Liver anatomy Flashcards
What structures can be seen if you reflect back the left lobe of the liver
- oesophagus from stomach
- diaphragm
What is found to left of liver
- Duodenum
- Right kidney
What is found behind the liver
IVC
Abdominal aorta/ coeliac trunk
Superior mesenteric vein and artery
Name the surfaces of the liver
Diaphragmatic surface
Visceral surface
Where is the visceral surface
Up against the organs behind the liver
What is the role of the subphrenic recess
Separates liver from the diaphragm
What divides the subphrenic recess longitudinally
Faciform liver
Where is the hepatorenal recess
Between the liiver and the kidney
Where do you 2 recesses join
Anterioly
How many lobes are in the liver
4
What is the largest lobe in the liver
Right lobe
What lobes are attached directly to right lobe
2 accesory lobes
What separates right and left lobes
Faciform ligament
What attaches the liver to anterior wall
Falciform ligament
How does the falciform ligament continue
Continues as the round ligament/ ligamentum teres
What other ligaments are formed peritoneum
Coronary
Triangular
Which surface of the liver is the fossa between right and left lobes found
Visceral
What is contained in the fossa between R and L lobes
Gall bladder and vena cava
Where is the caudate lobe found
Between fissure for ligamentum venosum and groove for IVC
How does the round ligament continue posteriorly
As the ligamentum venosum
Where is the quadrate lobe found
Between fissure for ligamentum teres and GB
Where is the bare area of the ligament
Anterior part of the liver
What kind of peritoneum on bare area of liverr
none
What is the porta-hepatis
Entrance into the liver
Where does the bile come out
Via bile duct
What attaches the lesser curvature of the stomach to the liver
Hepatogastric part of the lesser omentum
What attaches the liver to the duodenum
Hepatoduodenal part of the lesser omentum
What is contained in the porta hepatis
Hepatic portal vein
Hepatic artery
Bile duct
What is meant by the dual blood supply of the liver
Hepatic portal vein and the hepatic artery both go in
How many segments does Couinauds segments divide liver into
8
What transects the segments in horizontal plane
Left and right portal veins
What transects the segments in the vertical plane
Hepatic veins
What is meant by the pringle manoeuvre
Clamping the pedicle area by the hepato-duodenal ligament in order to buy time during a trauma
What is the first midline branch of the abdominal aorta
Coeliac trunk
What are the branches of the coeliac trunk
Left gastric
Splenic artery
Hepatic artery common
What significant branch comes off of the splenic artery
Left gastroepiploic
What branches come off the common hepatic artery
Gastroduodenal branch
Hepatic artery proper
Right and left hepatic artery
Where is cystic artery from?
What does it supply
Right hepatic artery
Gall bladder`
What % of blood supply to the liver is arterial
25
What % of blood supply to the liver comes from the hepatic portal system
75
Where does inferior mesenteric vein drain
Into the splenic
How many sites of porto-systemic anastamoses are there
4
How many capillary beds does the portal system have
2
What are the 3 main regions that can drain either into hepatic or caval system
- Oesophageal region
- Anterior abdominal wall region
- Rectal region
In which 2 ways can blood from the anterior abdominal region drain?
- Up to the umbilical and into hepatic portal system, through liver and then into IVC
- Down inferior and superficial epigastrics which joins iliacs and into IVC
In which 2 ways can blood from the rectal region drain
- Midlde and inferior rectal veins go into the caval system into iliacs and into the IVC
- Superior rectal vein goes into hepatic portal system
How does oesophageal region drain
Into the azygos region and into the SVC then into the right heart
Flow into gastric branches into portal vein etc
What problems are associated with having a dual drainage system
If there is damage to the liver there is a blockage of blood and back-up
It starts to course along collateral routes into caval system
Where is the fourth anastomoses
Colic veins and retroperitoneal veins
Define cirrhosis
Replacement of liver tissue by fibrosis, scar tissue amd regenerative nodules leading to loss of liver function
What is normal portal pressure
9mmHg
Define portal hypertension
When portain pressure gradient (difference between portal and IVC pressure) is more than 10
How large must the spleen be before it is palpatable
5 times it normal size
Where do oesophageal varices usually occur
Anastomoses of left gastric vein with oesophageal veins
Gastro-oesophageal junction
Main cause of oesophageal varices
Portal hypertension
Less common causes of oesophageal varices
Ulcers, tumours, erosision, gastroenteritis
Define ascites
Fluid in peritoneal space
How does liver cirrhosis lead to ascites
Non functioning liver means less albumin, so osmotic pressure not maintained
Fluid leaks from interstitial fluid into peritoneal cavity
Are haemorrhoids the ano-rectal varies the same
No
Why do ano-rectal varices happen
Swelling of vessels due to portal hypertension
