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BIOL21291 > Lecture 7 - The Liver and biliary tree > Flashcards

Lecture 7 - The Liver and biliary tree Flashcards

1
Q

The liver: what are its haematological, metabolic, and other functions?

A

Plasma protein synthesis (albumin, clotting factors)
Removal of toxins (excess hormones, antibodies)

Stores glucose (glycogen), minerals and vitamins
Regulates triglyceride, fatty acid and cholesterol circulating levels
Removes excess amino acids for protein production/ storage

Production and secretion of bile

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2
Q

Location of the liver in the abdominal anatomical positions and its relation to the diaphragm and ribs

A

Right hypochondrium, epigastrium, and left hypochondrium

Lies inferiorly to the diaphragm, posteriorly to the ribs, and moves with respiration

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3
Q

Anterior relations to the liver

A

anterior abdominal wall, diaphragm(?), costal margins (ribs 7-11), and lower margins of lungs and pleura

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4
Q

Posterior relations to the liver

A

Oesophagus, stomach, Duodenum,
Inferior vena cava and the gall bladder - both embedded into the liver

(??? listen to podcast back)

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5
Q

Diaphragmatic surface

A

Surface covered by the diaphragm and anterior body wall - regular and convex surface

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6
Q

Visceral surface

A

Moulded by viscera, irregular concave surface

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7
Q

The four lobes of the liver

A

Left lobe, right lobe, quadrate lobe (quadrate shape), and caudate lobe (caudate - tail: has a tail-like projection)

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8
Q

What are the superior and inferior fissures in the liver for?

A

The ligamentum venosum and the ligamentum teres

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9
Q

Porta hepatis: what does it mean and what are its contents?

A

‘door to the liver’

Right and left hepatic ducts, right and left branches of the hepatic arteries, the hepatic portal vein, sympathetic and parasympathetic nerve fibres, and hepatic lymph nodes

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10
Q

Hepatic portal vein

A

Blood from the gastrointestinal tract to the liver

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11
Q

Hepatic artery

A

Supply the liver with blood (only 30% of the total blood entering the liver)

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12
Q

Hepatic vein

A

Takes deoxygenated blood back to the inferior vena cava

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13
Q

Vascular segments

A

Portal lobes - right and left lobes which are further divided into 8 segments

Each segment is supplied with its own branch of the hepatic artery and hepatic portal vein and is drained by a hepatic duct

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14
Q

Anatomical lobes vs portal lobes

A

Anatomical lobes are the right, left, quadrate, and caudate lobes

The portal lobes are split into the right lobe (right lobe - the left medial division (LMD)), the left lobe (the left lobe + the LMD), and the caudate lobe

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15
Q

Segment I of the liver

A

The caudate lobe

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16
Q

Segment II of the liver

A

The upper part of the left lateral division

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17
Q

Segment III of the liver

A

The lower part of the left lateral division

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18
Q

Segment IV of the liver

A

The left medial division

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19
Q

Segment V of the liver

A

The lower part of the right medial division

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20
Q

Segment VI of the liver

A

The lower part of the right lateral division

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21
Q

Segment VII of the liver

A

The upper part of the right lateral division

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22
Q

Segment VIII of the liver

A

The upper part of the right medial division

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23
Q

Falciform ligament

A

The double fold of peritoneum - prevents the liver from moving too far away from where it should be, located between the right and left anatomical lobes of the liver

24
Q

Ligamentum teres

A

The remnant of the umbilical vein, runs in the free edge of the falciform ligament (round ligament of the liver)

25
Q

Bare areas of the liver

A

Directly contact the diaphragm - has no peritoneum on it

26
Q

Coronary ligament

A

The attachment of the liver to the diaphragm - surrounds the bare area

(listen to more on the podcast)

27
Q

Peritoneum: what is it and what does it do?

A

A membrane - a sheet of smooth tissue that lines your abdominopelvic cavity and surrounds your abdominal organs

It pads and insulates your organs, helps hold them in place and secretes a lubricating fluid to reduce friction when they rub against each other

28
Q

Bare area of the liver

A

in direct contact with the diaphragm, not covered by the visceral peritoneum

29
Q

Triangular ligaments

A

(ppodcast)

30
Q

Hepatogastic …

A

(podcast)

31
Q

Liver blood supply

A

70% - Hepatic portal vein (45% more oxygenated than vena cava blood - GI doesn’t use too much)
30% - Hepatic arteries

32
Q

Hepatic portal vein

A

Formed by the union of the superior mesenteric vein and the splenic vein

Delivers blood rich in nutrients from the gastrointestinal tract

33
Q

Portal systemic anastomoses

A

Oesophagus, anterior abdominal wall, secondarily retroperitoneal structures, and the anal canal

34
Q

Oesophagus: the portal-systemic anastomosis: the portal venous system, the systemic venous system, and where they interact.

