Liver Anatomy Flashcards
1
Q
Rank these from most hyperechoic to most hypoechoic
Liver
Pancreas
Renal Sinus
Renal Cortex
A
Renal Sinus
Pancreas
Liver
Renal Cortex
2
Q
What is the largest internal organ
A
Liver
3
Q
T or F:
The liver is intraperitioneal
A
True
4
Q
The liver is all intraperitoneal expect for which part of it’s anatomy
A
Bare Area
5
Q
The liver is covered by what type of capsule
A
Glisson’s Capsule
6
Q
The Glisson’s Capsule is ____ & ____
A
Fibro Elastic
Protective
7
Q
What is the avg. weight of the liver
A
1,200-1,600 grams
8
Q
What is the avg. length of the liver
A
15cm
9
Q
If you have a smaller person than their liver could be ____ and if you have a larger person than their liver could be ____
A
Smaller, Larger
10
Q
What are the windows to image the liver
A
Liver offers great window
Subdiaphragmatic
Intercostal
Decubitus
11
Q
What is the gross anatomy of the liver
A
Glisson’s Capsule
Intraperitoneal - Posterior and superior
Several ligaments suspend liver in place
12
Q
What are the 7 ligaments of the liver
A
2 Triangular - R & L
2 Coronary - A & P
1 Falciform
Lesser Omentum - Hepatogastric & Hepatoduodenal
13
Q
The falciform ligament connected the liver to
A
Anterior wall and diaphgram
14
Q
The falciform ligament extends from the umbilicus to
A
Diaphragm in sagittal plane
15
Q
The falciform ligament contains what ligament
A
Ligamentum Teres
16
Q
The coronary ligaments connect the ____ surface of the liver to
A
Superior surface
Undersurface of diaphragm
17
Q
In the superior aspect of the liver, the leaves of the falciform ligament separate to form the
A
Coronary ligaments
18
Q
What borders of the coronary ligaments outline the bare area
A
Anterior and posterior
19
Q
The triangular ligaments are located at the
A
R & L corners of coronary ligaments and bare area
20
Q
The triangular ligaments connect the R & L liver to
A
Diaphragm
21
Q
The lesser omentum is a total of __ ligaments and those are the _____ & ____
A
2 ligaments
Hepatogastric
Hepatoduodenal
22
Q
What are the 3 normal variants of the liver
A
Riedel’s Lobe
Small left lobe
Situs inversus totalis
23
Q
What is the Riedel’s lobe and it extends from
A
Tongue like extension of right lobe
Extends inferior to right kidney
24
Q
If you have a small left lobe it may not
A
Extend past the midline
25
If you have situs inversus totalis the liver will be located in what quadrant
LUQ
26
The liver is divided into various ____
Segments
27
The ___ and ___ veins help make the divisions ____ & ____ location
Portal & Hepatic veins
Consistent and reliable location
28
Liver division is needed when any liver ____ is performed
Resection
29
In the Couinaud's Anatomy each segment has it's own vascular
Inflow
Outflow
Biliary Drainage
30
These 3 veins make up the longitudinal divisions
Right Hepatic Vein
Middle Hepatic Vein
Left Hepatic Vein
31
The RHV is located in the ___ ____ ____ and divides the right lobe into right ____ (posterior) and right ___ (anterior) sections
Right intersegmental fissure
Right lateral and right medial
32
The MHV lies in the ___ ___ ___ and divides the liver into
Main lobar fissure
R & L lobes or R & L Hemiliver
33
The MHV has the vertical plane running from ____ to ___ ____ also known as the ___ ___
IVC to Gallbladder Fosse
Cantile's Line
34
In the MHV the right is the right ___ section and the left is the left ___ section
Medial section
Medial section
35
The LHV is located
Left intersegmental fissure
36
The LHV divides the ___ lobe into left ___ and left ___sections
Left lobe
Left medial
Left Lateral
37
In transverse division of the liver are made from the _ & _ __ veins
Right and left portal veins
38
What is the traditional system of the 3 lobes
Right lobe - 1
Left lobe - 1
Caudate lobe - 3
39
What is the traditional system of the 5 segments
Right anterior (1) and posterior (2) segments
