Chapter 95 Liver and Biliary System Flashcards
How many triangular ligaments are there?
Three:
One to R lateral, one to R medial, one to “L lobe”
Name the hepatic ligaments.
Coronary, tirangular, hepatorenal, lesser omentum (=hepatograstric + hepatoduodenal)
What % volume of blood does HA vs portal vein supply to liver?
And % oxygen supply each?
Portal vein supplied 80% of blood volume, HA 20%
Portal vein and HA supply 50% oxygen each
What artery does the cystic artery originate from?
Left branch of HA
What tributaries join the portal vein cranial proximal to the cofluence of cranial and caudal mesenteric veins?
Splenic vein and gastroduodenal vein (N.B. this is absent in cats).
Relevant re pringle manouvre - make sure to angle finger cranially to occlude gastroduodenal vein too).
The hepatic veins enter the CVC in a spiral fashion. Which side has the most caual entry?
R enter most caudal (usually within liver parenchyma)
L most cranial (usually close to where CVC passes through diaphragm)
Describe the borders of the epiploic formaen
Dorsal: CVC
Ventral: Portal vein and HA
Caudal: Mesoduodenum
Carnial: Liver
How many hepatic ducts are there in dogs?
2-8
When does cystic duct become CBD?
at entry of hepatic ducts
Where does the bile duct open?
What is the name of the sphincter?
Opens at major duodenal papilla
Sphincter of Oddi
How does feline CBD/pancreatic duct anatomy differ from dogs?
Dogs:
- Separate opening of CBD vs pancreatic duct (Duct of Wirsung) at major duodenal papilla
- Majority of pancreatic secretions via accessory pancreatic duct = Duct of Santorini (minor duodenal papilla)
Cats:
- Conjoined CBD and pancreatic ducts at major duodenal papilla
- Only 20% of cats have accessory duct (i.e. CBD disease/obstruction in cats may affect exocrin epancreatic secretions)
Where are the major and minor duodenal papillae located?
Major 3-6cm aboral to pylorus (usually 1-2cm distal to where CBD enters duodenum (i.e. 1-2cm intramural portion)
Minor 2cm aboral to major
List 6 broad functions of the liver
- Synthesis and clearance of plasma proteins:
- Carb and lipid metabolism
- Coagulation factor and anticoagulant synthesis: Almost all coagulation factors except vWf and VIII. Plasminigen, antithrombine etc
- Thrombopoetin synthesis
- Storage organ for vitamins fats, glycogen, zinc, copped
- Immune function: Reticuloendothelail function i.e. phagocytosis. Largest in body
How much hepatic function has to be lost before hypoalbuminaemia is evident?
70-80%
How much hepatic function capacity has to be lost for hypoglycaemia?
70-80%
How depleted do coag factors need to be before clotting time prolongation?
depleted to <15% of normal concentrations
What is the name of hepatic macrophages?
Kupffer cells
List 6 ‘ingredients; of bile
(BBBC…PW)
- Bile salts
- Bilirubin
- Bicarb
- Cholesterol
- Phospholipids
- Water
- Other ions
Where does majority of bilirubin come from?
80% from Hb breakdown
What are bile salts made from?
Cholesterol
What are bile acids conjugated with in dogs?
And cats?
Taurine or glycine in dogs
Taurine in cats
What does cholecystokinin do (stimulated by food in duodenum, released by SI cells)?
Caused GB contraction and Sphincter of Oddi relaxation.
List 2 functions of bile salts
- Emulsify fats
- Bind endotoxin to preven absorbtion
How is bilirubin excreted?
Bacteria convert bilirubin to urobilinogen
Urobilinogen converted to urobilin or stercobilin
90% excreted in faeces (small amoiunt in urine)
10% re-absorbed
