Anatomy + physiology of the liver

Question 1

What is the colour of the liver dependent on?

Answer 1

fat content

Question 2

What is the name of the fibrous capsule covering the liver?

Answer 2

Glisson capsule

Question 3

What parts of the liver are not encapsulated in the visceral peritoneum?

Answer 3

gallbladder fossa, porta hepatis and bare area

Question 4

What attaches the liver to the anterior abdominal wall?

Answer 4

falciform ligament

Question 5

How does the falciform divide the liver?

Answer 5

into anatomical left and right lobes

Question 6

What is the bare area of the liver?

Answer 6

where the liver contacts directly the diaphragmatic surface and no peritoneum is present

Question 7

Name the impressions on the liver

Answer 7

gastric impression
oesophageal impression
colic impression
renal impression

where other organs press onto the liver and leave outlines

Question 8

What is the lesser omentum?

Answer 8

double layer of the peritoneum that runs from the inferior surface of the liver to the lesser curvature of the stomach and proximal part of the duodenum

Question 9

What does the porta hepatis contain?

Answer 9

portal vein
hepatic artery proper (supplies liver + gallbladder)
hepatic nervous plexuses
common hepatic duct
lymph vessels

Question 10

Where does the gallbladder lie?

Answer 10

visceral surface of anatomical right lobe, between right lobe + quadrate lobe

Question 11

How many anatomical lobes of the liver are there?

Answer 11

4

Question 12

How many functional segments of the liver are there?

Answer 12

8

Question 13

What marks the border between the 2 functional lobes of the liver?

Answer 13

marked by IVC and gallbladder - Cantlie’s line

Question 14

What 2 veins form the main hepatic portal vein?

Answer 14

confluence of superior mesenteric vein and splenic vein

Question 15

What type of cell is a Kupffer cell?

Answer 15

macrophage

Question 16

Lymphatic drainage of liver

Answer 16

deep hepatic lymph vessels surround liver and follow hepatic portal veins
drain to hepatic lymph nodes as porta hepatis which further drain into colecial lymph nodes
coeliac lymph nodes drain to thoracic duct

Question 17

What are the stem cells of the liver called?

Answer 17

oval cells
present where canaliculus joins bile duct

Question 18

Describe bile salt production

Answer 18

primary bile acids synthesised from cholesterol
bile salts are conjugated to increase solubility
secreted into bile, concentrated in gallbladder during fasting, expelled into intestine in response to dietary fat

2 pathways:
- classical
- alternate
- common steps at end

Question 19

Components of bile

Answer 19

bile acids
phospholipid
cholesterol
proteins
bilirubin

Question 20

Role of bile salts

Answer 20

digestion + absorption of intestinal cholesterol, triglycerides, fatty acids and fat-soluble vitamins

gut liver axis

feedback regulatory mechanisms of hepatic bile acid synthesis and gallbladder motor function

Question 21

Where is albumen made?

Answer 21

hepatocytes

Question 22

What clotting factors does the liver make? and therefore what test can be used in prognosis of liver disease?

Answer 22

2, 7, 9, 10
INR

Question 23

Extrinsic pathway blood test

Answer 23

prothrombin time (and INR)

Question 24

Intrinsic pathway blood test

Answer 24

APTT

Question 25

What happens to the prothrombin time (and INR) in liver disease?

Answer 25

increases

Question 26

What is the function of the urea cycle?

Answer 26

removes excess ammonia
(therefore ammonia can accumulate in liver disease)

Question 27

Why can hypoglycaemia be seen in acute liver failure?

Answer 27

failure of liver to metabolise glycogen

Question 28

What does the cori cycle do?

Answer 28

clears lactate from blood and makes it into glucose
happens in liver
(lactic acidosis can be seen in liver failure)