liver Flashcards
What is the largest solid organ in the body?
The liver.
What are the surface anatomy reference points for the liver?
• Point A: Right 5th rib in mid-clavicular line
• Point B: Left 6th rib below the nipple
• Point C: Right lowest point of costal margin
What surface of the liver is related to the diaphragm and anterior abdominal wall?
Parietal (diaphragmatic) surface.
What is Glisson’s capsule?
The visceral peritoneum covering the liver, except for the bare area.
Name the important liver ligaments.
• Coronal ligament
• Falciform ligament
• Ligamentum teres
• Ligamentum venosum
What organs are related to the right side of the liver’s visceral surface?
Gallbladder, right kidney, and right colonic flexure.
What is found posterior to the liver on the visceral surface?
A: IVC (retroperitoneal) and gallbladder.
What are the fissures forming the H-shape on the liver’s visceral surface?
• Right sagittal fissure
• Left sagittal fissure
• Transverse fissure
What does the right sagittal fissure contain?
Fossa of gallbladder (anteriorly) and IVC groove (posteriorly).
What is found in the left sagittal fissure?
Round ligament (anteriorly) and ligamentum venosum (posteriorly).
What anatomical lobes are defined by the falciform ligament?
Right lobe and left lobe.
What lobe of the liver is associated with the IVC?
Caudate lobe.
What lobe is associated with the gallbladder?
Quadrate lobe
What imaginary line divides liver lobes based on blood supply?
Cantlie line.
How many segments does the liver have?
8
What is the name of segment 1 of the liver?
Caudate lobe.
What runs in the hepatoduodenal ligament?
The portal triad.
What are the components of the portal triad?
• Hepatic portal vein (posteriorly)
• Hepatic artery proper (anteriorly)
• Common bile duct (anteriorly)
Where do the portal triad branches enter the liver?
At the porta hepatis.
What supplies 75% of the liver’s blood?
Hepatic portal vein (supplies 50% of liver’s oxygen).
What supplies 25% of the liver’s blood?
Hepatic artery (branch of the celiac trunk), supplying 50% of liver’s oxygen.
How is the liver drained venously?
Through the hepatic veins which empty into the IVC.
What is the lymphatic drainage of the diaphragmatic surface of the liver?
Drains into phrenic lymph nodes
What is the lymphatic drainage of the visceral surface of the liver?
Drains into hepatic LNs, celiac LNs, cisterna chyli, and then thoracic duct.
What is the gallbladder and where is it located?
A pear-shaped organ that lies in the gallbladder fossa.
How is the gallbladder attached to the liver?
It is completely surrounded by peritoneum and binds to the liver.
What are the parts of the gallbladder?
• Fundus
• Infundibulum (Hartmann’s pouch)
• Ducts of Luschka (direct liver connection)
What is Murphy’s point?
A surface landmark of the gallbladder fundus at the right subcostal border, mid-clavicular line (L1 level).
What is the cystohepatic triangle?
A triangle bounded by the liver, cystic duct, and common bile duct.
What important structure passes through the cystohepatic triangle?
The cystic artery.
What is Calot’s triangle?
smaller part of the cystohepatic triangle bounded by:
• CBD (medially)
• Cystic artery (superiorly)
• Cystic duct (laterally)
What supplies the gallbladder arterially?
Cystic artery (branch from right hepatic artery).
How does venous drainage of the gallbladder occur?
Via cystic vein into the portal vein.
What is the lymphatic drainage of the gallbladder?
Celiac lymph nodes.
What are the components of the biliary tree?
• Canaliculi (smallest part)
• Canals of Hering (lined with cholangiocytes)
• Bile ductules
• Right & Left hepatic ducts
• Common hepatic duct
• Cystic duct (with spiral valves of Heister)
• Common bile duct
Where are spiral valves of Heister found?
In the mucosa of the cystic duct near its attachment to the common hepatic duct.
How is the common bile duct (CBD) formed?
From the union of the cystic duct and common hepatic duct in the lesser omentum.
What does the common bile duct join to form the hepatopancreatic ampulla (ampulla of Vater)?
The main pancreatic duct.
Where does the ampulla of Vater open?
Into the duodenum at the major duodenal papilla.
What controls the opening of the ampulla of Vater?
The hepatopancreatic sphincter (sphincter of Oddi).
What are the anatomical parts of the common bile duct?
• Supraduodenal
• Retroduodenal
• Pancreatic
• Intramural
What do high levels of aminotransferases (ALT & AST) indicate?
Liver damage; ALT is more sensitive and specific for liver damage than AST.
What is the significance of elevated alkaline phosphatase (ALK-P)?
Indicates bile flow obstruction (e.g., cholestasis); not liver-specific as it’s also found in bone, gut, and placenta.
If ALK-P is high, what test helps determine if the cause is hepatic?
Gamma-glutamyl transferase (GGT); if GGT is high, the cause is likely hepatic.
What does normal GGT with elevated ALK-P suggest?
Consider pregnancy or bone disease rather than hepatic origin.
When is GGT elevated?
In cholestatic liver disease.
What is the best imaging tool for visualizing the gallbladder?
Ultrasound
What type of stones are most commonly visible on ultrasound?
A: Cholesterol stones.
What parts of the biliary tree can ultrasound visualize?
Proximal CBD and cystic duct (not the retroduodenal part).
How can ultrasound help detect distal bile duct obstruction?
By showing dilated proximal ducts indirectly.
What is cholangiography used for?
Visualizing the bile duct.
What are the types of cholangiography?
• ERCP (Endoscopic Retrograde Cholangiopancreatography)
• Intra-op cholangiogram (IOC)
• Percutaneous transhepatic cholangiography (PTC)
What is ERCP commonly performed with?
Sphincterotomy (papillotomy).
What are the diagnostic and therapeutic roles of ERCP?
• CBD stone removal (using basket or stent)
• Decompression in cholangitis
• Removal of choledochal cysts (type III)
What is a major complication of ERCP?
Iatrogenic acute pancreatitis (1%).
What does the HIDA scan stand for?
Hepatobiliary Imino-Diacetic Acid scan.
What is injected during a HIDA scan?
RBCs tagged with Technetium 99.
How does the HIDA scan work?
The tagged RBCs are taken up by the liver and passed through the CBD into the duodenum.
Q: What do timed photographs in a HIDA scan assess?
The uptake process and gallbladder ejection fraction.
What does absent uptake on HIDA scan suggest?
Dysfunction or blockage of the gallbladder or bile ducts.