Left lateral (3) and medial (4) segments
Caudate lobe (5)
40
The main lobar fissure divides the liver into
And can be seen connecting
R & L lobes
Connecting RHV and GB fossa
41
The main lobar fissure is a true
Cleft/fissure
42
This vein courses within the fissure
MHV
43
The left lobe is the left intersegmental fissure that divides into
Medial and lateral segments
44
These 3 structures run within the left intersegmental fissure
LHV
Ascending branch of LHV
Falciform ligament/ligamentum teres
45
T or F
The left intersegmental fissure is a true fissure
False
Is not a true fissure
46
The LHV divides the ___ portion of the ___ lobe into ___& ___ segments
Superior portion
Left lobe
Medial & Lateral segemtns
47
The ascending branch of the LHV is used to divide the ___ portion of the ___ lobe into __ & __ segments
Mid portion
Left love
Medial and lateral segments
48
The falciform ligament is used to divide the ___ portion of the __ lobe into __ and __ segments
Inferior portion
Left lobe
Medial and lateral segments
49
The quadrate lobe is the absolute obsolete term referring to the ___ ___ portion of the ___ segment of the ___ lobe
Posterior inferior portion
Medial segment
Left lobe
50
The right lobe is separated into ___ and ___ segments by the right ___ ___
Anterior and posterior segments
Right intersegmental fissure
51
T or F
The right intersegmental fisure is not a true fissure
True
52
The RHV travels in the
Right intersegmentsl fissure
53
The caudate lobe is located on the
Posterior surface of the left lobe
54
T or F
Caudate lobe is completely separate lobe and has it's own vascular circulation
True
55
What are the landmarks of the caudate lobe with their location
Ligamentum venosum - Anterior
IVC - Posterior
MPV - Inferior
56
The ligamentum venosum separates the __ and ___ lobe
Left and caudate lobe
57
Where can the ligamentum venosum be seen ___ to ___ of liver as linear ____ line ___ to the ___ lobe
Inferior to dome of liver
Linear horizontal line
Anterior to the caudate lobe
58
What is the vascularity of the liver
Hepatic Veins
Portal Veins
Hepatic Arteries
59
The venous drainage of the liver is via the
Hepatic veins
60
Where are the hepatic veins located and are they intrasegmental or intersegmental
Intersegmental/Interlobar
Between segments and lobes
61
The smaller hepatic veins unite to form these 3 veins and dump into the
LHV, MHV, RHV
Dump into IVC
62
T or F
The hepatic veins do not sonographically have distinguishable walls
True
63
The hepatic veins course
Long in the liver
64
The hepatic veins carries blood out of the liver to the
IVC
65
Where can you see the larger branches of the hepatic veins
Superior aspect of the liver
66
___% of people have more than _ main hepatic veins
30%
3 main hepatic veins
67
The MHV may join the ___ prior to entering the ___
LHV
IVC
68
This vein supplies 70-90% of blood to the liver
Portal vein
69
The portal veins carry what type of blood with what type of changes with respiration
Carry deoxygenated, nutrient rich blood
Have phasic changes w/ respiration
70
This vein has a "hockey" stick appearance on U.S
Portal vein
71
The portal veins arise from the
Splenic vein
Superior & inferior mesenteric vein
72
The MHV enters into the
Porta hepatis
73
The MPV immeditely divides into ___ and ___ at the __ ___ which then branch into the right ___ & ___ and left ___ & ___ branches
RPV & LPV
Porta Hepatis
R Anterior & Posterior
Left Lateral & Medial
74
What is the purpose of the porta venous blood
Secondary flow of blood
75
The secondary flow of blood allows the liver to remove & prevent
Remove bacteria from bloodstream
Prevent harmful agents from entering the general circulation
76
The porta venous blood also bring required ___ to the
Nutrient to the liver protein synthesis
77
The portal veins travel within the ___ & ___:
Are they considered intrasegmental or intersegmental?
