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module 104 - theme 2 > anatomy of the liver > Flashcards

anatomy of the liver Flashcards

1
Q

where is the liver located?

A

below diaphragm: mostly right hypochondriac and epigastrum, but extends into left hypochondrium

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2
Q

what are the main functions of the liver?

A
  • detoxification
  • protein synthesis
  • production of bile: aids lipid digestion
  • glycogen storage
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3
Q

what are a few key characteristics of the liver?

A
  • largest gland in the body (excluding skin)
  • highly vascularised
  • pliable to touch; easily lacerated
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4
Q

what is the gross anatomy of the liver?

A
  • diaphragmatic upper surface blunt, dome shaped/sharp inferior border
  • anterior view: divided into 2 main lobes (left and right)
  • posterior view: 2 other lobes (quadrate and caudate)
  • surface covered by peritoneum except bare area, where it touches the diaphragm
  • falciform and lesser omentum ligaments separate right and left lobes
  • porta hepatis divides the quadrate and caudate lobes
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5
Q

what does the falciform ligament link together?

A
  • links anterior abdominal wall to liver

- ligamentum teres at lower end

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6
Q

what does the coronary ligament link together?

A

links diaphragm to liver

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7
Q

what does the lesser omentum link together?

A

links liver to stomach

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8
Q

what are the key characteristics of the lesser omentum?

A
  • from the 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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9
Q

what is the general blood supply to the gut like?

A
  • resort to embryological terms (foregut, midgut, hindgut)
  • each division with specific artery
  • all midline branches of the abdominal aorta
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10
Q

how does the liver work with metabolism?

A
  • hepatic artery, a branch of 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 gut, carrying nutrients, drugs, toxins, etc…
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11
Q

what are the 3 main branches of the coeliac artery?

A
  • left gastric (to stomach)
  • splenic (to spleen)
  • hepatic (to liver)
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12
Q

where does the coeliac exit the aorta?

A

T12/L1 level

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13
Q

what does the coeliac artery also supply?

A

duodenum and pancreas

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14
Q

what are the key characteristics of the porta hepatis?

A
  • at the hilum of the liver: is visceral surface
  • deep tissue: 5cm
  • entry/exit point for: hepatic portal vein, hepatic artery proper, common hepatic duct, nerves and lymphatics
  • once in: branching of the vessels (and ducts) leads to division of liver into lobes and segments
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15
Q

what is the functional anatomy of the liver?

A
  • metabolism: portal system

- production and secretion of bile

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16
Q

what are the characteristics of the liver segments?

A
  • liver lobules are subdivided into segments according to how the hepatic artery and portal vein subdivide
  • branches of hepatic artery and portal vein carry blood into sinusoids
  • tributaries of the bile ducts accompany the 2 above, but carrying bile in the opposite direction
  • all 3 structures are called the portal triad
17
Q

what is the function microscopic anatomy of the liver?

A
  • each lobe of the liver contains several lobules
  • hexagon shaped and contains hepatocytes
  • hepatocytes also secrete bile
  • each lobule has a portal triad at each corner
18
Q

what is the metabolic function of the hepatocytes?

A
  • synthesis and release plasma proteins into the blood
  • dominates amino acids, creating ammonia
  • converting bilirubin to bile pigment
  • production of bile salts, to emulsify fats
19
Q

what is the venous drainage of liver?

A
  • the mixed blood from the 2 sources 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 vein
  • interlobular/sublobular veins then drain into hepatic veins
  • hepatic veins drain into inferior vena cava
20
Q

what is the hepatic portal system?

A
  • the portal venous system is described as blood draining the GI tract towards the liver
  • this is distinct from the systemic venous system which drains the rest of the body
21
Q

what are the key characteristics of portal systemic anastomoses?

A
  • communications between some branches of the portal and systemic systems is crucial for survival
  • these are called portocaval anastomoses
  • this anastomoses is particularly important if the portal vein becomes blocked via liver meets resistance: portal hypertension
  • blood is therefore allowing to travel collateral to the liver on its return to the heart, without which subject would die
22
Q

what are some examples of portal systemic anastomoses?

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
23
Q

what is portal hypertension?

A
  • fairly common clinical condition
  • any obstruction to the portal vein
  • common presentation signs include: varicoses, caput medusa
24
Q

what is a portacaval shunt?

A
  • a shunt was traditionally employed to ameliorate hypertension
  • in effectively diverted blood from portal vein to the IVC
  • however this has largely been abandoned since the advent of TIPS (transjugular intrahepatic portosystemic shunting)
25
Q

what is the livers role in bile production?

A
  • bile is secreted by hepatocytes into canaliculi at a rate of around 40ml/hr
  • bile canacliculi join to form 2 main hepatic ducts - left and right - that drain the respective lobes
  • emerge from porta: unite to form common hepatic duct
  • although bile flows continuously towards the duodenum it is prevented entity by a closed sphincter of Oddi, located at the end of the biliary tree
26
Q

what are the key characteristics of lymphatic drainage in the liver?

A
  • liver produces vast amount of lymph that drain into lymph nodes located in the vicinity of porta hepatis
  • these nodes are termed coeliac to match the coeliac artery
  • coeliac nodes in turn drain into cisternal chyli

module 104 - theme 2 (18 decks)

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