Liver, Biliary and Portal Systems

Question 1

Where does the liver sit and where is the gallbladder?

Answer 1

Sup. border of the liver sits at ribs 5/6, beneath the diaphragm in the right hypochondrium/epigastric region

The gall bladder sits on the right mid clavicular line at costal cartilage 9

Question 2

Describe the gross morphology of the liver, anteriorly and inferiorly

Answer 2

Anteriorly: Two lobes, left and right with falciform ligament (remanent of ventral mesogastrium) and ligamentum teres (remanent of umbilical system)

Inferiorly: Have the gallbladder on the ant surface and the IVC on the post surface. Th quadrate lobe is ant. and inf. between gall bladder and left lobe is quadrate lobe. pot. and inf is the caudate lobe

Question 3

Where are the porta hepatis structures?

Answer 3

The hepatic artery proper is ant. and left
The common hepatic duct is ant. and right
The portal vein is post.

NB where fee edge of lesser omentum is

Question 4

What are the peritoneal ligaments of the liver

Think of bare area and sup and inf views

Answer 4

Falciform ligament, folds back on itself
Ligamentum teres
Right coronary
Right triangular
Left triangular

Question 5

What is the blood supply to the liver?

Answer 5

25% hepatic artery proper and 75% portal vein.
They split into right and left lobes, and contents are directed to central veins by sinusoids.
Central veins drain into R, L and central hepatic veins, then into the IVC

Question 6

How is the liver segmented and is blood supply mixed?

Answer 6

There are 8 liver lobes, and there is no arterial communication between lobes. Also note caudate lobe has vein draining directly into IVC

Question 7

What is the lymphatic drainage and ANS supply of the liver?

Answer 7

Lymphatics: 1/3 to 1/2 of all body lymphatics, and drains to coeliac nodes at T12

ANS: Coeliac plexus at T12 with PSNS from vagus nerve and SNS from greater splachnic nerves (T5-T9) so pain referral is right epigastric region, and right shoulder sometimes(diaphragm relationship)

Question 8

What is the blood supply and ANS of the gall bladder?

Answer 8

Arterial- Cystic artery, branch of right hepatic art.
Venous- Cystic vein drains into IVC
ANS- celiac plexus

Question 9

Describe arterial supply to the liver from the aorta

Answer 9

Aorta- Coeliac trunk (left gastric and splenic)- common hepatic (has right gastric and gastroduodenal branches)- hepatic artery proper- right hepatic (cystic artery) and left hepatic

Question 10

What are gallstones?

Answer 10

Cholelithiasis, are crystalline bodies made from bile components, such as cholesterol (yellow) or bilirubin and calcium salts

Question 11

Describe the outline of the portal system and where is the portal vein?

Answer 11

SMV and splenic vein drain into the portal vein, with the IMV draining mostly into the splenic vein

L1

Question 12

What is portal-systemic shunting? What are the main 3 shunts?

Answer 12

When there is portal hypertension (high BP, liver cirrhosis) blood is pushed back along the portal system and ends up in the systemic system

Bottom 1/3 of oesophagus causing oesophageal varices
Through umbilicus, lig. teres is forced open, causing caput medusa
Anus, causing anorectal varices