Intrasegmental
Segments and lobes
78
T or F
Portal veins course transversely
True
79
The portal veins have what type of borders due to
Echogenic borders due to triad
80
The portal veins carry blood ___ the liver
Into
81
The portain veins have little
Phasicity
82
The portal veins course within the ___/___
Segments/lobes
83
T or F
The hepatic veins course transversely
False
Course longitudinally
84
The hepatic veins have no
Echogenic walls
85
The hepatic veins carry blood ___ of the liver and into the ___
Out of the liver
Into the IVC
86
The hepatic vein has ___ flow
Phasic
87
The hepatic veins course between
Segments/lobes
88
The hepatic arteries supply approx. __% of total ___ ___ to the liver with this type of blood
25% total blood volume
Oxygenated blood
89
The common hepatic artery branches off the and gives off a branch from the ___ artery and becomes the ___ ___ ___
Celiac axis
Gastroduodenal artery
Becomes proper hepatic artery
90
Within the porta hepatis the proper hepatic artery branches into ___ & ___ ___ arteries.
They flow __ __ throughout the liver with __ ___ flow
Right and left hepatic arteries
Flow portal triad with low resistive flow
91
Most common variant is a replaced
Instead it would arise off the ___ instead
Hepatic artery
Arise from Superior mesentaric artery
92
What is the porta hepatis
Area at the enterance of the liver
93
How is the porta hepatis usally identified sonographically
By MPV crossing into IVC
94
What is the portal triad that enters into the liver
Portal vein
Hepatic artery
Bile duct
95
The intrahepatic stuctures are within the
Glisson's capsule
96
What are the structures located within the Glisson's capsule
Liver
Parenchyma
Branches of portal system
Hepatic arteries & veins
Peripheral bile ducts
97
Where are the extrahepatic structures located outside of the
Outside the liver parenchyma and Glission's capsule
98
The extrahepatic structures includes all the structures in the
Porta hepatis
99
The extrahepatic structures appear on U.S as if they are in the ___, however because they don't ___ the liver ___, the structures aren't ____
In the liver
Don't penetrate the liver capsule
Structures aren't intrahepatic
100
What are the functional units of the liver
Lobules
101
How many lobule units are
50,000-100,000
102
What do the lobule functional units consist of
Liver cells
Sinusoids
Central vein
Portal vein
Hepatic artery
Bile cancaliculi
Lymph vessels
103
What are sinusoids
Capillary-like connections in lobules traveling between columns of hepatocytes
104
What do sinusoids do for the liver
Carry inflow of portal venous and hepatic arterial blood
105
How many ml of blood enters the sinusoids per minute
1,450 ml
106
The sinusoids bring blood to the
Central vein
107
What are hepatocytes
Functioning cells surrounding the sinusoids
108
Where are the Kupffer cells located
Scattered along walls of sinusoids
109
The Kupffer cells are ___ cells that remove ___ ___ from the ___ such as
Phagocytic cells
Remove toxic substances from the blood
Bacteria, old RBC's, debris
110
Both ___ cells & ___ remove ___ from the ______
Kupffer cells and hepatocytes remove substances from the blood stream
111
Central veins of each lobule join together and eventually become the
Intersegmental main hepatic veins
112
The branches of the ___ ___, ___ ___, and ___ ___ are arranged around the ___ of each lobule
Portal vein, hepatic artery, and bile ducts
Arranges around the outside of each lobule
113
What are bile cancaliculi
Blind-ended channels where the biliary tree originates
114
Where does the biliary tree originate
Bile canaliculi
115
The inflow of blood is from the ___ and ___ --> Blood flows through ___ and into the ___ where these cells ingest ___ and these cells remove needed ___ --> The ___ material and ___ goes into spaces of ___ --> Blood flow into ___ ___ --> __ __ --> ___
Portal vein & hepatic artery
Through the branches
Into sinusoids where Kupffer cells ingest bacteria, hepatocytes remove needed substances
Lymph material and fluid goes into spaces of Disse
Flow into Central vein --> hepatic veins --> IVC
116
What is Morrison's Pouch?
Space between the posterior subphrenic and posterior subhepatic space of RUQ
