Liver Structure and Function

Question 1

What are the four lobes of the liver?

Answer 1

Right
Left
Caudate
Quadrate

Question 2

Where do blood vessels, lymphatic vessels, ducts and nerves enter and exit the liver?

Answer 2

Via the porta hepatis

Question 3

What are the functions of the falciform ligament?

Answer 3

Attaches liver to anterior surface of the abdomen

Separates the lobes

Question 4

What is the name of the only area of the liver not covered by connective tissue?

Answer 4

Bare area

Question 5

Hepatocytes make bile which runs out through the _ to the _

Answer 5

canaliculus

to the outer of the liver lobule and into the bile duct

Question 6

What is the difference between the two blood supplies received by the liver?

Answer 6

One is oxygen rich but nutrient depleted via hepatic artery, the other is oxygen depleted but nutrient rich via hepatic vein

Question 7

The hepatic sinusoids are

Answer 7

open blood vessels, so blood is in very close contact with the hepatocytes as it passes between them

Question 8

What are the main components of bile?

Answer 8

Bile acids 
Lecithin 
Cholesterol 
Bile pigments 
Toxic metals 
Bicarbonate

Question 9

Bile acids, lecithin and cholesterol are synthesised in the

Answer 9

liver and solubilise fat

Question 10

What feature of bile acids, lecithin and cholesterol allows them to solubilise fat and prevent the re-aggregation of fat droplets?

Answer 10

They are amphipathic

Question 11

Bile pigments are breakdown products of

Answer 11

haemoglobin from old/damaged erythrocytes

Question 12

Where are toxic metals detoxified?

Answer 12

In the liver

Question 13

Bicarbonate neutralises

Answer 13

acid chyme

Question 14

When bilirubin is extracted from the blood by hepatocytes and secreted into the bile, what colour will the bile be?

Answer 14

Yellow

Question 15

Bile acids are synthesised by hepatocytes in the liver from

Answer 15

cholesterol

Question 16

What happens to bile acids before secretion?

Answer 16

They are conjugates with glycine or taurine to produce bile salts to make them soluble and able to put into solution

Question 17

Secreted bile salts are recycled via the

Answer 17

enterohepatic circulation

Question 18

When the sphincter in the duodenum is closed, excess bile in the common bile ducts moves

Answer 18

to the gall bladder for storage

Question 19

What are the main functions of the gallbladder?

Answer 19

Stores bile

Secretes bile into the cystic duct which secretes into common bile duct

Question 20

What is the function of the sphincter of Oddi?

Answer 20

Controls the release of bile and pancreatic juice into the duodenum

Question 21

When the sphincter of Oddi is contracted, the bile is forced

Answer 21

back into the gallbladder

Question 22

By how many times does the gallbladder concentrate the bile?

Answer 22

5-20 times

Question 23

The presence of fat in the duodenum stimulates cholecystokinin causing the sphincter of Oddi to

Answer 23

relax and the gallbladder to contract

Question 24

Cholecystokinin causes

Answer 24

pancreatic enzyme secretion and bile secretion

Question 25

Surgical treatment of gallstones is only indicated when

Answer 25

the patient is symptomatic

Question 26

What are the symptoms of gallstones?

Answer 26

Post-cholecystectomy pain
Painful obstructive jaundice
Acute pancreatitis
Ascending cholangitis

Question 27

What tests are most effective to identify gallstones and the structures being obstructed by them?

Answer 27

MRCP
EUS
Amylase and lipase
CT

Question 28

Why would a WCC be done if suspecting gallstones?

Answer 28

To determine any signs of sepsis

Question 29

What two invasive procedures might be done to gather more information once there is evidence of gallstones?

Answer 29

PTC

ERCP

Question 30

What are the possible surgical options for gallstones?

Answer 30

Open/mini/NOTES/single port/subtotal cholecystectomy

Laparoscopic cholecystectomy - treatment of choice

Question 31

What is the typical presentation of cholangiocarcinoma?

Answer 31

Obstructive jaundice
Itching
Non-specific symptoms e.g. fatigue, malaise

Question 32

Give 6 investigations which would be done if suspecting cholangiocarcinoma

Answer 32

Bloods 
USS 
EUS 
CT 
MRA 
MRCP 
PTC 
Angiography 
FDG PET 
ERCP 
Cholangioscopy and cytology

Question 33

What are the possible treatment options for cholangiocarcinoma?

Answer 33

Surgery is the only potentially curative option

Palliative care