Liver, Hepatic Portal Circulation Flashcards
What is the location of the liver?
Right upper quadrant
Extends from the right hypochondrium, greater part of epigastric and left hypochondrium regions
What are the functions of the liver?
Metabolism of carbohydrates, fats and proteins
Synthesis of bile and prothrombin
Excretion of drugs, toxins, poisons, cholesterol, bile pigments, and heavy metals
Protective by conjugation, destruction, phagocytosis, antibody formation and excretion
Storage of glycogen, iron, fat, vitamins A and D and blood
What are the surfaces of the liver?
Anterior
Posterior
Superior
Inferior
Right
What forms the diaphragmatic surface of the liver?
Anterior, posterior and superior surfaces of the liver
What separates the diaphragmatic surface of the liver from the diaphragm?
The subphrenic recess
What forms the visceral surface of the liver?
Superior and inferior surfaces
What separates the visceral surface of the liver from the right kidney?
Hepatorenal recess
What does the inferior border of the liver separate?
Anterior surface from inferior surface
Right surface from inferior surface
What notch is located on the anterior border of the liver?
Interlobular notch or notch for ligamentum teres
Cystic notch for the gall bladder
What divides the liver in right and left lobes?
Falciform ligament anteriorly and superiorly
Fissure for ligamentum teres hepatis inferiorly
Fissure for ligamentum venosum posteriorly
What are the smaller lobes located on the right lobe of the liver?
Caudate and quadrate lobe
On which surface is the caudate lobe located?
Posterior surface
What are the boundaries of the caudate lobe?
Right = groove for IVC
Left = fissure for ligamentum venosum
Inferiorly = porta hepatis
What does the caudate lobe connect the right lobe to?
Caudate process
What is the small, rounded elevation located inferiorly and to the left of the caudate lobe?
Papillary process
On which surface of the liver is the quadrate love located?
Inferior surface
What are the boundaries of the quadrate lobe?
Anteriorly = inferior border
Posteriorly = porta hepatis
Right = fossa for gall bladder
Left = fissure for ligamentum teres
What is the elevation located on the inferior surface of the left lobe, near the fissure for ligamentum venosum?
Omental tuberosity
What is the porta hepatis?
A deep, transverse fissure located on the inferior surface of the right lobe
What enters and leaves the liver through the porta hepatis?
Portal vein
Hepatic artery proper
Right and left hepatic ducts
What attaches to the lips of the porta hepatis?
Omental bursa
Which parts of the visceral surface are not covered by peritoneum?
Fossa for gall bladder
Porta hepatis
Which structures are related to the visceral surface of the liver?
Oesophagus
Right anterior part of stomach
Right kidney and suprarenal gland
Right transverse colon
IVC
Gallbladder
How many segments make up the liver?
8
Which lobe of the liver is segment 1?
Caudate love
Which areas of the liver are not covered by peritoneum?
Bare are of the liver
Groove for IVC
Fossa for gallbladder
Porta hepatis
Which ligaments are found on the liver?
Falciform ligament
Left and right triangular ligaments
Left and right coronary ligaments
Lesser omentum
What does the falciform ligament attach?
It attaches the anterosuperior surface of the liver to the anterior abdominal wall and inferior surface of the diaphrgam
What supplies blood to the liver?
Hepatic artery (20%)
Portal vein (80%)
How do the hepatic artery and portal vein divide to eventually supply the hepatic sinusoids?
They divide into right and left branches
They divide into segmental vessels and interlobular vessels
The interlobular vessels further branch to open into the hepatic sinusoids
What is the pattern of venous drainage of the liver?
Hepatic sinusoids
Interlobular veins
Sublobular veins
Hepatic veins
IVC
Where do the superficial lymphatic drain into?
Caval lymph nodes
Hepatic lymph nodes
Paracardial lymph nodes
Coeliac lymph nodes
Where do the deep lymphatics drain into?
Lymph nodes around IVC
Hepatic lymph nodes
Which organs are drained by the hepatic portal vein?
Abdominal part of GIT, except lower part of anal canal
Spleen
Pancreas
What forms the hepatic portal vein?
The union of the superior mesenteric vein and splenic vein
Where does the formation of the hepatic portal vein occur?
Between the neck of the pancreas and IVC at the level of L2
What is the extrahepatic course of the portal vein?
It passes upwards and to the right, behind the neck of the pancreas and 1st part of the duodenum
Enters the free margin of the lesser omentum, in from of the epiploic foramen, with the bile duct and hepatic artery
It then reaches the porta hepatis
Which veins directly into the portal vein?
Right and left gastric veins
Posterior superior pancreaticoduodenal vein
Which vein drains into the right branch of the portal vein?
Cystic vein
Which vein drains into the left branch of the portal vein?
Paraumbilical vein
Where are the portocaval anastomoses?
Around the inferior end of the oesophagus
Around the inferior part of the stomach
Around the umbilicus
Region where the liver is in contact with the diaphragm
Wall of GIT in contact with posterior abdominal wall
Posterior surface of pancreas
What happens if there is blockage of the hepatic portal vein?
This affects the venous return of the abdominal parts of the GIT.
Blood is no longer able to be drained into the portal vein, and thus drains into the systemic system.
This causes the vessels anastomosing with the portal tributaries to enlarge, dilate and become tortuous to allow for passage of blood to the heart
Which portal and systemic veins anastomose around the cardia of the stomach?
Left gastric vein with tributaries of azygous venous system
What is the pathology in the portocaval anastomosis around the cardia of the stomach?
Oesophageal varices
Which portal and systemic veins anastomose at the anorectal junction?
Superior rectal vein with the middle and inferior rectal vein
What is the pathology of the portocaval anastomosis around the anorectal junction?
Haemorrhoids
Which portal and systemic veins anastomose on the anterior abdominal wall around the umbilicus?
Paraumbilical veins with veins on the anterior abdominal wall
What is the pathology of the portocaval anastomosis around the umbilicus?
Caput medusae
