Liver

Question 1

Size of the liver compared to other glands/organs

Answer 1

Largest gland

Second largest organ behind skin

Question 2

How are nutrients absorbed from the digestive tract conveyed to the liver

Answer 2

Portal venous system

Question 3

What quadrant does the liver occupy

Answer 3

Right upper quadrant

Question 4

What protects the liver

Answer 4

Rib cage and diaphragm

Question 5

Describe the location of the liver

Answer 5

Deep to ribs 7-11 on the right side
Crosses the midline towards the left nipple
Inferior to diaphragm
Anterior to foregut derived organs (oesophagus, stomach, gall bladder, proximal duodenum)

Question 6

Which abdominal regions does the liver occupy

Answer 6

Right hypochondrium
Upper region of the epigastrium
Extends into the left hypochondrium

Question 7

What affects the position of the liver

Answer 7

Breathing - moves with the excursions of the diaphragm

Gravity - located more inferiorly on standing

Question 8

What is the convex side of the liver

Answer 8

Diaphragmatic surface (anterior, superior, some posterior)

Question 9

What is the concave side of the liver

Answer 9

Visceral surface (posteroinferior)

Question 10

What separates the visceral and diaphragmatic surfaces of the liver

Answer 10

Separated anteriorly by the sharp inferior border

Question 11

What does the inferior border follow

Answer 11

The right costal margin

Question 12

Why is the visceral surface irregular

Answer 12

Moulded by shape of surrounding organs:

Oesophagus, right kidney, right adrenal gland, right colic flexure, duodenum, gall bladder and stomach

Question 13

What is the bare area of the liver

Answer 13

Section of the diaphragmatic surface not covered by visceral peritoneum

Question 14

What and where is the ligamentum teres/round ligament

Answer 14

Remnant of the umbilical vein

Contained within the free edge of the falciform ligament

Question 15

What do the left and right coronary ligaments attach

Answer 15

Superior surface of the liver to the diaphragm

Question 16

What do the left and right triangular ligaments attach

Answer 16

Superior surface of the liver to the diaphragm

Question 17

Where is the inferior vena cava in relation to the liver

Answer 17

Runs through a deep groove in the bare area

It is secured hepatic veins and fibrous tissue

Question 18

What are hepatic recesses

Answer 18

Spaces between the liver and surrounding structures

Question 19

What are subphrenic spaces

Answer 19

Superior extensions of the greater peritoneal sac between the diaphragm and anterior and superior aspects of the diaphragmatic surface of the liver

Question 20

What is the subhepatic space

Answer 20

Extension of the greater peritoneal sac between the inferior aspect of the liver and the transverse colon

Question 21

What and where is morison’s pouch (hepatorenal recess)

Answer 21

Posterosuperior aspect of the right subhepatic space

Between the visceral surface of the liver and the right kidney

Question 22

Cause of a subphrenic abscess

Answer 22

Accumulation of pus in the subphrenic space as a result of peritonitis

Question 23

Which side do subphrenic abscesses more commonly occur and why

Answer 23

Right

Increased frequency of appendicitis and ruptured duodenal ulcers

Question 24

What marks out the bare area

Answer 24

Reflection of the peritoneum from the diaphragm to the bare area as the anterior and posterior layers of the coronary ligament

Question 25

What makes up the right triangular ligament

Answer 25

Anterior and posterior layers of the coronary ligament converge on the right side of the liver

Question 26

What makes up the left triangular ligament

Answer 26

Near the apex, anterior and posterior layers of the coronary ligament converge on the left side of the liver

Question 27

What covers the entire liver

Answer 27

Glisson's capsule (fibrous)

Question 28

What are the lobes of the liver

Answer 28

Anatomical - let and right | Accessory - caudate and quadrate

Question 29

What divides the liver into the left and right lobes

Answer 29

Falciform ligament (peritoneal fold that attaches liver to anterior abdominal wall)

Question 30

Where is the visceral surface not covered in peritoneum

Answer 30

Fossa for the gallbladder | Porta hepatis

Question 31

What is the porta hepatis

Answer 31

Transverse fissure where the hepatic portal vein, hepatic artery proper and bile duct enter and leave the liver

Question 32

Where are the accessory lobes located

Answer 32

Visceral surface on the right lobe

Question 33

Which fissures divide the right lobe into accessory lobes

Answer 33

Left and right sagittal fissures | Porta hepatis

Question 34

Where is the caudate lobe

Answer 34

Superior to porta hepatis and between the inferior vena cava and fossa for the ligamentum venosum

Question 35

Where is the quadrate lobe

Answer 35

Inferior to porta hepatis and between the gall bladder and fossa for the ligamentum teres

Question 36

What are hepatocytes arranged into

Answer 36

Hexagonal lobules with a central vein

Question 37

What's at the periphery of each lobule

Answer 37

``` Portal triad: Arteriole - branch of hepatic artery proper Venule - branch if hepatic portal vein Duct - branch of bile duct Lymphatic vessels Vagus nerve ```

Question 38

Venous drainage of the liver

Answer 38

3 hepatic veins which drain into the IVC | Hepatic portal vein is the main blood supply to the liver parenchyma

Question 39

Innervation of liver parenchyma

Answer 39

Hepatic plexus which contains: Sympathetic fibres - from the coeliac plexus Parasympathetic fibres (vagus nerve)

Question 40

Innervation of Glisson's capsule

Answer 40

Branches of the lower intercostal nerve therefore distension of the capsule results in well localised pain

Question 41

Where are hepatic lymph nodes

Answer 41

Along hepatic vessels and ducts in the lesser omentum

Question 42

What do the hepatic lymph nodes drain into

Answer 42

Coeliac lymph nodes

Question 43

When is a percutaneous liver biopsy required

Answer 43

Abnormal LFTs of unknown cause Hepatitis C - assessment of disease progression Following liver transplantation

Question 44

Describe a percutaneous liver biopsy

Answer 44

Liver is located by ultrasound Local anaesthetic is injected on the mid-axillary line where on percussion there is dullness Needle biopsy is taken during held expiration to avoid lung damage

Question 45

What biopsy is used if the patient has abnormal clotting

Answer 45

Transvenous liver biopsy

Question 46

Describe a transvenous liver biopsy

Answer 46

Internal jugular vein is cannulated | Biopsy needle is passed through the hepatic veins