Hepatobiliary system Flashcards
Where does the liver reside in relation to the diaphragm?
Inferior to the cdiapjgram, in the upper right quadrant of the abdominal cavity. Liver is divided into two primary lobes, right and left
What are the two primary lobes of the liver?
Right and left
Which folds connect the liver to the abdominal wall and diaphragm?
Pertioneal folds (ligaments)
What is the falciform ligament?
The falciform ligaments runs inferiorly from the diaphragm across the anterior edge of the liver to its inferior border. At the inferior end of the liver, the falciform ligament forms the ligamentum teres of the liver.
What are the four lobes of the liver?
Left, right caudate, and quadrate
What ligament separates the right and left lobe?
The falciform ligament
Where is the caudate lobe located within the liver?
Posterior side of the right lobe, wraps around the inferior vena cava
Where is the quadrate lobe in relation to the caudate lobe?
The quadrate lobe is inferior the the caudate, wrapping around the gallbladder.
Which lobe wraps around the gallbladder?
The quadrate lobe
Which part of the lobe does the hepatic artery and hepatic portal veins enter?
Porta hepatis
What vessel delivers the majority of blood to the liver?
Hepatic portal veins
Which vessels deliver blood to the liver?
Hepatic portal veins
Hepatic artery
What % of blood flow arises from the hepatic artery into the liver?
25%
What is the hepatic artery?
Delivers oxygenated blood from the heart to the liver
What is the hepatic portal vein?
Delivers partially deoxygenated blood containing nutrients and toxins absorbed from the small intestine, pancreas, gall bladder and spleen to the liver
What is the main outflow of the liver?
There are 3 hepatic veins (right, middle and left), these drain into the inferior vena cava
The right and left hepatic duct converge to form which duct?
The common hepatic duct
Where int deliver do the right and hepatic ducts converge?
The hilum
Which duct does the common hepatic duct converge with to form the common bile duct?
The cystic duct
What is the primary function for the common bile duct?
Carry bile to the duodenum of the small intestine. Bile produced by the liver is pushed back up the cystic duct y peristalsis to arrive in the gallbladder for storage.
What are the three main hepatic veins?
Right hepatic vein
Middle hepatic vein
Left hepatic vein
What is the middle hepatic vein, and its role in liver anatomy?
Obliquely runs from the inferior vena cava to the gallbladder fossa. Separates the anterior segment of the right hepatic lobe from the medial segment of the hepatic lobe
What is the right hepatic vein and its anatomical divisions?
Divides anterior and posterior segments of the right hepatic lobe
What is the left hepatic vein and its anatomical divisions?
Left hepatic vein separates the medial and lateral segments of the left hepatic lobe
Where do the 3 hepatic veins drain into?
Drain into the inferior vena cava
Which ligament separates the lateral and medial segments?
Ligamentum teres
Which lobe is associated with the medial segment?
Quadrate lobe
How segments comprise one liver?
8 segments
Each segment contains what?
Has its own vascular inflow, outflow and binary drainage
What is in the centre of each hepatic lobule?
Branch of the oral vein, hepatic artery & bile duct
What is the first hepatic segment?
Caudate lobe, situated posterior, recieves supply from both right and left branches of the portal, contains multiple hepatic veins
Which lobe is associated with the first hepatic segment?
Caudate lobe
Which branches of hepatic portal veins supply the first hepatic segment?
Right and left
In which direction are segments II - VII numbered?
Clockwise fashion
Which hepatic veins forms the drainage of segments (1-4)?
Middle and left hepatic vein
Which segments reside lateral to the falciform ligament?
Segments II & III
what is the relation of the portal venous supply to segment II & III?
Segment II is superior to the portal venous supply, and III is inferior.
Which segment is medial to the falciform ligament?
Segment IV
Which hepatic segment is the most inferior and medial
Segment V
Which vein forms the drainage of segments 5-8?
Right hepatic vein
Which hepatic segment is the most posterior?
Segment VI
Which segment is superior to segment VI?
Segment VII
Which hepatic segment is in the super medial position?
Segment VIII (8)
What are the three main components of the liver?
Hepatocytes
Bile canaliculi
Hepatic sinusoids
What are the main hepatic cells?
Hepatocytes
What term is used to describe plates of hepatocytes?
Hepatic laminae
What are hepatic laminae?
Hepatic laminae radiate outward from the portal vein in each hepatic lobule.
What is in the central of the hepatic lobule?
Central vein
What is the central vein in the hepatic lobule?
Collects blood from the hepatic sinusoids –> hepatic vein to the inferior venous cava
What are the two side faces of the lobule hepatocyte rows?
Sinusoid facing side, and bile canaliculi facing side
What is the function performed by bile canaliculi?
Adjacent hepatocytes, grooves in cell surface membrane provides bile canaliculus Accumulate bile produced by hepatocytes. Bilirubin processed & excreted into bile canaliculi.
What is a hepatic sinusoid?
