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GI > Liver > Flashcards

Liver Flashcards

1
Q

Size of the liver compared to other glands/organs

A

Largest gland

Second largest organ behind skin

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2
Q

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

A

Portal venous system

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3
Q

What quadrant does the liver occupy

A

Right upper quadrant

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4
Q

What protects the liver

A

Rib cage and diaphragm

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5
Q

Describe the location of the liver

A

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)

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6
Q

Which abdominal regions does the liver occupy

A

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

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7
Q

What affects the position of the liver

A

Breathing - moves with the excursions of the diaphragm

Gravity - located more inferiorly on standing

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8
Q

What is the convex side of the liver

A

Diaphragmatic surface (anterior, superior, some posterior)

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9
Q

What is the concave side of the liver

A

Visceral surface (posteroinferior)

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10
Q

What separates the visceral and diaphragmatic surfaces of the liver

A

Separated anteriorly by the sharp inferior border

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11
Q

What does the inferior border follow

A

The right costal margin

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12
Q

Why is the visceral surface irregular

A

Moulded by shape of surrounding organs:

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

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13
Q

What is the bare area of the liver

A

Section of the diaphragmatic surface not covered by visceral peritoneum

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14
Q

What and where is the ligamentum teres/round ligament

A

Remnant of the umbilical vein

Contained within the free edge of the falciform ligament

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15
Q

What do the left and right coronary ligaments attach

A

Superior surface of the liver to the diaphragm

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16
Q

What do the left and right triangular ligaments attach

A

Superior surface of the liver to the diaphragm

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17
Q

Where is the inferior vena cava in relation to the liver

A

Runs through a deep groove in the bare area

It is secured hepatic veins and fibrous tissue

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18
Q

What are hepatic recesses

A

Spaces between the liver and surrounding structures

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19
Q

What are subphrenic spaces

A

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

20
Q

What is the subhepatic space

A

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

21
Q

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

A

Posterosuperior aspect of the right subhepatic space

Between the visceral surface of the liver and the right kidney

22
Q

Cause of a subphrenic abscess

A

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

23
Q

Which side do subphrenic abscesses more commonly occur and why

A

Right

Increased frequency of appendicitis and ruptured duodenal ulcers

24
Q

What marks out the bare area

A

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

25
Q

What makes up the right triangular ligament

A

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

26
Q

What makes up the left triangular ligament

A

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

27
Q

What covers the entire liver

A

Glisson’s capsule (fibrous)

28
Q

What are the lobes of the liver

A

Anatomical - let and right

Accessory - caudate and quadrate

29
Q

What divides the liver into the left and right lobes

A

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

30
Q

Where is the visceral surface not covered in peritoneum

A

Fossa for the gallbladder

Porta hepatis

31
Q

What is the porta hepatis

A

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

32
Q

Where are the accessory lobes located

A

Visceral surface on the right lobe

33
Q

Which fissures divide the right lobe into accessory lobes

A

Left and right sagittal fissures

Porta hepatis

34
Q

Where is the caudate lobe

A

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

35
Q

Where is the quadrate lobe

A

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

36
Q

What are hepatocytes arranged into

A

Hexagonal lobules with a central vein

37
Q

What’s at the periphery of each lobule

A 
Portal triad:
Arteriole - branch of hepatic artery proper
Venule - branch if hepatic portal vein 
Duct - branch of bile duct 
Lymphatic vessels
Vagus nerve
38
Q

Venous drainage of the liver

A

3 hepatic veins which drain into the IVC

Hepatic portal vein is the main blood supply to the liver parenchyma

39
Q

Innervation of liver parenchyma

A

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

40
Q

Innervation of Glisson’s capsule

A

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

41
Q

Where are hepatic lymph nodes

A

Along hepatic vessels and ducts in the lesser omentum

42
Q

What do the hepatic lymph nodes drain into

A

Coeliac lymph nodes

43
Q

When is a percutaneous liver biopsy required

A

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

44
Q

Describe a percutaneous liver biopsy

A

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

45
Q

What biopsy is used if the patient has abnormal clotting

A

Transvenous liver biopsy

46
Q

Describe a transvenous liver biopsy

A

Internal jugular vein is cannulated

Biopsy needle is passed through the hepatic veins

GI (19 decks)

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