Liver and biliary tree Flashcards
Functions of liver
Hormone production/breakdown RBC breakdown Detoxification Bile production Glycogen storage Albumin production
Where is the liver?
RHS of abdomen Below diaphragm (at T7/8) Protected by 7-10th ribs
Inferior to liver
On RHS is superior pole of right kidney and hepatic colon flexure and adrenal gland
Where is IVC in relation to liver?
Posterior
4 lobes of liver
Right
left
Caudate
Quadrate
Arterial supply to liver
Left gastric, splenic and common hepatic from celiac flexure at T12
Function of hepatic portal vein
Transport venous blood to liver
Function of hepatic veins
Drain liver of blood
Where do hepatic veins drain to?
IVC
3 fissures in liver
Left and right sagittal, connected by aorta hepatis
Where is the bile duct?
From liver to duodenum
Portal triad
Portal vein, hepatic artery and bile duct
How does ductus venous form?
Umbilical vein + hepatic portal vein
What does umbilical vein form?
Round ligament and ductus venous -> ligamentum venous
How does bile reach its site of action?
Channels through r and l hepatic duct to reach common hepatic duct
Common hepatic duct through portal hepatic
Hepatic duct + cystic duct -> common bile duct
Lesser momentum
Hepatic vein and artery
What is the bare area of the liber?
No peritoneum
Clinical relevance of hepatorenal and subphrenic recesses
Collect fluid
Ascitis - fluid builds up in peritoneal space
Albumin increases oncotic pressure of blood
Where does the falciform ligament run?
Abdominal wall to liver
Where are the triangular ligaments?
They travel towards diaphragm
Where are the coronary ligaments?
From peritoneum to diaphragm
Liver failure sx
- Clubbing
- Spider neavi
- Palmer erythema
- Encephalopathy
- Asterixis
- Gynecomastica
- Bruising
- Xanthoma
Gall stones
- Gall stones: collection of cholesterol in gall bladder
- Normally gall bladder squeezes stones towards duodenum and scrape lining of biliary tree
- Gall stones have normal obs, just pain in RUQ
- If stone lodges in cystic duct forms back up of bile into gall bladder, distending it and causing bacteria to grow (cholecystitis)
What is cholecystitis
Gall stone lodges in cystic duct and creates back up of bile into gall bladder
Is there jaundice with cholecystitis and why
- Cholecystitis unlikely to be jaundiced
- Bilirubin is breakdown product and excreted in bile fluid
- Bilirubin can be excreted in cystitis so no jaundice
Ascending cholangitis
Ascending cholangitis: stone blocked in bile duct - bile builds up in liver and bilirubin builds up in blood causing jaundice
Charcot’s triad
Fever, jaundice, abdominal pain
Symptoms of pancreatic cancer
Painless jaundice
What shape are liver lobules?
Hexagonal
Which three things are found between liver lobules
Portal vein, artery and bile duct
What is found in the centre of liver lobules?
Central vein
What communicates between the centre and edge of lobules
Sinusoids and hepatocytes
Where does bile move in the liver lobules?
To bile duct in portal triad
Function of stellate cells
Stellate cells secrete collagen (hepatocytes damaged in cirrhosis for example)
Asterixis
Liver failure due to build up of toxins = flapping hands
Does oestrogen increase or decrease in liver failure?
Increase
Why is collagen bad?
- Collagen narrows channels to stop blood running to central vein → build up of bile
- Blood can’t get through liver - back up of blood in portal venous system
