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liver Flashcards

1
Q

what ae the regions occupied by the liver?

A

Right hypochondrium

Epigastric

Part of the left hypochondrium

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2
Q

what are the surfaces of the liver?

A

5 surfaces:

-Superior

-Inferior

-Right Lateral surface ( no left later cuz its pointed at the left )

-Anterior

-Posterior

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3
Q

which surfaces make up the diaphragmatic surface?

A

Right lateral surface

Superior surface

Anterior surface

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4
Q

which surfaces make up the visceral surface?

A

Posterior

Inferior

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5
Q

what ligament is above the liver and cover it?

A

Falciform ligament

Sickle shaped fold –> like a a triangle but flipped

has an apex and base

covering the liver anteriorly and superiorly

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6
Q

what is found at the apex of the falciform ligament ?

A

Umbilicus ( attached also to LIGAMENTUM TERES )

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7
Q

where is the base of Falciform ligament?

A

Superior and anterior surfaces

Which they are attached to :

Under surface of the diaphragm and anterior abdominal wall

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8
Q

what does the falicoform ligament divide the liver to??

A

at the superior and anterior surface

it divides into into Large Right and Small Left lobes

( posterior, inferiorly , lateral you cant see the division )

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9
Q

what is porta hepatis ?

A

Structure containing :

1-Portal vein

2- Proper Hepatic Artery - Continuation of common hepatic artery ( branch of celiac trunk )

3- Hepatic Ducts

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10
Q

where is the location of porta hepatis ?

A

Between :

Ligamentum Venosum

and

Ligamentum Teres

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11
Q

what is the course of hepatic artery?

A

ascends in the RIGHT FREE MARGIN OF LESSER OMENTUM

gets into porta hepatis then divides into 2 TERMINAL BRANCHES :

Right and Left terminal hepatic arteries

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12
Q

describe course of hepatic ducts?

A

right and left hepatic ducts Unite to form COMMON HEPATIC —> UNITES WITH CYSTIC DUCT FROM GALLBLADDER

to form common bile duct

so Common hepatic duct + cystic duct = common bile duct

then the common bile duct will :

1- Descend on the RIGHT side of the hepatic artery in the RIGHT FREE MARGIN of lesser OMENTUM

2-Behind the duodenum it descends on the RIGHT side of the GASTRODUODENAL ARTERY

3- Behind the Pancreas

4- Goes into the 2 part of the duodenum at MAJOR DUODENAL PAPILLA

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13
Q

what is the major event that happens behind the neck of the pancreas at lvl of tranpyoloric plane? L1?

A

Formation of PORTAL VEIN from the anastomosis of :

Splenic + superior mesenteric vein

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14
Q

what is the course of portal vein course ?

A

1-Ascend behind the first part of duodenum BEHIND the gastroduodenal artery and common bile duct ( which was right to the artery)

2- Then ascends in the RIGHT free margin of lesser omentum , BEHIND the hepatic artery and common bile duct

3- Enter porta hepatis , where it divides into TERMINAL BRANCHES - Right and Left terminal branches

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15
Q

what does the right free margin of lesser omentum contain ?

A

Hepatic artery —> LEFT

Common Bile duct —> RIGHT

Portal vein —-> POSTERIOR

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16
Q

what is found POSTERIOR behind the free margin of lesser omentum ( the 3 vessels )?

A

EPIPLOIC FORAMEN

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17
Q

what is POSTERIOR behind the epiploic foreman ?

A

IVC

so the epiploic foramen separates the portal vein and the other vessels in the Right free margin of lesser omentum from IVC

Vessels –> Epiploic foreman —> IVF

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18
Q

what is superior to the Epiploic foramen ?

A

Caudate Process of liver

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19
Q

what is inferior to epiploic foramen?

A

First part of the duodenum

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20
Q

so what are the boundaries of epiploic foreman ?

A

Superiorly —-> Caudate process of liver

Anteriorly —> Right free margin of Lesser omentum ( Vessels )

Posteriorly —> IVC

Inferiorly —> First part of duodenum

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21
Q

what is found behind first part of the duodenum?