A

Lower 1/3 -> left gastric -> portal system

Middle 1/3 -> azygos

Lower 1/3 - Middle 1/3

35
Q

Anterior abdominal wall: the portal-systemic anastomosis: the portal venous system, the systemic venous system, and where they interact.

A

paraumbilical veins -> portal system

superficial veins -> axillary or femoral

paraumbilical veins - superficial veins

36
Q

Secondarily retroperitoneal structures: the portal-systemic anastomosis: the portal venous system, the systemic venous system, and where they interact.

A

superior and inferior mesenteric and splenic veins -> portal system

Renal, lumbar, and phrenic veins -> inferior vena cava

S, I mesenteric and splenic veins - R, L, and P veins

(watch podcast)

37
Q

Anal canal: the portal-systemic anastomosis: the portal venous system, the systemic venous system, and where they interact.

A

Superior rectal veins -> portal system

Middle rectal veins -> internal iliac
Inferior rectal veins -> internal pudendal

Superior rectal veins - middle/inferior rectal veins

38
Q

Portal hypertension: what is it and what can it lead to?

A

Less blood can pass through - blood tails back until it reaches a portal-systemic anastomoses

Can lead to varicose veins and may cause bleeding from oesophageal varices (fatal)

39
Q

Caput medusae: what is it and what does it usually signify?

A

Sometimes called a palm tree sign - appears as a network of painless, swollen veins around your bellybutton (looking like Medusa’s head)

While it’s not a disease, it is a sign of an underlying condition, usually liver disease

40
Q

Microscopic structure: what is the functional unit of the liver

A

Lobules - hexagonal-shaped units that are connected by connective tissue

41
Q

Liver lobule histology

A
  • Central vein
  • Plates of hepatocytes from the end of the lobule towards the central vein
  • Sinusoids between plates of hepatocytes
  • Portal triad in each corner: hepatic artery, portal vein, and bile duct
42
Q

Blood and bile flow

A

Blood passes through sinusoids towards central veins and nutrients, oxygen, and toxins are filtered

Central vein - hepatic vein - inferior vena cava

Bile is secreted by hepatocytes: bile canaliculi -> interlobular biliary ducts -> bile ductile -> bile ducts

Bile flows in the opposite direction to blood

43
Q

Venous drainage of the liver

A

Right, left, and intermediate hepatic veins

44
Q

Lymphatic drainage

A

1/3 of lymph received by thoracic duct is from liver

Hepatic nodes - coeliac nodes - intestinal trunk - cisterna chyli and thoracic duct

45
Q

Liver autonomic innervation

A

Sympathetic innervation: T5-T9 -> greater splanchnic nerve -> coeliac plexus -> hepatic plexus

Parasympathetic innervation - Vagus nerve

46
Q

Vagus nerve

A

innervates all superior abdominal structures (? listen to leccy)

47
Q

Bile flow: what is it, what does it do, what is its travel path, and where is it stored and concentrated?

A

Green/yellow/brown liquid that is produced continuously

Emulsifies fat

Passes down right and left hepatic ducts into the common hepatic duct

CHD is joined by the cystic duct to form the bile duct (common bile duct) where it is moved into the gall bladder - where it’s stored and concentrated

48
Q

Bile flow: what is its process

A

Bile duct unites with main pancreatic duct to form hepatopancreatic ampulla

Distal end of ampulla opens into duodenum at the major duodenal papilla

The sphincter of Oddi surrounds the distal end

49
Q

Gall baldder

A

Pear-shaped sac

Holds 30-60ml of bile

Receives blood from the right hepatic artery which leads into the cystic artery

50
Q

Gall bladder location

A

Right hypochondrium, projects below the inferior margin of the liver

Relations:
– Anterior: anterior abdominal wall and liver
– Posterior: duodenum (1st and 2nd parts) and transverse colon

51
Q

Gall bladderr histology

A

Mucosa - many folds: (why?)
* Epithelium: simple columnar epithelium with many microvilli
* Lamina propria: lots of blood vessels and
lymphocytes

Muscularis - longitudinal/oblique fibres allow liver movement

Outer layer - Mainly serosa but attached to the liver by an adventia

52
Q

Lamino propia

A

Lots of blood vessels - drainage (? podcast - just before venous drainage)

53
Q

Gall bladder venous drainage

A

Cystic veins from the body and fundus neck drain directly into liver sinusoids

  • Cystic veins from neck drain directly into liver sinusoids or into hepatic portal vein
54
Q

Gall bladder lymphatic drainage

A

Lymph drains to cystic lymph node at the gall
bladder neck then to hepatic lymph nodes

  • Hepatic nodes → coeliac nodes →intestinal trunk → chysterna chyli and thoracic duct
55
Q

Gall bladder innervation

A

Sympathetic innervation: T5-T9 -> greater splanchnic nerve -> coeliac plexus -> hepatic plexus

Parasympathetic innervation: Vagus nerve

BIOL21291 (13 decks)

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