Hepatobiliary System Lecture Powerpoint Flashcards
this one is gonna suck dick
Liver borders
Superior - diaphragm
Lateral and anterior - rib cage
Medial - crosses into left upper quadrant
Inferior - gall bladder
How does the liver allow for living donor transplants?
Because it is divided into 8 functionally independent segments each with own vascular in and outflow
Falciform ligament
Infolding of mesentary that separtes right and left lobes of livers suspending it from the diaphragm and anterior abdominal wall
Round ligament of the liver
Fibrous remains of fetal umbilical vein, travels inferiorally from in between the right and left lobes to the umbilicus
Lesser omentum
Small piece of double layer peritoneum that anchors liver to lesser curvature of stomach
Visceral peritoneum
Covers entire liver except for superior bare area of liver
Bare area of the liver
Superior diaphragmatic triangular portion of the liver containing portacaval anastamoses where infection can spread to the thoracic cavity
Hepatic portal vein
Derived from: merging of splenic and superior mesenteric veins
Travels to the liver receiving branches from gastric and cystic veins before bifurcating and entering
Empties into: hepatic veins
Hepatic veins
Derived from: hepatic portal vein
Travels throughout the liver to filter and remove toxins
Empties into the inferior vena cava
Splenic vein
Derived from: the spleen
Travels toward the liver, receiving blood supply from inferior mesenteric vein
Drains into: hepatic portal vein
Gastric vein
Derived from: stomach
Travels toward the liver
Empties into the hepatic portal vein shortly before it bifurcates
Cystic vein
Derived from: the gall bladder
Travels toward the liver
Empties into the heppatic portal vein shortly after it bifurcates
Superior mesenteric vein
Derived from: The small intestine
Travels toward the liver
Empties into the hepatic portal vein after merging with the splenic vein
Inferior mesenteric vein
Derived from: Large intestine
Travels toward the liver
Empties into the splenic vein superiorally
Hepatic portal vein carries ___ of hepatic blood supply, the hepatic artery carries ___
75%, 25%
Hepatic artery
Derived from: celiac trunk artery
Travels giving off the gastroduodenal artery before supplying the liver
Hepatic hypertension can manifest as distally as….
….rectal hemorroids
Biliary canuliculi
Projections off hepatocytes that collect bile excreted by hepatocytes to eventually enter the common hepatic duct
Bilirubin
Breakdown product of red blood cell degradation, gives a yellow coloration
Common hepatic duct
Product of bile canaliculi from hepatocytes within the liver converging, exits the inferior base of the liver before merging with the common cystic duct to form the common bile duct
Common cystic duct
Derived from the gall bladder, connects to the common hepatic duct to form the common bile duct
Gall bladder
Accessory organ used to store and concentrate bile, contracts via smooth muscle layer in response to lipid presence in intestine to promote emulsification, if removed can see difficutly digesting fatty meals
Common bile duct
Formed from the combination of the common cystic duct and common hepatic duct, receives branch from pancreatic duct before exiting at the spincter of Oddi in the duodenum
Pancreatic duct
Releases exocrine secretions from the pancreas into the common bile duct to exit via sphincter of Oddi
CCK mechanism of action
- Stimulated for release by chyme entering duodenum
- enters blood stream
- Induces secretion of pancreatic enzymes
- Induces gallbladder contracttion
Secretin mechanism of action
- Release by chyme entering duodenum
- enters blood stream
- Induces secretion of pancreatic bicarbonate
An obstruction in sphincter of Oddi often causes….
pancreatitis
Portal triad
Groups of hepatic artery, hepatic portal vein, and hepatic duct that sit at corners of lobules in the liver
Central vein
Drainage structure that eventually combines into the vena cava after receiving blood flow from hepatic sinusoids in a lobule as they are modified by hepatocytes
Hepatic sinusoids
Paths that blood flows from hepatic veins and hepatic arteries before draining into a central vein where it is filtered by hepatocytes
Pathway of blood flow generally to the liver
- hepatic portal vein and hepatic artery
- hepatic sinusoids
- central veins
- hepatic veins
- inferior vena cava
Space of disse
Space between hepatocyte and a sinusoid that allows for proteins to be absorbed by microvilli from the hepatocytes
Kupffer cells and their 4 key functions
Liver macrophages
1) RBC destruction
2) Antibody production aid
3) phagocytosis
4) cause early ETOH induced liver injury
11 Liver functions
- produce bile salts
- eliminate bilirubin
- metabolize steroid hormones
- metabolize drugs
- meetabolize fat
- metabolize protein
- metabolize carb
- recycling vitamins
- remove bacteria
- coagulation factors
- produce urea
RBC breeakdown pathway
- RBC to hemoglobin in spleen or kupfer cells
- Globin recylced in liver
- Heme digested to iron and bilirubin
- Iron turned to storage form (ferritin)
- Bilirubin enters liver
Bile components
-Bile acids
-cholesterol
bilirubin
-electrolytes
0water
Unconjugated bilirubin (indirect bilirubin)
Bound to albumin, water insoluble but fat soluble, typically calculated and not measured
Conjugated bilirubin (direct bilirubin)
In the hepatocyte, Water soluble, can be measured via liver function test
Total bilirubin =
Direct + indirect
Excess not reasorbed conjugated bilirubin is converted by bacteria into…
…urobilinogen (if reabsorbed gives urine yellow color, most exits into colon giving feces brown color)
Kernicterus
High levels of bilirubin buildup in babies causing neurological problems
3 types of jaundice
Prehepatic - excessive hemolysis of RBC
Intrahepatic - affect ability of liver to remove or conjugate bilirubin
Posthepatic - obstruction between liver and intestine
Absorptive state characteristics
- Glucose to glycogen
- Excess becomes triglycerides
- amino acids to protein syntehsis
Postabsorptive state characteristics
- Glycogenolysis
- Gluconeogenesis
- Ketogenesis
Urea formation in liver
Ammonia conversion via combination with CO2
Common liver function test in response to alcohol abuse
GGT
Portal hypertension
Occurs when portal blood cannot flow thru liver increasing pressure in portal vasculature
Hepatorenal syndrome
Tendency for cirrhosis of the liver to cause compromising of circulation to abdominal vessels, sometimes disrupting renal blood supply leading to renal failure
3 alcohol metabolizing systems in the liver
1) alcohol dehydrogenase (ADH) system in cytoplasm
2) Microsomal ethanol oxidizing system (MEOS) in ER
3) Catalase in peroxisomes
