Liver and Gall Bladder Flashcards
Name the two recesses of the liver.
Subphrenic/suprahepatic recess - separates diaphragmatic surface of liver from diaphragm.
Hepatorenal recess/Pouch of Morrison - between liver and right kidney and suprarenal gland.
Name all the ligaments of the liver.
Falciform ligament Ligamentum Teres Right and left anterior and posterior coronary ligaments Right and left triangular ligaments Ligamentum venosum Hepatoduodenal ligament Hepatogastric ligament
What is bordered by the coronary ligaments?
Bare area - liver and diaphragm in direct contact, with lymphatic vessels running directly from liver into thorax (potential Plath for spread of cancer)
What is the fibrous coat of areolar connective tissue that covers the liver called?
Glisson’s capsule.
What is the deepest part of the abdominal cavity when someone is lying on their back?
Hepatorenal recess/Pouch of Morrison
What is the falciform ligament embryo logically derived from?
Ventral mesentery of foregut
What is the ligamentum Teres derived from?
Obliterated umbilical vein
Where is the fundus of the gall bladder?
Tip of 9th costal cartilage, transpyloric plane (L1/L2)
Which lobe of the liver overlaps the inferior vena cava, and has the ligamentum venosum on the other side?
Caudate lobe
Which lobe of the liver has the gall bladder on one side and the ligamentum Teres on the other?
Quadrate lobe
What is the difference between the anatomical left lobe of the liver and the physiological left lobe?
The anatomical left lobe is divided from the right by the falciform ligament and does not include the caudate and quadrate lobes.
The physiological left lobe includes the caudate and quadrate lobes as they are all supplied by the same branch of the hepatic artery (left hepatic artery).
Name the ten organs associated with the visceral surface of the liver.
Right superior part of stomach Superior duodenum (D1) Oesophagus Inferior vena cava Gall bladder Right kidney Right suprarenal gland Right colic flexure Right part of transverse colon Lesser omentum
What is contained in the hepatoduodenal ligament?
Portal triad - common bile duct, hepatic artery, hepatic portal vein
Where is the hilum of the liver, and what is it called?
Porta hepatis - between caudate and quadrate lobes
How are the vessels positioned in the portal trials?
Common bile duct anterior and on the right.
Hepatic artery anterior and on the left.
Portal vein posterior.
Think DAVE - duct, artery, vein, epiploic foramen
What is another name for the epiploic foramen?
Foramen of Winslow.
What is the proportion of blood and the proportion of oxygen supplied to the liver by the portal vein and by the hepatic artery?
Hepatic artery - supplies 20% of liver’s blood but 80% of its oxygen
Hepatic portal vein - supplies 80% of liver’s blood but 20% of its oxygen
What are the origins of the hepatic artery and the hepatic portal vein?
Hepatic artery - coeliac trunk
Portal vein - capillary bed of gastrointestinal tract
How many segments does the liver have?
8
What is each segment of the liver supplied by?
A segmental artery, segmental portal vein, segmental bile duct.
Hepatic veins are on the periphery of the segments.
Which abdominal regions is the liver in?
Epigastrium and right hypochondrium.
What connects the neck of the gall bladder to the common bile duct?
Cystic duct
What are the three parts of the gall bladder?
Fundus, body, neck
What does the major duodenal papilla embryologically represent?
The junction between the foregut and the midgut.
When imaging the biliary tree (cholangiopancreatography) with contrast medium, what does it mean if the gall bladder is imaged well?
The gall bladder is empty and can take in lots of contrast agent so it must be emptying properly and be functional.
If the gall bladder is full, no contrast will get in and you can suspect obstruction.
What is the medical term for gallstones?
Cholelithiasis
If you’re imaging to look for gall stones, where would you look?
Junction between 12th rib and L1 (that’s right next to L1)
What are the 4 components of liver histology?
1) Hepatocytes - specialised epithelial cells forming hepatic laminae (bordered by hepatic sinusoids)
2) Bile cannaliculi - small ducts between the hepatocytes that collect the bile
3) Hepatic sinusoids - discontinuous blood capillaries with a subendothelial space, between the hepatic laminae, which deliver blood to the central vein
4) Stellate reticuloendothelial cells - hepatic macrophages which destroy old/damaged erythrocytes and bacteria
What is one hepatic lobule?
A hexagon with a central vein in the middle and a portal triad in each of three corners.
What is one portal lobule?
A triangle with a portal triad at the centre and a central vein at each corner.
What is one hepatic acinus?
An oval that includes portions of 2 neighbouring lobules.
Its short axis is defined by the branches of one portal triad (which run along the borders of hepatic lobules). Its long axis connects two neighbouring central veins.
Where are zones 1 and 3 in the hepatic acinus?
Zone 1 is periportal (closest to the branches of the portal triad) and is the first to receive oxygen, nutrients and toxins from incoming blood.
Zone 3 is centrilobular/perivenous
What are the primary functions of the cells in zone 3?
Glycolysis, ketogenesis, lipogenesis, cytochrome P450 based drug detoxification.
What type of epithelium lines the gall bladder?
Simple columnar epithelium with rugae in the mucosa.
Name 4 drugs that decrease plasma LDL.
Statins
Fibrates
Nicotinic acid
Fish oil derivatives
How do fibrates decrease plasma LDL?
Increase production of lipoprotein lipase, so reduce circulating VLDL, and increase hepatic LDL uptake.
Name three drugs that inhibit cholesterol absorption?
Bead sequestrians and Beta-glucans
Ezetimibe
Plant sterols
