Liver Flashcards
Dome shaped
Anterior, superior and posterior parts
Covered with visceral peritoneum except posteriorly in the bare area
Diaphragmatic
Ligaments
Falciform ligament
Coronary ligament
R/L triangular ligaments
Ligamentum teres / round ligament
Ligamentum venosum
Remnant of umbilical vein
Between left lobe and quadrate lobe
Ligamentum teres / round ligament
Remnant of ductus venous
Between left lobe and caudate lobe
Ligamentum venosum
The median umbilical ligament is a remnant of what fetal structure?
Urachus
Gubernaculum
Round ligament
Urachus
Median umbilical ligament
Ductus venosum
Ligamentum venosum
Ductus arteriosus
Ligamentum arteriosum
Umbilical vein
Ligamentum teres
Umbilical artery
Medial umbilical ligament
Ductus venosus
Ligamentum venosum
Foramen ovale
Fossa ovalis
Ductus arteriosus
Ligamentum arteriosum
A pediatric surgeon is resecting a possible malignant mass from the liver of a neonate. The surgeon divides the round ligament during surgery. A fibrous remnant of which of the following fetal vessels is severed?
Left umbilical vein
Caudate lobe is located in what functional surgical segment of liver?
Medial superior
Segments
I - Medial superior II - Lateral superior III - Lateral inferior IV - Medial inferior V - Anterior inferior VI - Posterior inferior VII - Posterior superior VIII - Anterior superior
APICES of triangular cross-sections of portal lobules are CENTRAL VEINS; PORTAL AREAS for the CENTERS of these lobules
Based on BILE FLOW
Portal Lobule
Based on blood flow
DIAMOND-SHAPED AREA of the liver whose axis is the straight line between neighboring central veins and whose short acis is the intersecting line between neighboring portal areas
Liver Acinus - ACINUS OF RAPPAPORT
3 zones of LIVER ACINUS
Zone 1 - closest to the portal tract and receives the most O2
Zone 2
Zone 3 - farthest and receives the least O2, most susceptible to ischemic injury
Examination of a 54 y/o man reveals an isolated tumor located at the Porta hepatis. The tumor most likely compresses on which structure?
Branches of PORTAL VEIN
Portal triad
Portal vein
Common bile duct
Hepatic artery
Blood supply
Portal vein - formed by union of superior mesenteric & splenic veins; 70%
Hepatic vein - branch of celiac artery; 30%
Liver biopsy done usually at?
R 10th ICS in MAL
Right ICS 8,9 or 10 just after the patient exhales
Skin –> superficial fascia –> external oblique muscle –> intercostal muscles –> costal parietal pleura –> costodiaphragmatic rcess –> diaphragmatic parietal pleura –> diaphragm –> peritoneum
Liver biopsies
Affects the development of intra & extrahepatic bile ducts
MC cause of persistent jaundice in infancy
SSX: jaundice, dark urine, clay-colored stool
Liver biopsy: bile duct proliferation with dilatation of bile canaliculi & bile plugs
Congenital biliary atresia
Granulomatous destruction of medium-sized intrahepatic bile ducts
Mitochondrial pyruvate dehydrogenase autoantibodies
Primary biliary cirrhosis
Inflammation, fibrosis & segmental dilatation of both intra & extrahepatic bile ducts
Often in association with chronic ulcerative colitis
Primary sclerosing cholangitis
Removing one of the liver segments (5 total segments) or one of the liver subsegments (9 total subsegments)
Hepatic veins as landmark, mark the periphery of the liver segment
Surgical resection
Divided into R & L lobe by interlobar fissure
Secured in position by attachment of hepatic veins to the IVC (allows very little rotation of the liver during surgery)
Liver
Left lobe contains
Calcified ligament
Ligamentum teres (remnant of umbilical vein) on inferior border
Located on diaphragmatic surface
No peritoneum
Bare area of the liver
Lies mainly in the RUQ of the abdomen occupies most of the R hypochondrium, the upper epigastrium and extends into the L hypochondrium
Liver
