anatomy of the liver and gallbladder Flashcards
where is the liver?
right hypochondrium &epigastricareas
what are its 2 external surfaces?
- diaphragmatic (anterior superior)
2. visceral (posteroinferioro)
is the liver intra or retroperitoneal?
infraperitoneal
is the liver covered in peritoneum?
yes except for the ‘bare area’ on posterior surface which has direct contact with diaphragm
what are ligaments of the liver made of?
double layer of peritoneum
which ligament attaches the anterior surface of the liver to the anterior abdominal wall?
the falciform ligament
describe the shape of the falciform ligament?
sickle shaped
what ligament is contained within the free edge of the falciform ligament?
the ligamentum teres (a remnant of the umbilical vein)
which ligament attaches the superior surface of the liver to theinferior surface of thediaphragm ? and demarcates the bare area of the liver?
coronary ligament
what is the coronary ligament made of?
- has an anterior and posterior fold
how are the left and right triangular ligaments formed?
by the union of the anterior and posterior folds of the coronary ligament
what attachments do the left and right triangular ligaments make?
Right attaches right liver lobe to Diaghragm, left attaches left lobe to diaphragm
what structure connects the liver to the lesser curvature of the stomach and 1st part of duodenum?
the lesser omentum
what 2 ligaments are contained within the lesser omentum?
the hepatoduodenal
the hepatogastric
which ligament surrounds the portal triad?
the hepatoduodenal (within lesser omentum)
where is the liver divided anatomically into the 2 main lobes?
by the falciform ligament
where is the liver divided functionally into 2 lobes?
functionally - meaning if you removed one half, the other won’t be affected
down gallbladder and IVC
- this means both sides have their own single portal branch, a single hepatic artery branch and a single hepatic duct tributary.
how many independent functional segments are there in the liver?
8
what are the 4 lobes of the liver?
right
left
caudate
quadrate
where do the 2 accessory lobes arise from?
caudate and quadrate arise from right main lobe on visceral surface
where exactly is the caudate lobe?
- on upper visceral surface
- It lies between the inferior vena cava and a fossa produced by the ligamentum venosum (a remnant of the fetal ductus venosus).
where exactly is the quadrate lobe?
- on the lower aspect of the visceral surface.
2. It lies between the gallbladder and a fossa produced by the ligamentum teres
what is the porta hepatis?
where all the neurovascular structures (except hepatic veins) enter/exit the liver
it is a deep transverse fissure that separates the quadrate and caudate lobes (on inferior surface)
what are the hepatic arteries branches from?
aorta -> coeliac axis -> the common hepatic -> hepatic arteries
where does the portal vein drain into?
drains the whole bowel
drains into the liver
briefly outline the pathway of bile from liver to gallbladder
secreted by liver -> collecting ducts -> hepatic ducts -> common hepatic duct -> cystic duct -> stored in gallbladder
briefly outline the pathway of bile from gallbladder to duodenum
released from gallbladder -> cystic duct -> common bile duct -> ampulla of vater (once pancreatic duct joins) -> into the duodenum via major duodenal papilla
why is the blood supply to the liver unique?
its a dual blood supply from proper hepatic artery (25%) and hepatic portal vein (75%)
describe the role of the portal vein
supplies majority of blood to liver by draining the bowels
blood is partially deoxygenated but high in nutrients
describe the venous drainage of the liver
via the hepatic veins into IVC
describe the sympathetic innervation of the liver
the celiac plexus (part of hepatic plexus)
describe the parasympathetic innervation of the liver
vagus nerve (part of hepatic plexus)
what is glissons capsule?
the fibrous covering of the liver
what is the innervation of the glissons capsule?
lower intercostal nerves - well localised pain
what are the structural units of the liver?
lobules or acini (same concept but different way of displaying)
what are each of the lobules of the liver made of?
- hexagonal plates of hepatocytes
- portal triads at each of the vertices
- a central vein
where does the central vein of a lobule drain?
central vein -> interlobular vein -> hepatic vein -> IVC
what are the 3 main structures in a portal triad?
- arteriole ( branch off hepatic artery)
- venule (branch off portal; vein)
- bile duct
what 2 other structures run alongside the portal triads??
lymphatic vessels andvagus parasympathetic fibres
how is blood transported from portal triads (hepatic artery and portal vein) on the vertices into the central vein?
via sinusoids
- low pressure vascular channels
- mix the blood from hepatic arteries and portal veins
describe the structure of ancinus
- an acinus encompasses the liver tissue that is served by a single terminal branch of the hepatic artery.
- diamond-shaped in cross section, with a hepatic arteriole crossing the center and with central veins at the two opposite corners.
make 3 direct comparisons between a lobule and acinus
- shape
- location of central vein
- location of portal triad branches
hexagonal/diamond
1 in centre/2 on face corners
on all 6 corners/on the 2 short corners
histology of sinusoids: how are they separated from hepatocytes?
by the space of disse
histology of sinusoids: what specialised cells do they consist of?
endothelial and kupffer cells
