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m2 > liver anatomy > Flashcards

liver anatomy Flashcards

1
Q

what is the largest gland in the body?

A

liver

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2
Q

where is the liver?

A

sits under the right dome of the diaphragm

mainly covered by ribcage

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3
Q

why can the liver be felt on inspiration?

A

diaphragm flattens on inspiration and flattens the liver down so the inferior border can be palpated

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4
Q

where is the liver on expiration?

A

tucked under the costal margin

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5
Q

what is the biggest lobe of the liver?

A

right lobe

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6
Q

how many lobes on the posterior surface of the liver?

A

4

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7
Q

is the liver retroperitoneal or intraperitoneal?

A

intraperitoneal

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8
Q

where is the falciform ligament found?

A

anterior abdominal wall to the liver

separates the left and right lobe of the liver

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9
Q

what does the falciform ligament split into?

A

the anterior coronary ligaments

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10
Q

where is the triangular ligament?

A

where the anterior and posterior coronary ligaments join

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11
Q

what is the bare area of the liver?

A

between the coronary and triangular ligaments

area of the liver that isnt covered by any ligaments

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12
Q

where does blood from the umbilical vein go?

A

some drains into the hepatic portal vein and the rest goes through the ductus venosus to the IVC

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13
Q

in the fetal circulation, where does blood go from the IVC?

A

2 routes

1 - IVC –> RA –> foramen ovale –> rest of the body

  1. IVC –> RV –> pulmonary trunk –> ductus arteriosus –> aorta
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14
Q

how is the ligamentum teres formed?

A

umbilical vein fibroses to form the ligamentum teres

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15
Q

what does the lesser omentum connect?

A

the liver to the stomach

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16
Q

what passes through the origin of the lesser omentum?

A

hepatic portal vein
hepatic artery proper
common bile duct (porta hepatis)

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17
Q

what is the clinical relevance of the opening of the lesser omentum?

A

if any of the vessels passing through it are bleeding then you can clamp then and the bleeding stops

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18
Q

what are the 2 different blood supplies to the liver? how much do each contribute?

A

75% - hepatic portal vein

25% - hepatic artery proper

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19
Q

where does all blood to the gut pass before it goes to the IVC?

A

goes to the liver first

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20
Q

describe the path of the hepatic portal circulation

A 
aorta
coeliac trunk
stomach (food is digested and breakdown products go into the venous blood away from the gut)
hepatic portal vein
liver
hepatic vein
IVC
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21
Q

what are the 2 main functions of the liver?

A
  • Store and release glucose as needed.

- Clearing the blood of drugs and other harmful substances.

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22
Q

what artery supplies the foregut?

A

coeliac trunk

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23
Q

what is the foregut?

A

oesophagus to the 2nd part of the duodenum

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24
Q

what artery supplies the midgut?

A

superior mesenteric artery

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25
Q

what is the midgut?

A

3rd part of the duodenum, jejenum, ileum, cecum, appendix, ascending colon and then 2/3 along the transverse colon

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26
Q

what artery supplies the hindgut

A

inferior mesenteric artery

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27
Q

what is the hindgut?

A

from 2/3 transverse colon to the rectum (not to the anus)

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28
Q

what level does the coeliac trunk come off?

A

T12

29
Q

what arteries does the coeliac trunk give rise to and what do they supply?

A

Left gastric (supplies lesser curvature of the stomach)

Splenic artery (behind the stomach to the spleen)

Common hepatic artery (towards the right to the liver)

30
Q

what does the common hepatic artery split into?

A

gastroduodenal artery (runs behind the duodenum)

right gastric artery (runs to the lesser curvature of the stomach)

31
Q

where does the greater curvature of the stomach get its blood supply from?

A

gastroepiploic artery

32
Q

where do the right and left gastroepiploic artery come from?

A

Right gastroepiploic from the gastroduodenal artery

Left gastroepiploic from the splenic artery

33
Q

what happens to the common hepatic artery after it splits?

A

becomes hepatic artery proper

splits into R and L and then goes to supply the liver

34
Q

what branches does the left gastric artery give off?

A

oesophageal branches

35
Q

where does the superior mesenteric artery run?

A

behind the head of the pancreas

36
Q

what branches does the SMA give off?

A

ileal and jejenal
middle colic
right colic
ileocolic

37
Q

what branches does the IMA give off?

