Liver Structure and Function Flashcards
What are the four lobes of the liver?
Right
Left
Caudate
Quadrate
Where do blood vessels, lymphatic vessels, ducts and nerves enter and exit the liver?
Via the porta hepatis
What are the functions of the falciform ligament?
Attaches liver to anterior surface of the abdomen
Separates the lobes
What is the name of the only area of the liver not covered by connective tissue?
Bare area
Hepatocytes make bile which runs out through the _ to the _
canaliculus
to the outer of the liver lobule and into the bile duct
What is the difference between the two blood supplies received by the liver?
One is oxygen rich but nutrient depleted via hepatic artery, the other is oxygen depleted but nutrient rich via hepatic vein
The hepatic sinusoids are
open blood vessels, so blood is in very close contact with the hepatocytes as it passes between them
What are the main components of bile?
Bile acids Lecithin Cholesterol Bile pigments Toxic metals Bicarbonate
Bile acids, lecithin and cholesterol are synthesised in the
liver and solubilise fat
What feature of bile acids, lecithin and cholesterol allows them to solubilise fat and prevent the re-aggregation of fat droplets?
They are amphipathic
Bile pigments are breakdown products of
haemoglobin from old/damaged erythrocytes
Where are toxic metals detoxified?
In the liver
Bicarbonate neutralises
acid chyme
When bilirubin is extracted from the blood by hepatocytes and secreted into the bile, what colour will the bile be?
Yellow
Bile acids are synthesised by hepatocytes in the liver from
cholesterol
What happens to bile acids before secretion?
They are conjugates with glycine or taurine to produce bile salts to make them soluble and able to put into solution
Secreted bile salts are recycled via the
enterohepatic circulation
When the sphincter in the duodenum is closed, excess bile in the common bile ducts moves
to the gall bladder for storage
What are the main functions of the gallbladder?
Stores bile
Secretes bile into the cystic duct which secretes into common bile duct
What is the function of the sphincter of Oddi?
Controls the release of bile and pancreatic juice into the duodenum
When the sphincter of Oddi is contracted, the bile is forced
back into the gallbladder
By how many times does the gallbladder concentrate the bile?
5-20 times
The presence of fat in the duodenum stimulates cholecystokinin causing the sphincter of Oddi to
relax and the gallbladder to contract
Cholecystokinin causes
pancreatic enzyme secretion and bile secretion
Surgical treatment of gallstones is only indicated when
the patient is symptomatic
What are the symptoms of gallstones?
Post-cholecystectomy pain
Painful obstructive jaundice
Acute pancreatitis
Ascending cholangitis
What tests are most effective to identify gallstones and the structures being obstructed by them?
MRCP
EUS
Amylase and lipase
CT
Why would a WCC be done if suspecting gallstones?
To determine any signs of sepsis
What two invasive procedures might be done to gather more information once there is evidence of gallstones?
PTC
ERCP
What are the possible surgical options for gallstones?
Open/mini/NOTES/single port/subtotal cholecystectomy
Laparoscopic cholecystectomy - treatment of choice
What is the typical presentation of cholangiocarcinoma?
Obstructive jaundice
Itching
Non-specific symptoms e.g. fatigue, malaise
Give 6 investigations which would be done if suspecting cholangiocarcinoma
Bloods USS EUS CT MRA MRCP PTC Angiography FDG PET ERCP Cholangioscopy and cytology
What are the possible treatment options for cholangiocarcinoma?
Surgery is the only potentially curative option
Palliative care
