Hepatobiliary System - Alegra

Question 1

Where is the liver suspended from?

Answer 1

IVC and diaphragm

Question 2

bare area of liver

Answer 2

Adventitia.
Posterior, mostly R lobe.
Outlined by coronary ligament (reflected peritoneum).
NO PERITONEUM.

Question 3

coronary ligament of liver

Answer 3

Serosa/viseral peritoneum.
Transitional from adventitia to mesothelium.
Surrounds bare area.
Reflected peritoneum.

Question 4

mesentary

Answer 4

Double layer of peritoneum btwn body wall and organ.

Meso- prefix used.
Usually the posterior wall.

Question 5

ligament

Answer 5

Double layer of peritoneum beetween organs or between an organ and the abdominal wall

Question 6

omentum

Answer 6

Double layer of peritoneum between STOMACH and another organ

Question 7

ventral mesentary

Answer 7

Liver develops within ventral mesentery.

Forms adult lesser omentum and falciform ligament

Question 8

ligaments of lesser omentum

Answer 8

Hepatogastric ligament.

Hepatoduodenal ligament.

Question 9

lesser sac

Answer 9

Opening: epiploic foramen (of Winslow).
Formed by lesser omentum.
Btwn stomach and liver.

Question 10

portal triad

Answer 10

Portal vein.
Hepatic artery.
Common bile duct.

Within hepatoduodenal ligament.

Question 11

hepatorenal recess

Answer 11

Potential site for collection of fluid.
Bounded by right kidney and liver.
Drains along right colic gutter into pelvis.

Question 12

falciform ligament

Answer 12

From ventral mesentary.
Between ventral wall and the liver.
Lower free border = ligamentum teres

Separates R and L lobes of liver

Question 13

ligamentum teres

Answer 13

Obliterated umbilical vein (carried blood from mother to fetus).
On lower free end of falciform ligament.

Question 14

lobes of liver

Answer 14

Right.
Left.
Caudate.
Quadrate.

R and L separated ventrally by falciform ligament/ligamentum teres.
Posteriorly, L is separated from all others by umbilical fissure (ligamentum venosum, ligamentum teres hepatis)

Question 15

umbilical fissure

Answer 15

Separates L lobe from Caudate, Quadrate lobes.

Consists of ligamentum venosum, ligamentum teres

Question 16

blood supply to liver

Answer 16

75% venous flow via portal vein.

25% arterial flow via hepatic artery proper (divides into R/L hepatic aa) (from celiac trunk, common hepatic a)

Question 17

L hepatic artery supplies

Answer 17

Left lobe.
Quadrate lobe.
1/2 caudate lobe.

Question 18

R hepatic artery supplies

Answer 18

Right lobe.
1/2 Caudate lobe.
Gallbladder

Question 19

functional lobes of liver

Answer 19

Separated by hepatic arteries, portal veins, bile ducts, hepatic veins.

8 segments

Question 20

cause of hepatic cirrhosis

Answer 20

Alcohol abuse.
Hepatitis infection.
Autoimmune disease.
Industrial solvents.

Question 21

presentation of cirrhosis

Answer 21

Hobnail appearance.
Splenomegaly (bc portal hypertension.
Ascites.

Question 22

which hepatic cells play critical role in generating cirrhotic scar tissue?

Answer 22

Ito/stellate cells.

Question 23

with portal hypertension (reduced portal blood flow), blood can be shunted _________

Answer 23

To systemic circulation, via:
Esophageal v.
Retroperitoneal v.
Rectal v.
Paraumbilical v.

Question 24

esophageal varices

Answer 24

enlarged veins in esophagus.
Due to portal hypertension, blood needs to be shunted here away from liver.
More flow than it can handle.
Rupture can be fatal.

Question 25

intestinal varices

Answer 25

Enlarged retroperitoneal veins.
Due to portal hypertension, blood needs to be shunted here away from liver.
More flow than it can handle.

Question 26

anorectal varices

Answer 26

Enlarged rectal veins.
Due to portal hypertension, blood needs to be shunted here away from liver.
More flow than it can handle.

Question 27

caput medusa

Answer 27

Dilation of periumbilical veins.
Due to portal hypertension, blood needs to be shunted here away from liver.
Characteristic of cirrhotic liver.

Question 28

porto-systemic shunt

Answer 28

Treatment for cirrhotic liver failure.
Bypass function of the liver to get the blood back into systemic circulation without using anastomotic shunts that lead to varices.

Question 29

bile duct system

Answer 29

Bile canaliculi –> terminal bile ductules –> hepatic ducts –> R/L hepatic duct –> common hepatic duct –> cystic duct

Question 30

sympathetic input to hepatobiliary system

Answer 30

Greater splanchnic n, (T5-T9).
Synapse on celiac ganglion.
Periarterial plexus follows blood vessels to target.

Question 31

parasympathetic input to hepatobiliary system

Answer 31

Vagus nerve (CN X).

stimulate bile production, glycogen synthesis (BUT hormones control most functions)