Liver Flashcards
Size of the liver compared to other glands/organs
Largest gland
Second largest organ behind skin
How are nutrients absorbed from the digestive tract conveyed to the liver
Portal venous system
What quadrant does the liver occupy
Right upper quadrant
What protects the liver
Rib cage and diaphragm
Describe the location of the liver
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)
Which abdominal regions does the liver occupy
Right hypochondrium
Upper region of the epigastrium
Extends into the left hypochondrium
What affects the position of the liver
Breathing - moves with the excursions of the diaphragm
Gravity - located more inferiorly on standing
What is the convex side of the liver
Diaphragmatic surface (anterior, superior, some posterior)
What is the concave side of the liver
Visceral surface (posteroinferior)
What separates the visceral and diaphragmatic surfaces of the liver
Separated anteriorly by the sharp inferior border
What does the inferior border follow
The right costal margin
Why is the visceral surface irregular
Moulded by shape of surrounding organs:
Oesophagus, right kidney, right adrenal gland, right colic flexure, duodenum, gall bladder and stomach
What is the bare area of the liver
Section of the diaphragmatic surface not covered by visceral peritoneum
What and where is the ligamentum teres/round ligament
Remnant of the umbilical vein
Contained within the free edge of the falciform ligament
What do the left and right coronary ligaments attach
Superior surface of the liver to the diaphragm
What do the left and right triangular ligaments attach
Superior surface of the liver to the diaphragm
Where is the inferior vena cava in relation to the liver
Runs through a deep groove in the bare area
It is secured hepatic veins and fibrous tissue
What are hepatic recesses
Spaces between the liver and surrounding structures
What are subphrenic spaces
Superior extensions of the greater peritoneal sac between the diaphragm and anterior and superior aspects of the diaphragmatic surface of the liver
What is the subhepatic space
Extension of the greater peritoneal sac between the inferior aspect of the liver and the transverse colon
What and where is morison’s pouch (hepatorenal recess)
Posterosuperior aspect of the right subhepatic space
Between the visceral surface of the liver and the right kidney
Cause of a subphrenic abscess
Accumulation of pus in the subphrenic space as a result of peritonitis
Which side do subphrenic abscesses more commonly occur and why
Right
Increased frequency of appendicitis and ruptured duodenal ulcers
What marks out the bare area
Reflection of the peritoneum from the diaphragm to the bare area as the anterior and posterior layers of the coronary ligament
What makes up the right triangular ligament
Anterior and posterior layers of the coronary ligament converge on the right side of the liver
What makes up the left triangular ligament
Near the apex, anterior and posterior layers of the coronary ligament converge on the left side of the liver
What covers the entire liver
Glisson’s capsule (fibrous)
What are the lobes of the liver
Anatomical - let and right
Accessory - caudate and quadrate
What divides the liver into the left and right lobes
Falciform ligament (peritoneal fold that attaches liver to anterior abdominal wall)
Where is the visceral surface not covered in peritoneum
Fossa for the gallbladder
Porta hepatis
What is the porta hepatis
Transverse fissure where the hepatic portal vein, hepatic artery proper and bile duct enter and leave the liver
Where are the accessory lobes located
Visceral surface on the right lobe
Which fissures divide the right lobe into accessory lobes
Left and right sagittal fissures
Porta hepatis
Where is the caudate lobe
Superior to porta hepatis and between the inferior vena cava and fossa for the ligamentum venosum
Where is the quadrate lobe
Inferior to porta hepatis and between the gall bladder and fossa for the ligamentum teres
What are hepatocytes arranged into
Hexagonal lobules with a central vein
What’s at the periphery of each lobule
Portal triad: Arteriole - branch of hepatic artery proper Venule - branch if hepatic portal vein Duct - branch of bile duct Lymphatic vessels Vagus nerve
Venous drainage of the liver
3 hepatic veins which drain into the IVC
Hepatic portal vein is the main blood supply to the liver parenchyma
Innervation of liver parenchyma
Hepatic plexus which contains:
Sympathetic fibres - from the coeliac plexus
Parasympathetic fibres (vagus nerve)
Innervation of Glisson’s capsule
Branches of the lower intercostal nerve therefore distension of the capsule results in well localised pain
Where are hepatic lymph nodes
Along hepatic vessels and ducts in the lesser omentum
What do the hepatic lymph nodes drain into
Coeliac lymph nodes
When is a percutaneous liver biopsy required
Abnormal LFTs of unknown cause
Hepatitis C - assessment of disease progression
Following liver transplantation
Describe a percutaneous liver biopsy
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
What biopsy is used if the patient has abnormal clotting
Transvenous liver biopsy
Describe a transvenous liver biopsy
Internal jugular vein is cannulated
Biopsy needle is passed through the hepatic veins
