Liver, Biliary and Portal System Flashcards
Liver
2nd largest organ
1-5-2kg
Exocrine and endocrine function
Functions of the liver
Detoxification
bile drainage
synthesis & storage of nutrients
blood filtration
What is the dual blood supply to the liver?
1/4 hepatic artery
3/4 portal vein
Where is the liver located?
Right hypochondrium, into the epigastric region
Sup: ribs 5-6
post to liver: oesophagus, duodenum, R kidney, gall bladder
Where is the gall bladder located
9th costal cartilage
What separates the lobes of the liver? Where does it come from
Left and right (larger) separated by the ‘falciform ligament’. Remnant of the ventral mesogastrium in which the liver grew, runs down body wall to umbilicus
What does the falciform ligament contain. How is it formed
Ligamentum teres, remnant of the umbilical cord/vein.
What can you see on the posterior surface of the liver
Right/left lobe Quadrate lobe Caudate Lobe IVC Gall bladder porta hepatis bare area
What are caudate and quadrate both doing?
Sitting between a structure and the left lobe
Bare area?
Where the liver is posteriorly pressed up against the diaphragm and the peritoneum has be obliterated
Porta Hepatis? Where is this?
'doorway to liver' where structures enter / exit Hepatic Artery Proper (ant & LHS) Bile Duct (ant & LHS) Portal Vein (posterior) largest
Found where the free edge of lesser omentum attaches. Behind the hepatoduodenal ligament
The lesser Omentum is split into…
Two ligaments
1) Hepatogastric (stomach > liver)
2) Heptoduodenal (liver > duodenum)
What happens at the porta hepatis?
Common hepatic (bile) duct splits > Right & left hepatic ducts
Proper Hepatic artery splits
Will you find hepatic veins at the Porta Hepatis
NO, they come in later and directly drain liver to IVC
How does the liver affect the lungs spatially?
Fills up a huge amount, displaces the lungs. During inflation the diaphragm pulls down the liver, allowing lung inflation.
What is the liver covered in
Visceral Peritoneum (*except for the bare area) so it is INTRAPERITONEAL (gall bladder is also)
What forms the falciform ligament and Right/Left triangular ligaments
Peritoneum (past ventral mesogastrium) that has folded back on itself
Right layer of FL forms
Coronary and R. triangular ligaments
Left layer of FL forms
Left triangular ligament (lips back on itself)
Ligament Venosum
Embryological remenant of Ductus venosus ( a shunt that would direct blood ti the IVC)
The wrapping of peritoneum over structures and then folding over on itself creates spaces. What are these called?
Right and left Suprahepatic (above liver)
Right and left subhepatic (below liver)
Blood supply to Liver consists of? what does this drain to?
25% Hepatic artery (oxygenated)
75% Portal Vein (nutrient-rich)
blood conducted to liver> branches until it reaches sinusoids > reaches central veins of liver lobule.
Central veins > R & L hepatic veins > IVC
Sinusoids
‘leaky areas’ that blood and other substances can leak across
Difference between central veins and central hepatic veins
Central Veins: found in every liver lobule
Central hepatic vein: only the one, drains directly to IVC
Couinaud Classification. What does this mean about liver transplantation
8 segments of physiologically lobes, important radiologically.
There is no arterial communication between left and right halves of the liver!
Each lobe has its own portal triad of vessel supplying it. Therefore you can remove/transplant a lobe without affecting the rest of the liver
Hepatic Venous drainage of the liver? what is different about the caudate lobe?
Right, left and central hepatic veins drain to IVC
(central drains both left and right lobes)
CL has its own vein draining straight to IVC
Lymphatic Drainage of liver
Lymph from liver = 1/3 to 1/2 of total lymph
Nodes at porta hepatis, that flow to ‘coeliac nodes @T12’
**small amount passes through diaphragm to posterior mediastinum
ANS of liver
visceral supply from coeliac plexus @T12
PS: vagus [X]
S: greater splanchnic nerves (T5-9)
Pain referred to epigastric region
**small amount via diaphragm to right shoulder due to some AN fibres
What can happen in the spaces caused by the peritoneum
Fluid can accumulate.
If the fluid remains there long enough, you get pseudomembranes that start to contain themselves»_space; ABSCESS
Pain will present when these push against the body wall
The biliary tree contains
Liver > L&RHD > CHD > GB
When we eat
GB > Cystic Duct > BD (8cm)
Bile duct joins with Pancreatic Ducts to form Ampulla of vater, which pierces the 2nd part of the duodenum via the sphincter of Oddi
Gross morphology of Gall bladder
Fundus : hangs below liver
Body: contacts visceral surface of liver
Neck: joins cystic duct
Covered in visceral peritoneum
Stores and concentrates bile
Arterial supply to liver comes from?
Abdominal aorta > coeliac axis > CHA (gastroduodenal branch) > HA proper > LHA and RHA(cystic branch)
The cystic artery (from RHA) passes through the…
What does the CA supply?
Triangle of Calot
Formed by RHA, inferior liver and GB/CD.
Supplies the gallbladder
GB venous drainage?
ANS?
Lymph?
Venous : cystic vein (to portal vein)
ANS: via coeliac plexus > pain to epigastic
Lymph: cystic nodes > hepatic > coeliac
Cholelithiasis? Types?
Gall stones: crystalline bodies made from bile components
Size from grain of sand > golf ball
Cholesterol = green/yellow
Pigment stones = bilirubin and calcium salts, small and dark
Gallstones specifically in the common bile duct
Choledocolithiasis