Open porous blood space formed by sinusoidal capillaries from hepatic portal veins
Hepatocytes are densely packed around sinusoidal epithelium, proving accessibility to blood supply
. From central position, hepatocytes process nutrients, toxins and waste substrate. Hepatic sinusoids combine, sending blood to a central vein Hepatic vein Inferior vena cava. (Blood & bile flow in opposite directions).
What is a portal triad?
Arrangement around perimeter of hepatic lobules, consists of: Bile duct, hepatic artery branch, and a hepatic portal vein.
How many hepatic lobules are linked by a portal triad?
3 hepatic lobules
Describe the movement of bile through the ducts:
Bile flows into bile ductules Bile duct Right & left hepatic ducts Common hepatic duct + Cystic duct (from gallbladder) Common bile duct.
What is the role of the hepatic artery?
Delivers oxygenated blood into the live to support the metabolic demands of hepatocytes
Where does the portal vein arise from?
Mixed venous blood from the gastrointestinal tract (nutrients, bacteria & toxins), and spleen (metabolic waste substrates).
Hepatocytes process nutrients, detoxify & excrete waste.
What is the main outflow of the hepatic lobule?
Bile produced from hepatocytes drains into bile canaliculi, these ducts coalesce with cholangiocyte-lined bile ducts present around lobule perimeter
What is a hepatic acinus?
Consists of 1/6th of hepatic lobule, comprises of two portal triads extending into the hepatic lobule towards the central vein
Where does the central vein reside in relation to the acinus?
Resides within the acinus apex.
How many zones comprise a hepatic acinus?
Three
Which hepatic acinus zone has the greatest oxygen concentration?
Zone 1
Which hepatic acinus zone has the lowest oxygen concentration, and lowest toxin risk?
Zone 3
Describe the structure of sinusoidal endothelium?
Absence of basement membrane
The endothelium is fenestrated (discontinuous), therefore increasing permeability to substrate, facilitating the movement of lipids and substrates to and from hepatocytes
What space resides between the sinusoidal endothelial supply and the hepatocyte?
Space of Disse
What is the Space of Disse?
The perisinusoidal space, where the blood plasma is contained
Microvilli of hepatocytes extend into this space, allowing proteins and plasma components from the sinusoids to be absorbed by hepatocytes
Which cells reside in the Space of Disse?
Hepatic stellate cells
Which cells are attached to the sinusoidal endothelium?
Kupffer cells
What are Kupffer cells?
Kupffer cells are attached to the sinusoidal endothelium exhibiting the capacity to undergo phagocytosis, agonistically functioning as sinusoidal macrophages Eliminating & detoxifying substances arriving in liver from portal circulation.
Hemosiderin store Available production of haemoglobin.
Which hepatic cells store vitamin A?
Stellate cells
What are hepatic stellate cells?
Hepatic stellate cells reside within the perisinusoidal space, the Space of Disse. Exist in quiescent state, providing available storage of Vitamin A in cytosolic droplets.
Stellate cells undergo activation in response to hepatic damage, expressing fibroblast activity Proliferate, chemotactic & deposit collagen in extra-cellular matrix.
What are hepatocytes?
Cubical cells responsible for the synthesis of albumin, clotting factors & bile salts. Site of drug metabolism; receives nutrients & substrates from sinusoids.
80% of liver mass
Where do cholangiocytes reside?
On the edge of the bile duct, secrete bicarbonate and water in bile
What do cholangiocytes secrete?
Bicarbonate & water into bile
What are the main functions of hepatocytes?
Metabolic & catabolic functions: Synthesis & utilisation of carbohydrates, lipids and proteins.
Secretory & excretory function: Synthesis and secretion of proteins, bile & waste prodcuts
Detoxification & immunological functions: Degradation of ingested pathogens, and processing of drugs
Carbohydrate metabolism
What is glycolysis?
Glycolysis: Anaerobic conversion of glucose Lactate (RBCs, renal medulla & skeletal muscle); aerobic oxidation of glucose Pyruvate (CNS, heart, skeletal muscle).
What is glycogenesis?
Synthesis of glycogen from glucose (Liver & muscle)
What is glycogenolysis?
Breakdown of glycogen to glucose
What is gluconeogenesi?
Gluconeogenesis: Production of glucose from non-sugar substrates: Amino acids (glutamine) in liver & renal cortex; lactate (from anaerobic glycolysis in RBCs & muscles); glycerol from lipolysis.
What is lipolysis?
Hydrolysis of triacylglycerols into glycerol and free fatty acids
What is lipoegenesis?
Synthesis of triacylglycerols (storage in adipose tissue)
Which cycle converts lactate into pyruvate?
The Cori cycle
What is the Cori cycle?
Refers to the metabolic pathway in which lactate produced through anaerobic glycolysis in the myocyte is transported to the liver under The action of lactate dehydrogenase to form pyruvate
Converted into glucose via gluconeogenesis