A

Gastroduodenal artery –> ( Left )

Common Bile duct —> RIGHT ( of the artery)

Portal vein —> ( Posterior to both artery and duct )

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22
Q

what is found behind the Pancreas ?

A

Common bile duct –> Right ( its going down for the papillae )

Portal vein –> Posterior to the duct and its formed behind the neck

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23
Q

what is ligamentum venosum?

A

Obliterated ductus venosus

( during fetal life carried blood from the left branch of portal vein to the IVC )

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24
Q

what is the function of ligamentum venosum ?

A

POSTERIORLY

Divides the liver into LARGE right lobe and small left one

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25
what is ligamentum teres?
Obliterated left umbilical vein ( during fetal life carried oxygenated blood from placenta to ductus venosus )
26
What is the function ligamentum teres ?
divide the liver into RIGHT LIVER and small LEFT lobe BUT INFERIORLY So Superiorly = Flicform Posteriorly = Venosum Inferiorly = Teres
27
What is the relation of the UPPER 1/3 of the right lateral surface?
Right lung Pleura Diaphragm Note : Lung boundaries - 6- 8 (midaxillary )- 10 Pleura is little bit lower so = 8-10-12
28
what is the relation of the middle 1/3 of lateral right surface?
Pleura Diaphragm
29
what is the relation of the lower 1/3 part of the right lateral surface?
Diaphragm
30
what caudate lobe?
A lobe of the right lobe on the POSTERIOR surface Between the : Groove of IVC AND Fissure for ligamentum venosum
31
what is the superior boundary of Caudate lobe?
Ligamentum venosum will come from the left side then ARCH above the lobe cuz it wants to go IVC
32
what is the right boundary of caudate lobe?
IVC
33
what is the LEFT boundary of caudate lobe?
Fissure of ligamentum venosum
34
what is the inferior boundary of caudate lobe?
Porta hepaitis
35
what is the relation of caudate lobe at the aortic opening ?
2 crura of the diaphragm at the aortic opening
36
what is the bare area of liver ?
Area in the liver on the POSTERIOR surface not covered by PERITONEUM why ? cuz peritoneum gets reflected and doesnt meet
37
what is the base boundary of the Bare area of liver?
IVC
38
what is the upper boundary of bare area ?
Upper coronary ligament
39
what is the lower boundary of bare area?
Lower coronary ligament
40
What is the apex boundary of bare area ?
Right triangular ligament extends from the right lobe of the liver to the diaphragm ( up )
41
which gland is found in the bare area?
Suprarenal gland thats why also the anterior surface of suprarenal gland is not covered with peritoneum
42
what are the attachments of lesser omentum ?
From : Lesser curvature of Stomach + First inch of the first part of the duodenum TO 1- Lips ( Margins ) of porta hepatis 2- Edge of porta hepatis 3- Fissure for the ligamentum venosum ( or Teres depend on source )
43
what is tuberomental or omental tuberosity ?
Elevated area in the liver which is in direct contact with lesser omentum
44
what is quadrate lobe?
a lobe of the right lobe On the INFERIOR surface between the: 1-Fossa of gall bladder and 2-Fissure for ligamentum teres
45
what are the relations of quadrate lobe of liver?
From anterior to posterior Transverse colon --> most ant Pylorus of stomach + first part of duodenum Lesser omentum ----> Most post
46
what are the relations of inferior surface of liver?
From left to right : Gastric impression --> MOST LEFT Omental tuberosity Fissure for ligament teres Quadrate lobe of liver Fossa of gallbladder Duodenal impression Colic impression Renal impression + Suprarenal impression --> MOST RIGHT
47
What are the peritoneal ligaments of liver?
Left and right Triangular ligament Upper and Lower layers of coronary ligament Falciform ligament ( at the lower free margin of it we have ligamentum teres (umbilical vein ) ) Ligamentum teres and venosum ARRE NOT PERITONEAL
48
ALL liver is covered by peritoneum except?
Bare area of liver Groove of IVC Fossa of gallbladder Porta hepatis Fissure for ligamentum of teres
49
describe liver?
Largest gland Occupies whole right hypochondrium , greater part of the epigastrium and extend to left hypochondrium up the lateral vertical line
50
what is the shape of liver?