A

3x branches

left colic, sigmoid arteries and the superior rectal artery

38
Q

what drains into the splenic vein?

A

All blood from the stomach, spleen and lower part of the oesophagus

39
Q

what does the splenic vein join?

A

mesenteric veins to form the hepatic portal vein

40
Q

what is the portal venous drainage and systemic venous drainage of the oesophagus?

A

PVD - left gastric vein

SVD - azygous vein

41
Q

what is the portal venous drainage and systemic venous drainage of the rectum?

A

PVD - superior rectal vein

SVD - inferior rectal vein

42
Q

what is the portal venous drainage and systemic venous drainage of the anterior abdominal wall?

A

PVD - paraumbilical veins

SVD - intercostal and inferior epigastric

43
Q

what is the portal venous drainage and systemic venous drainage of the retro-peritoneal?

A

PVD - duodenal, pancreatic, right and left colic veins

SVD - lumbar veins

44
Q

what is cirrhosis? what is it characterised by?

A

Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to loss of liver function.

45
Q

how does portal hypertension occur?

A

instead of having smooth channels in the sinusoids, the channels get broken up and distorted so you increase resistance to blood flow through the liver –> increase BP in the portal vein

46
Q

where do oesophageal varices occur?

A

occur at the anastomoses of left gastric vein with oesophageal veins at gastro-oesophageal junction

47
Q

why are oesophageal varices the most clinically relevant?

A

lowest pressure needed for these to form

48
Q

how do oesophageal varices present?

A

haematemesis

49
Q

how are oesophageal varices treated?

A

Can be treated with oesophageal banding – elastic bands around the oesophagus so they stop bleeding

50
Q

what is caput medusa?

A

recanalised umbilical vein within the faliciform ligament.

• Paraumbilical veins radiate superiorly to IC veins and inferiorly to epigastric vein

51
Q

what is ascites?

A

fluid in the peritoneal space

52
Q

what can cause ascites?

A

portal hypertension
hypoalbuminemia
aldosterone related renal sodium retention, with consequent blood volume expansion (further exacerbated by additional pressure on kidneys)

53
Q

explain how portal hypertension can cause ascites?

A

Increased portal hypertension  increased cap pressure  increased lymph fluid  increased ascites

54
Q

how do vasodilators contribute to ascites?

A

Also makes more vasodilators  arterial vasodilation  reduction in blood pressure  triggers activation of SNS and RAA system  sodium and water retention  increased plasma volume  increases peritoneal fluid

55
Q

what does the superior rectal vein drain into?

A

superior mesenteric vein

56
Q

what is the inferior rectal vein a branch of?

A

internal pudendal vein which is a branch of the internal iliac vein

57
Q

what causes splenomegaly?

A

Consequence of increased HPP: blood gets backed up into the hepatic portal system. Goes directly into the spleen  increased blood volume in the spleen  splenomegaly

58
Q

what do the L and R hepatic duct join to form?

A

common hepatic duct

59
Q

what branches off the common hepatic duct?

A

cystic duct

60
Q

where does the cystic duct go?

A

gallbladder

61
Q

what joins to form the common bile duct?

A

joining of the common hepatic duct and cystic duct

62
Q

where is bile produced?

A

liver

63
Q

where is bile stored and released from?

A

the gallbladder

64
Q

when are gallstones asymptomatic?

A

when they’re just sitting in the gallbladder not blocking anything

65
Q

what happens when gallstones get stuck in the neck of the gallbladder? how does this present?

A

stone blocks bile leaving the gallbladder
when gallbladder contracts, URQ pain
biliary colic

66
Q

how does acute cholechystitis occur?

A

if gallstones are stuck in the gallbladder for long enough it causes inflammation

67
Q

how is acute cholechystitis tested for?

A

Murphy’s sign which is when you put your hand under the costal margin, get the patient to inhale. Push the liver down and pushes on the gallbladder  pain if inflammation

68
Q

what happens if the gallstone blocks bile leaving the gallbladder and the liver?

A

So bilirubin in bile is not able to be broken down and so accumulates in blood causing jaundice and biliary colic.

69
Q

what happens if the gallstoe blocks the bile and pancreatic ducts?

A

stops flow of bile and pancreatic enzymes

causes biliary colic, jaundice and pancreatitis

m2 (24 decks)

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