Liver

Question 1

liver - location, function

Answer 1

right hypochondrium and epigastric areas, extends into left hypochondrium
accessory digestion gland - synthesis of bile, glycogen storage and clotting factor production

Question 2

liver surfaces

Answer 2

diaphragmatic and visceral

Question 3

diaphragmatic surface

Answer 3

anterosuperior
smooth and convex - fits beneath diaphragm
posterior aspect not covered by visceral peritoneum - direct contact w/ diaphragm

Question 4

visceral surface

Answer 4

posteroinferior
covered w/ peritoneum (except fossa of gall bladder and porta hepatis)
moulded by shape of surrounding organs - irregular and flat
contacts right kidney, right adrenal gland, right colic flexure, transverse colon, duodenum, gall bladder, oesophagus and stomach

Question 5

how are liver ligaments formed?

Answer 5

attach liver to surrounding structures

formed by double layer of peritoneum

Question 6

falciform ligament

Answer 6

attaches anterior surface of liver to anterior abdominal wall
natural division between left and right liver lobes
free edge contains ligamentum teres (remnant of umbilical vein)

Question 7

coronary ligament (anterior and posterior folds)

Answer 7

attaches superior surface to inferior surface of diaphragm - demarcates bare area
folds unite to form triangular ligaments on right and left lobes

Question 8

triangular ligaments (left and right)

Answer 8

left - union of anterior and posterior layers of coronary ligament at apex of liver, attaches left lobe to diaphragm
right - union of layers, adjacent to bare area
attaches right lobe to diaphragm

Question 9

lesser omentum

Answer 9

attaches liver to lesser curvature of stomach and first part of duodenum.
hepatoduodenal ligament - surrounds portal triad (duodenum to liver) and hepatogastric ligament (stomach to liver)

Question 10

hepatic veins and fibrous tissue

Answer 10

secure posterior surface of liver to inferior vena cava

Question 11

hepatic recesses

Answer 11

anatomical spaces between liver and surrounding structures
infections may collect - abcess formed
subphrenic, subhepatic and morison’s pouch

Question 12

subphrenic spaces

Answer 12

between diaphragm and anterior and superior liver - divided into right and left by falciform ligament

Question 13

subhepatic space

Answer 13

subdivision of supracolic compartment

between inferior liver and transverse colon

Question 14

Morison’s pouch

Answer 14

potential space between visceral surface of liver and right kidney
deepest part of peritoneal cavity when supine - blood/ascites most likely to collect in bedridden patient

Question 15

what is the liver covered by?

Answer 15

fibrous layer - Glisson’s capsule

Question 16

accessory lobes arising from right lobe

Answer 16

caudate lobe
quadrate lobe
visceral surface

Question 17

caudate lobe

Answer 17

upper aspect of visceral surface

between IVC and fossa produced by ligamentum venosum (remnant of fetal ductus venosus)

Question 18

quadrate lobe

Answer 18

lower aspect of visceral surface

between gallbladder and fossa produced by ligamentum teres (remnant of fetal umbilical vein)

Question 19

what separates the caudate and quadrate lobes

Answer 19

porta hepatis - transmits all vessels, nerves and ducts entering/leaving liver except hepatic veins

Question 20

microscopics of the liver

Answer 20

hepatocytes arranged into lobules (structural units of liver) - hexagonal shaped and drained by central vein

Question 21

portal triad

Answer 21

arteriole - branch of hepatic artery entering liver
venule - branch of hepatic portal vein entering the liver
bile duct - branch of bile duct leaving liver
contains lymphatic vessels and vagus nerve fibres

Question 22

liver blood supply

Answer 22

hepatic artery proper (25%) - supplies non-parenchymal structures with arterial blood. derived from coeliac trunk.
hepatic portal vein (75%) - supplies liver w/ partially deoxygenated blood, carrying nutrients absorbed from small intestine. allows its functions, e.g. detoxification

Question 23

venous drainage

Answer 23

hepatic veins
hepatic portal vein - splenic vein, inferior mesenteric vein, superior mesenteric vein
central veins of hepatic lobule form collecting veins, combine to form hepatic veins - open into IVC

Question 24

what is the parenchyma of the liver innervated by?

Answer 24

hepatic plexus - sympathetic (coeliac plexus) and parasympathetic (vagus nerve) fibres
enter at porta hepatis, follow branches of hepatic artery and portal vein

Question 25

what is Glisson’s capsule innervated by>

Answer 25

branches of lower intercostal nerves

Question 26

lymphatic drainage of anterior aspect of liver

Answer 26

hepatic lymph nodes - lie along hepatic vessels and ducts in lesser omentum, empy in colic lymph nodes, drain into cisterna chyli

Question 27

lymphatic drainage of posterior aspect of liver

Answer 27

phrenic and posterior mediastinal nodes - join right lymphatic and thoracic ducts