Liver masterclass Flashcards
what are the 2 major lobes of the liver
right and left
What are the accessory lobes
quadrate and caudate
what is the Glisson capsule
covers the liver and is a continuation of peritoneum
Which ligament is anterior
falciform ligament
what is found around the portal vein
posterior plexus
what are the posterior ligaments called
triangular ligaments
where is the anterior plexus found
around the hepatic artery
what % of CO goes to the liver
25% (hepatic artery)
what supplies 75% of the blood to the liver
portal vein
what flows into the portal vein
SMV, IMV, splenic vein and the left gastric vein
what is the normal pressure range in the portal vein
5-8mmHg
How does blood enter and exit the liver
hepatic artery and portal vein enters the liver via the hilum/porta hepatis and then the vessels are distributed into segments and passes into the segments via portal tracts. blood leaves the sinusoids via central veins which coalesce to form the 3 main branches of hepatic vein (right, middle and left) before entering IVC
How many segments are found in the liver
8
what segments are found in the left liver
2,3,4
what segments are found in the right liver
5,6,7,8
what segments are found in caudate lobe
1
what segment is autonomous and has independent blood supply
1 (in caudate lobe)
what is the structural unit of liver
hepatic lobule which is a polyhedron surrounded by 4-6 portal tracts and portal venous branches
what is the functional unit of liver lobule
acinus (parenchyma supplied by the smallest portal tracts containing PV radicles, hepatic arterioles and bile ductules)
True or false: Blood flows from the periphery of acinus to the centre?
False: blood flows from the centre to the terminal branches
which zone is well oxygenated and found around the portal tracts
1
which zone is around the central vein and is the least oxygenated
3
True or false: zone 1 is most susceptible to anoxic injury
false: zone 3 is because of it being least oxygenated
name 5 functions of the liver
formation and secretion of bile
nutrient and vitamin metabolism
inactivation of various substances
drug and alcohol metabolism
synthesis of plasma proteins
what metabolic processes are found in peiportal zone 1:
gluconeogenisis, B-oxidation, amino acid metabolism, ureagenesis
what processes are found at zone 3
glycolysis, lipogenesis, ammonia clearance, detox
which zone helps with hepatocyte regeneration
2
Into what is ammonia converted to be excreted in urine
urea
How is jaundice described in Gilbert’s syndrome
Jaundice associated with fasting/intercurrent illness.
Pathogenesis may involve complex defects in the liver’s uptake of bilirubin. Glucuronyl transferase activity is low, though not as low as in Crigler-Najjar syndrome type II. In many patients, red blood cell destruction is also slightly accelerated, but this acceleration does not cause anemia or hyperbilirubinemia. Liver histology is normal.
What are the fat soluble vitamins
D,K,A
what does deficiency in vit K cause
easy bruising
what does vitamin D deficiency cause
bone pain
what does vit A deficiency cause
night blindness
Name 3 causes of RUQ discomfort
acute viral hepatitis
alcoholic hepatitis
NAFLD
How is RUQ pain in galls stones described
increases over hours and then decreases
what causes colic pain
small and large bowel obstruction
Name 2 symptoms of acute budd chiari syndrome
sudden onset of severe RUQ pain and ascites
risk factors of viral hepatitis
travel history
sexual history
contacts with jaundice
IV drug use
body piercing/tattoos
True or false: Drug history is not important in liver problems
false
what autoimmune conditions is associated with liver disease
thyroid disease, RA, DM
what metabolic causes of liver disease are there
haemochromatosis. Wilson’s disease., alpha 1-antitrypsin defciency
what signs will be seen in a patient with metabolic syndrome
acanthosis nigricans, skin tags
what can cause pigmentation of the abdomen
haemochromatosis
porhyria cutanea tarda
primary biliary cirrhosis
what signs will be seen in Fe deficiency
koilonychia
angular stomatitis
atrophic glossitis
what will be seen in folate/B12 def
tongue raw, beefy appearance
angular stomatitis
what are the features of chronic liver disease
leukonychia
palmar erythema
spider naevi
gynaecomastia
How will autoimmune liver disease present
thyromegaly, synovitis, skin rashes
What will cause arthropathy
hemochromatosis
What will you find in hep B patients
Pyoderma gangrenosum + erythema nodosum
where will you find kayser fleischer rings
wilsons disease
what will causes palpable left lobe in epigastrium
ethanolic liver disease and NAFLD
What will cause increased encephalopathy, increased asictes, abdominal discomfort with no gaurding and no rebound tenderness
spontaneous bacterial peritonitis
what will cause a palpable caudate lobe in epigastrium
budd-chiari syndrome
How many cm below costal margin must the liver be palpable to be hepatomegaly
> 5cm/ total span >15cm
what will causes a palpable gallbladder
cystic duct obstruction
obstruction of common bile duct
what will cause palpable gallbladder and jaundice?
pancreatic cancer
distal cholangiocarcinoma
true or false: the lower pole of the kidneys can be palpable in thin individuals
true
Name 5 causes of ascites
constrictive pericarditis
nephrotic syndrome
protein losing enteropathy
malignant ascites
chylous ascites
what is absence of bowel sounds for 2 minutes called
paralytic ileus
