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Digestive System > Liver, Biliary and Portal System > Flashcards

Liver, Biliary and Portal System Flashcards

1
Q

Liver

A

2nd largest organ
1-5-2kg
Exocrine and endocrine function

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2
Q

Functions of the liver

A

Detoxification
bile drainage
synthesis & storage of nutrients
blood filtration

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3
Q

What is the dual blood supply to the liver?

A

1/4 hepatic artery

3/4 portal vein

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4
Q

Where is the liver located?

A

Right hypochondrium, into the epigastric region

Sup: ribs 5-6
post to liver: oesophagus, duodenum, R kidney, gall bladder

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5
Q

Where is the gall bladder located

A

9th costal cartilage

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6
Q

What separates the lobes of the liver? Where does it come from

A

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

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7
Q

What does the falciform ligament contain. How is it formed

A

Ligamentum teres, remnant of the umbilical cord/vein.

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8
Q

What can you see on the posterior surface of the liver

A 
Right/left lobe
Quadrate lobe
Caudate Lobe
IVC
Gall bladder
porta hepatis
bare area
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9
Q

What are caudate and quadrate both doing?

A

Sitting between a structure and the left lobe

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10
Q

Bare area?

A

Where the liver is posteriorly pressed up against the diaphragm and the peritoneum has be obliterated

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11
Q

Porta Hepatis? Where is this?

A 
'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

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12
Q

The lesser Omentum is split into…

A

Two ligaments

1) Hepatogastric (stomach > liver)
2) Heptoduodenal (liver > duodenum)

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13
Q

What happens at the porta hepatis?

A

Common hepatic (bile) duct splits > Right & left hepatic ducts

Proper Hepatic artery splits

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14
Q

Will you find hepatic veins at the Porta Hepatis

A

NO, they come in later and directly drain liver to IVC

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15
Q

How does the liver affect the lungs spatially?

A

Fills up a huge amount, displaces the lungs. During inflation the diaphragm pulls down the liver, allowing lung inflation.

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16
Q

What is the liver covered in

A 
Visceral Peritoneum (*except for the bare area) 
so it is INTRAPERITONEAL (gall bladder is also)
17
Q

What forms the falciform ligament and Right/Left triangular ligaments

A

Peritoneum (past ventral mesogastrium) that has folded back on itself

18
Q

Right layer of FL forms

A

Coronary and R. triangular ligaments

19
Q

Left layer of FL forms

A

Left triangular ligament (lips back on itself)

20
Q

Ligament Venosum

A

Embryological remenant of Ductus venosus ( a shunt that would direct blood ti the IVC)

21
Q

The wrapping of peritoneum over structures and then folding over on itself creates spaces. What are these called?

A

Right and left Suprahepatic (above liver)

Right and left subhepatic (below liver)

22
Q

Blood supply to Liver consists of? what does this drain to?

A

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

23
Q

Sinusoids

A

‘leaky areas’ that blood and other substances can leak across

24
Q

Difference between central veins and central hepatic veins

A

Central Veins: found in every liver lobule

Central hepatic vein: only the one, drains directly to IVC

25
Q

Couinaud Classification. What does this mean about liver transplantation

A

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

26
Q

Hepatic Venous drainage of the liver? what is different about the caudate lobe?

A

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

27
Q

Lymphatic Drainage of liver

A

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

28
Q

ANS of liver

A

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

29
Q

What can happen in the spaces caused by the peritoneum

A

Fluid can accumulate.
If the fluid remains there long enough, you get pseudomembranes that start to contain themselves&raquo_space; ABSCESS

Pain will present when these push against the body wall

30
Q

The biliary tree contains

A

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

31
Q

Gross morphology of Gall bladder

A

Fundus : hangs below liver
Body: contacts visceral surface of liver
Neck: joins cystic duct

Covered in visceral peritoneum
Stores and concentrates bile

32
Q

Arterial supply to liver comes from?

A

Abdominal aorta > coeliac axis > CHA (gastroduodenal branch) > HA proper > LHA and RHA(cystic branch)

33
Q

The cystic artery (from RHA) passes through the…

What does the CA supply?

A

Triangle of Calot
Formed by RHA, inferior liver and GB/CD.
Supplies the gallbladder

34
Q

GB venous drainage?
ANS?
Lymph?

A

Venous : cystic vein (to portal vein)
ANS: via coeliac plexus > pain to epigastic

Lymph: cystic nodes > hepatic > coeliac

35
Q

Cholelithiasis? Types?

A

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

36
Q

Gallstones specifically in the common bile duct

A

Choledocolithiasis

Digestive System (27 decks)

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