Liver Anatomy

Question 1

main functions of liver

Answer 1

detoxification

protein synthesis

produce bile

glycogen storage

Question 2

what are the 4 lobes of the liver, and what divides them

Answer 2

anteriorly view: left and right divided by falciform ligament anteriorly and lesser omentum posteriorly

posterior view: caudate and quadrate separated by porta hepatis

Question 3

3 ligaments and 1 peritoneal fold that connects liver to other things

Answer 3

falciform ligament links diaphragm to upper surface of liver, attaches liver to anterior body wall

round ligament (ligament teres) is at bottom of falciform ligament, its embryological remnant of left umbilical vein

coronary ligaments link interior diaphragm to liver

lesser omentum links liver to lesser curvature of stomach/ duodenum

Question 4

At what vertebral level is coeliac artery

what are its 3 branches

Answer 4

T12/L1 level

left gastric, splenic and common hepatic

Question 5

3 common cases of hepatic artery variations

Answer 5

R hepatic artery instead of arising from coeliac trunk, arises from superior mesenteric artery

L hepatic artery instead of arising from common hepatic artery, arises from L gastric artery

Trifurcation of common hepatic artery into R and L hepatic artery, and gastroduodenal artery

Question 6

liver receives blood supply from which artery and vein

what do they contain

Answer 6

proper hepatic artery contains oxygenated blood

portal vein (sup mesenteric + splenic) contains deoxygenated blood, nutrients, toxins, drugs

Question 7

liver lobes are subdivided into ________ segments

branches of hepatic artery and portal vein carry blood into _________

branches of bile duct accompany branches of hepatic artery and portal vein in a portal _____

Answer 7

couinaud

sinusoids

triad

Question 8

4 metabolic functions of liver

Answer 8

synthesis and release of plasma proteins into blood eg albumin, clotting factors for coagulation cascade

deaminates amino acids > urea into blood

bilirubin into bile pigment

bile salts > emulsification of fats

Question 9

venous drainage of liver

Answer 9

portal vein enters porta hepatis, branches form portal triads and drain into sinusoids mixed with arterial blood, sinusoids drain into central vein, which drains into sublobular veins which drain into hepatic veins > IVC back to heart

Question 10

4 places hepatic portal system forms portocaval anastomoses

Answer 10

1) anastomoses with left gastric tributaries and oesophageal branches of azygos vein in abdominal portion of oesophagus
2) anastomoses between superior rectal veins with middle and inferior rectal in anal canal
3) anastomoses between paraumbilical veins and epigastric veins at umbilicus
4) anastomoses between veins of colon, duodenum, pancreas and liver with renal, lumbar and phrenic veins

Question 11

consequence of portal hypertension in:

oespophagus

anterior abdominal wall

rectum

Answer 11

oesophageal varices

caput medusa

haemorrhoids

Question 12

a) lymph drainage of liver
b) what about the liver makes it susceptible to trauma

Answer 12

a) lymph nodes at porta hepatis drain into coeliac nodes which drain into cisterna chyli
b) closely related to lower ribs, fractured ribs easily penetrate liver

high vascularisation = risk of haemorrhage

Question 13

portocaval shunt can be used surgically to treat portal hypertension, but it isn’t used as much since the introduction of what surgical technique

Answer 13

TIPS

transjugular intrahepatic portosystemic shunting