply to the gut? 5

A
  • Each division has a specific artery
  • All midline branches of the abdominal aorta
  • foregut= coeliac artery/ trunk
  • midgut= superior mesenteric artery
  • hindgut=inferior mesenteric artery
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8
Q

describe the liver and metabolism? 2

A
  • Hepatic artery, a branch from the coeliac trunk brings oxygenated blood from the heart
  • Portal vein, formed by the coming together of the superior mesenteric and splenic veins, brings deoxygenated blood from the gut, carrying nutrients, drugs, toxins etc
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9
Q

describe the coeliac artery? 7

A
  • Aka trunk or axis, has 3 main branches
  • Left gastric (to stomach)
  • Splenic (to spleen)
  • ## Hepatic (to liver)
  • Exits aorta at T12/L1 level
  • Also supplies the duodenum and the pancreas
  • There is no coeliac vein
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10
Q

describe hepatic artery variations? 5

A
  • Seen in 40-45% of people

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)
  • Critical test done prior to any surgery to the liver
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11
Q

describe the port hepatis? 5

A
  • At the hilum of the liver= visceral surface
  • Deep fissure= 5cm
  • Entry/exit point for hepatic portal vein, hepatic artery proper, common hepatic duct, nerves and lymphatics
  • Once in: branching of vessels (and ducts)
  • Division of liver into lobes and segments
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12
Q

what are liver segments? 4

A
  • Liver lobes are divided into segments (couinaud) according to how the hepatic artery and portal vein subdivide
  • Branches of the hepatic artery and portal vein carry blood into sinusoids
  • Tributaries of the bile ducts accompany the two above but carrying bile in the opposite direction. All three structures are called the portal triad
  • there are 8
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13
Q

what does each lobe of the liver have? 4

A
  • Each lobe of the liver contains several lobules (functional units of the liver)
  • Hexagon shaped and contain hepatocytes
  • Hepatocytes secrete bile
  • Each lobule has a portal trial at each corner
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14
Q

what is the metabolic function of hepatocytes? 4

A
  • Synthesis and release of plasma proteins into the blood (albumin, clotting factors)
  • Deaminates amino acids, creating ammonia (this is then converted into urea in order to be safe)
  • Converting bilirubin to bile pigment
  • Production of bile salts, to emulsify fats
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15
Q

describe the venous drainage of the liver? 5

A
  • The mixed blood from the two sources= portal and hepatic- in the sinusoids passes through the hepatocytes and from there into the central vein
  • The =central vein is found at the centre of a hepatic lobule
  • Several central veins then drain into the interlobular (sub-lobular) vein
  • interlobular veins then drain into hepatic veins
  • hepatic veins drain into the inferior vena cava
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16
Q

describe the hepatic portal system? 3

A
  • The portal venous system is described as blood draining the GI trat towards the liver
  • This is distinct from the systemic venous system which drains the rest of the body
  • Toxins, drugs that are absorbed from the GI have to pass through the liver before reaching the heart
17
Q

describe portal systemic anastomosis? 4

A
  • Communications between some branches of the portal and systemic systems is crucial for survival
  • These are known as portocaval anastomosis
  • This is important if the portal vein becomes blocked, or passage via the liver meets resistance portal hypertension
  • Blood is therefore allowing to travel collateral to the liver on its return to the heart, without which the subject would die
18
Q

describe portal hypertension? 4

A
  • Fairly common
  • Any obstruction to the portal vein
  • Varicoses (life threatening if they burst)
  • Caput medusa (oesophageal varices)
19
Q

what is a portacaval shunt?

A
  • Diverting blood from the portal vein to the ICV

- Not used anymore since TIPS (transjugula intrahepatic portosystemic shunting)

20
Q

what is the liver’s role in bile production? 4

A
  • Bile is secreted by the hepatocytes into canaliculi at around 40ml/hr
  • Bile canaliculi join to form the two main hepatic ducts, left and right which drain the respective lobes
  • Emerge from porta- unite to form the common hepatic duct
  • Although bile flows continuously towards the duodenum, it is prevented entry by a closed sphincter of Oddi, located at the end of the biliary tree
21
Q

describe lymphatic drainage of the liver? 3

A
  • Liver produces a vast amount of lymph that drain into the lymph nodes located in the vicinity of porta hepatis
  • These nodes are termed coeliac to match the coeliac artery
  • Coeliac nodes in turn drain to cisterna chyli
22
Q

describe liver trauma? 4

A
  • Closely related to lower ribs
  • Fracture ribs/ penetrating wounds
  • High vascularisation= severe haemorrhage
  • Remove portions due to segmental nature of liver and vessels/ducts supplying it liver biopsies, metastatic spread, cirrhosis

104-theme 2-the liver and regulation of metabolism (19 decks)

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