Wedge shaped and resembles 4 sided pyramid laid on one side with its apex directed to the left Base of the liver = posterior surface
51
what is the right lateral surface related to?
Base of the wedge ( Is the right lateral surface) Is quadrilateral and convex related to the diaphragm which separate it from : Right 7-11 ribs ( mid axillary line ) Right lung = 8 rib ( mixaxillary line ) Right pleura at 10 ( mid axillary line )
52
what is anterior surface related to?
Triangular and slightly convex Related to : Xiphoid process in median plane Anterior abdominal wall in median plane Diaphragm on each side Above the diaphragm its related to the PLEURA and BASE of the lung
53
What does the anterior surface shows?
Falciform ligament is also attached to superior surface
54
what is superior surface related to?
Marked by cardiac Impression in the middle related to the DIAPHRAGM diaphragm separates it from : 1- Pericardium and heart ( middle ) 2- Pleura and lung ( sides)
55
what are the impressions on posterior surface?
Triangular Middle ---> Vertebral impression 1-Esophagus impression 2- Fissure of ligament venosum 3- Caudate lobe of liver 4- Groove for IVC 5- Bare area of liver
56
impressions of inferior surface?
Face viscera = visceral surface 1- Gastric impression 2- Omental tuberosity 3- Ligamentum teres 4- Quadrate lobe of liver 5- Fossa of gallbladder 6- Duodenal impression ( 2nd part ) 7- Colic impression 8- Renal impression 9- Suprarenal impression (on the bare area )
57
what is the left boundary of quadrate lobe ?
Fissure of ligamentum teres
58
what is the right boundary of quadrate lobe?
Fossa of gallbladder
59
what is the posterior boundary of quadrate lobe ?
Porta hepatis ( also superiorly )
60
what is the anterior boundary of quadrate lobe?
Inferior border of the liver
61
blood supply of liver?
75% from portal vein 25% from hepatic artery
62
describe hepatic veins ?
3 Large hepatic veins which emerge from the posterior surface of liver in the upper of groove for IVC to end in IVC
63
describe artery division ?
Common hepatic artery ( From celiac ) divides into 2 terminal branches : Proper hepatic artery and Gastroduodenal artery Proper hepatic artery then divide into RIGHT n LEFT hepatic arteries going into liver through porta hepatis
64
what are some variations ?
Left hepatic can arise from Left gastric Right hepatic can arise from Superior mesenteric artery
65
describe liver engorgement and hepatomegaly?
Liver is soft and highly vascular Receives large amount of blood before it enters the heart The inferior vena cava and portal veins are VALVELESS When liver is enlarged its inferior edge is readily palpable below right costal margin
66
What is Runners stitch?
Temporary engorgement stretches the fibrous ( GLISSON CAPSULE ) producing pain in the right hypochondrium
67
what other disease can lead to liver enlargement ?
Congestive heart failure = engorgement of the liver
68
describe secondary liver metastasis ?
Liver is common site of metastatic carcinoma from organs drained by portal system of veins Cancer may pass to the liver from thorax because of the communication between thoracic lymph nodes and bare area of liver Portal vein has 2 unique aspects --> left and right branches + V streaming of the blood
69
left lobe of the liver is affected by what lesions ?
affected by HIND lesions as blood from the hindgut drain into portal vein via inferior mesenteric vein
70
what lesions affect the right lobe of liver?
Affected by MIDGUT lesions as blood from the midgut drains into portal vein via superior mesenteric vein
71
why does the distribution above happens?
portal vein maintain partial separation of blood ( V streaming ) as it enters the liver
72
wheres liver biopsy taken from?
Right 10th intercostal space MIDAXILLARY LINE patient is asked to hold their breath in full expiration to reduce costodiaphragmatic recess and lessens the possibility of damaging the lung and contaminating pleural cavity
73
what is the lymph drainage of liver?
lymph nodes at porta hepatis then to CELIAC LYMPH NODES Bare area ---> through diaphragm --> POSTERIOR MEDIASTINAL LYMPH NODE
74
Nerve supply of the liver?
Sympathetic and parasympathetic ( vagus ) from CELIAC PLEXUS

ANATOMYY2S2 (19 decks)

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