Liver

Question 1

where is the liver locateed

Answer 1

right upper quadrant of the abdomen.

Question 2

functions of the liver

Answer 2

synthesis of bile, glycogen storage and clotting factor production.

Question 3

lympjatic drainage od the posterior aspect of teh liver

Answer 3

rom the posterior aspect of the liver however, drain into phrenic and posterior mediastinal nodes which join the right lymphatic and thoracic ducts.

Question 4

lymphatic drainage of the anterior aspect of the liver

Answer 4

The lymphatic vessels of the anterior aspect of the liver drain into hepatic lymph nodes. These lie along the hepatic vessels and ducts in the lesser omentum, and empty in the colic lymph nodes which in turn, drain into the cisterna chyli.

Question 5

nerve supply of teh livers parencyma

Answer 5

The parenchyma of the liver is innervated by the hepatic plexus, which contains sympathetic (fcoeliac plexus) and parasympathetic (vagus nerve) nerve fibres. These fibres enter the liver at the porta hepatis and follow the course of branches of the hepatic artery and portal vein

Question 6

nerve supply of the glissons capsule

Answer 6

Glisson’s capsule, the fibrous covering of the liver, is innervated by branches of the lower intercostal nerves. Distension of the capsule results in a sharp, well localised pain.

Lymphatic Drainage

Question 7

arterial supply of the liver

Answer 7

The liver has a unique dual blood supply:

Hepatic artery proper (25%) – supplies the non-parenchymal structures of the liver with arterial blood. It is derived from the coeliac trunk.
Hepatic portal vein (75%) – supplies the liver with partially deoxygenated blood, carrying nutrients absorbed from the small intestine. This is the dominant blood supply to the liver parenchyma, and allows the liver to perform its gut-related functions, such as detoxification.

Question 8

veinous drainag od the liver

Answer 8

Venous drainage of the liver is achieved through hepatic veins. The central veins of the hepatic lobule form collecting veins which then combine to form multiple hepatic veins. These hepatic veins then open into the inferior vena cava.

Question 9

Microscopically, the cells of the liver (known as hepatocytes) are arranged into what

Answer 9

lobules

Question 10

what is the structural unit of the liver

Answer 10

lobules

Question 11

Each anatomical lobule is hexagonal-shaped and is drained by a central vein. At the periphery of the hexagon are three structures collectively known as the portal triad describe it

Answer 11

Each anatomical lobule is hexagonal-shaped and is drained by a central vein. At the periphery of the hexagon are three structures collectively known as the portal triad:

Arteriole – a branch of the hepatic artery entering the liver.
Venule – a branch of the hepatic portal vein entering the liver.
Bile duct – branch of the bile duct leaving the liver.
The portal triad also contains lymphatic vessels and vagus nerve (parasympathetic) fibres.

Question 12

what is tefibrous layer that covers the liver

Answer 12

known as Glisson’s capsule.

Question 13

what is the glissons capsule divided into and what by

Answer 13

divided into a right lobe and left lobe by the attachment of the falciform ligament.

Question 14

what are the two further ‘accessory’ lobes that arise from the right lobe, and are located on the visceral surface of liver: and describe them

Answer 14

Caudate lobe – located on the upper aspect of the visceral surface. It lies between the inferior vena cava and a fossa produced by the ligamentum venosum (a remnant of the fetal ductus venosus).
Quadrate lobe – located on the lower aspect of the visceral surface. It lies between the gallbladder and a fossa produced by the ligamentum teres (a remnant of the fetal umbilical vein).

Question 15

what separates the caudate and quadrate lobes

Answer 15

a deep, transverse fissure – known as the porta hepatis. It transmits all the vessels, nerves and ducts entering or leaving the liver with the exception of the hepatic veins.

Question 16

what are hepatic recesses and why are they linicaly important

Answer 16

natomical spaces between the liver and surrounding structures. They are of clinical importance as infection may collect in these areas, forming an abscess.

Question 17

desrive the three hepaic recesses

Answer 17

Subphrenic spaces – located between the diaphragm and the anterior and superior aspects of the liver. They are divided into a right and left by the falciform ligament.
Subhepatic space – a subdivision of the supracolic compartment (above the transverse mesocolon), this peritoneal space is located between the inferior surface of the liver and the transverse colon.
Morison’s pouch – a potential space between the visceral surface of the liver and the right kidney. This is the deepest part of the peritoneal cavity when supine (lying flat), therefore pathological abdominal fluid such as blood or ascites is most likely to collect in this region in a bedridden patient.

Question 18

location of the liver

Answer 18

predominantly located in the right hypochondrium and epigastric areas, and extends into the left hypochondrium.

Question 19

how are the external surfaces of teh liver described

Answer 19

by their location and adjacent structures. There are two liver surfaces – the diaphragmatic and visceral:

Question 20

describe tge two liver surfaces

Answer 20

Diaphragmatic surface – the anterosuperior surface of the liver.
It is smooth and convex, fitting snugly beneath the curvature of the diaphragm.
The posterior aspect of the diaphragmatic surface is not covered by visceral peritoneum, and is in direct contact with the diaphragm itself (known as the ‘bare area’ of the liver).
Visceral surface – the posteroinferior surface of the liver.
With the exception of the fossa of the gallbladder and porta hepatis, it is covered with peritoneum.
It is moulded by the shape of the surrounding organs, making it irregular and flat.
It lies in contact with the right kidney, right adrenal gland, right colic flexure, transverse colon, first part of the duodenum, gallbladder, oesophagus and the stomach.

Question 21

what are the various legaments that attach the liver to teh surrounding structures formed by

Answer 21

a double layer of peritoneum.

Question 22

how is the posterior surfacr of the liver asecured tot eh inferior vena cava?

Answer 22

by hepatic veins and fibrous tissue

Question 23

what are the 4 ligaments of the liver and desciibe their shapes and attachemnts

Answer 23

Falciform ligament – this sickle-shaped ligament attaches the anterior surface of the liver to the anterior abdominal wall and forms a natural anatomical division between the left and right lobs of the liver. The free edge of this ligament contains the ligamentum teres, a remnant of the umbilical vein.
Coronary ligament (anterior and posterior folds) – attaches the superior surface of the liver to the inferior surface of the diaphragm and demarcates the bare area of the liver The anterior and posterior folds unite to form the triangular ligaments on the right and left lobes of the liver.
Triangular ligaments (left and right):
The left triangular ligament is formed by the union of the anterior and posterior layers of the coronary ligament at the apex of the liver and attaches the left lobe of the liver to the diaphragm.
The right triangular ligament is formed in a similar fashion adjacent to the bare area and attaches the right lobe of the liver to the diaphragm.
Lesser omentum – Attaches the liver to the lesser curvature of the stomach and first part of the duodenum. It consists of the hepatoduodenal ligament (extends from the duodenum to the liver), and the hepatogastric ligament (extends from the stomach to the liver) and surrounds the portal triad.