Liver Flashcards
The Normal Liver Overview
Largest internal organ, central organ of _____
2% of body’s weight ≈ ______ grams
Receives ____% of cardiac output to accomplish functions
Provides an acoustic window through which the ______ abdomen and retroperitoneum
Frequently involved in systemic and local disease
Receives
–oxygenated blood from the ______ artery and deoxygenated, nutrient-rich, sometimes toxic blood from the portal vein;
its venous blood is drained by the hepatic veins into the ______ vena cava.
–Contains the portal triad, which is a group of the branches of the ______ vein, ______ artery, and ______ duct, at every corner of the lobule,
surrounded by a connective tissue sheath, the perivascular fibrous capsule.
metabolism 1500 28 upper hepatic inferior portal hepatic bile
Location
- -Intraperitoneal; ___
- -Most of right ______ and part of ______; suspended from right hemidiaphragm
- -______ border - 5th intercostal space, midclavicular line
- -______ border - to or slightly below costal margin
US Scan:
Typically scan from coronal side of the body to place the liver more superficial and to avoid scanning thru intestines and intestinal gas
RUQ hypochondrium epigastrium upper lower
Embryology
Embryologic Functions
–Hemopoiesis wk 6, peaks at ___-___ weeks, ceases at birth
–Lymphocyte formation ____ wk through birth
–Coagulation factors manufactured ____-___ weeks
–Bile produced ____-____ weeks
- ______ week
(early) fetal development of the liver, GB and biliary duct system; size rt. lobe = lt. lobe
–______ week
⇑ size rt. lobe; caudate lobes develop from right lobe; lt. lobe size ⇓; liver fills most of abdominal cavity; yolk sac ⇓ in size as liver ⇑ in size
Fetal Blood Circulation thru Liver (in utero)
–Oxygenated blood and nutrients ⇒ umbilical vein ⇒ ascends to liver ⇒ hepatic portion umbilical vein (aka ligamentum teres postnatally) ⇒ lt. portal vein ⇒ ductus venosus (ligamentum venosum postnatal) ⇒ IVC
12 24 10 10 12 13 16 4th 6th
Size
–Mostly subjectively decided bc can be very difficult to measure…if seems enlarged, then it is to be measured from the Craniocaudal - _____ line
–NL Length is (less than)< ______ cm CC-Mid-clacviular Line
–When (greater than) > 16 cm…..75% of the time is abnl and attributed to ______ (aka- enlarged liver or Gosnick Liver)
Normal Variants may make the Liver seem enlarged:
1) ______ Lobe – seen (greater) > in females
Tongue like extension of right lobe inferiorly w/ significant overlie of RT kidney
2)______ Tail (aka-sliver of liver) - seen (greater) > in females
elongated left liver lobe extends laterally to contact and/or surround the spleen
midclavicular 16 hepatomegaly riedel's beaver
Typically indication of subjective enlargement is when:
(1) Inferior left lobe edges of the liver become _____ rather than sharp
(2) Liver becomes ______ wedged shaped and more concave and “hovering” over the RK
(3) RK will appear to be ______ than normal
rounded
less
smaller
Liver Surfaces
–The external surfaces of liver are described by their location and adjacent structures
–There are 2 liver surfaces –the diaphragmatic and visceral:
1) _____ surface – the anterio-superior surface of the liver
- -Smooth, convex, fitting snugly beneath the curvature of the diaphragm
–posterior aspect of the diaphragmatic surface is not covered by visceral peritoneum, and is in direct contact with the diaphragm itself (known as the ‘______ area’ of the liver)
2) ______ surface – the posterior-inferior surface of the liver
- -With the exception of the fossa of the ______ and porta ______, it is covered with peritoneum
–The porta ______ serves as “a point of entry” into the liver for the PV HA and an “exit point out of the liver” for the hepatic ducts
–molded by shape of the surrounding ______, making it irregular and flat
–lies in contact with the right ______, right ______ gland, right ______ flexure, ______ colon, first part of the ______, ______, ______ and the ______
diaphragmatic bare visceral gallbladder hepatis hepatis organs kidney adrenal colic transverse duodenum gallbladder esophagus stomach
FISSURES of NL LIVER - divide the liver ANATOMICALLY
–_____ - A sagittal groove or “tunnel” on the visceral surface of the liver in which ligaments run through
–______ w/in the fissure (groove) help to divide the liver into anatomical portions/lobes and may be seen on US as normal echogenic structures and is used to identify normal liver lobe anatomy and pathology
–Fissures are found on the ______ surface and the ______ surface (visceral surface)
1) Fissure on the Anterior anatomical surface of the liver
______ ligament/fissure/groove
divides liver into anatomical RT and LT lobes
2) Fissures on the Viseral/Posterior anatomical surface of the liver
a) Left Sagittal Fissure/Groove formed by:
- -______ PH area – ligamentum venosum - remnant of –Ductus Venosus from embryo circulation
–______ PH area (posterior on US)- round ligament and ligamentum teres (remnant of LT Umb Vein from embryo circulation)
b) Right Sagittal Fissure/Groove formed by:
- -______ PH area (anterior on US) - _____
- -______ PH area (posterior on US) - _____/_____ Fossa
3) Transverse Fissure/Groove or porta hepatis (see next page) area which is a deep fissure and approx. ___ cm in L, extending transversely beneath the left portion of the RT lobe of liver
** The LT and RT fissures on the posterior/visceral together participate with the ______ ligament on the anterior surface to separate the liver anatomically into RT and LT lobes
fissure ligaments anterior posterior falciform above below IVC GB GB 5 falciform
Porta Hepatis (Hilum of the Liver)
–A _____ fissure found on the posteroinferior surface and lies between the caudate and quadrate lobes.
–The upper part of the free edge of the lesser omentum is attached to its margins.
Structures passing through the porta hepatis include:
–Right and Left ______ ducts
–Right and left branches of the hepatic ______
–Right and left branches of the portal ______
–______ and ______ nerve fibers
–A few hepatic lymph nodes lie here; they drain the ______ and ______ and send their efferent vessels to the celiac lymph nodes.
transverse hepatic artery vein sympathetic parasympathetic liver gallbladder
Fissures of NL Liver –divide the liver anatomically….
Let’s review fissures and what they divide …..
–the ____ fissure/groove which contains the falciform ligament divides the liver into anatomical RT and LT Lobes on the anterior surface
–The LT sagittal fissure/groove formed by the Lig. ______ above the PH and the Lig. ______ below the PH divides the liver into anatomical RT and LT Lobes on the visceral surface
–the RT sagittal fissure/groove which contains the ____ above the PH and ______/fossa below the PH divide the functional RT lobe into RT Lobe, Caudate and Quadrate Lobes (which are added to the Left Lobe, functionally)
–the Porta ______ which forms a transverse separate will divide Caudate and Quadrate lobes
NOW……you have to KNOW THAT THE LIVER IS ALSO DIVIDED
FUNCTIONALLY,
division of the liver funtionally is just to the RT of ______ ligament (which makes Caudate and Quadrate lobes part of LT lobe
falciform venosum teres IVC GB hepatis falciform
_____ (porta hepatis)
_____ sagittal fissure (ligaments)
_____ sagittal fissure (gallbladder and IVC)
The 3 Fissures make an imaginary “H” on the visceral surface of the liver
hilum
left
right
