M104 T2 L1

Question 1

What is the largest gland in the body?

Answer 1

the skin

Question 2

What is the second largest gland in the body?

Answer 2

the liver

Question 3

How much does the liver weigh?

Answer 3

1.5 kg

Question 4

What is the topography of the liver?

Answer 4

wedge shaped - it tapers off in a slightly triangular kind of shape
colour - reddish brown
the right side is taller

Question 5

Where is the liver located?

Answer 5

below the diaphragm

Question 6

Which quadrants does the liver encompass?

Answer 6

mostly in the right hypochondrium and epigastrium

but it extends into the left hypochondrium

Question 7

What are the main roles of the liver?

Answer 7

detoxification
protein synthesis
production of bile – accessory GI organ
glycogen storage

Question 8

What is the liver like in respect to tactility?

Answer 8

pliable to touch, easily lacerated

Question 9

Why is it especially bad tha the liver is easily lacerated?

Answer 9

bc it’s highly vascularised so it will bleed a lot

Question 10

How does the location of the liver affect the shape of the diaphragm?

Answer 10

it gives the diaphragm its domed shape on one side when it’s relaxed

Question 11

How does the topography of the liver affect the location of the kidneys?

Answer 11

the mismatch in the shape of the liver between the left and right sides means that the right kidney sits lower in the abdomen than the left kidney does

Question 12

What are the locational relations the liver has to other organs?

Answer 12

below diaphragm
right of the stomach
above the colon
overlies gallbladder

Question 13

Where is the liver in relation to the ribs?

Answer 13

Usually covered by them but when breathing down and the contraction pushes the viscera down, it may not be covered by the ribs anymore

Question 14

What are the two anterior lobes of the liver?

Answer 14

left and right

Question 15

What are the ligaments in the liver?

Answer 15

coronary ligaments
falciform ligament
ligamentum teres

Question 16

What ligament does the falciform ligament contain?

Answer 16

the ligamentum teres

Question 17

What happens to the ligamentum teres after birth?

Answer 17

it isn’t needed anymore, so it obliterates and closes up

Question 18

What are the two posterior lobes of the liver?

Answer 18

caudate lobe

quadrate lobe

Question 19

What are the two impressions of the liver?

Answer 19

gastric impression

renal impression

Question 20

What organ is the bare area of the liver in contact with?

Answer 20

the lower part of the diaphragm

Question 21

Which of the four main heart vessels is in physical contact with the liver?

Answer 21

the IVC

Question 22

Which ligaments separate the right and left lobes of the liver?

Answer 22

the falciform ligament

the lesser omentum ligament

Question 23

What structure divides the quadrate and caudate lobes?

Answer 23

porta hepatis (fissure)

Question 24

Which two structures does the falciform ligament link together?

Answer 24

the anterior abdominal wall to liver

Question 25

Which two structures does the coronary ligament link together?

Answer 25

the diaphragm and the liver

Question 26

Which two structures does the lesser omentum link together?

Answer 26

the liver to stomach

Question 27

From where does the lesser omentum span to?

Answer 27

the lesser curvature stomach to the porta hepatis

Question 28

What is the free margin of the lesser omentum made up of?

Answer 28

ventral mesentry

Question 29

What does the lesser omentum enclose?

Answer 29

portal triad lymph vessels gastric vessels (close to stomach)

Question 30

What structure does the coeliac trunk supply?

Answer 30

the foregut

Question 31

What structure does the superior mesentric artery supply?

Answer 31

the midgut

Question 32

What structure does the inferior mesentric artery supply?

Answer 32

the hindgut

Question 33

What artery is the liver supplied by?

Answer 33

the hepatic artery

Question 34

What vein does the liver use?

Answer 34

IVC

Question 35

Which two veins join to make the portal vein?

Answer 35

the superior mesenteric vein | the splenic vein

Question 36

What are the branches of the coeliac trunk / artery?

Answer 36

left gastric artery - supplies the stomach splenic artery - supplies the spleen common hepatic artery - supplies the liver

Question 37

At what vertebral level does the coeliac artery exit the aorta?

Answer 37

T12/L1 Level

Question 38

What structures does the coeliac artery supply?

Answer 38

``` liver (CHA) stomach (LGA, r&lGEAs) spleen (SA) duodenum (GDA) pancreas (SGDA) abdominal oesophagus (OB'LGA) ```

Question 39

What is the statistical variation of the heptic artery?

Answer 39

40-45% of people (abnormal)

Question 40

Where are the most common cases for hepatic artery variation?

Answer 40

Type 1 - CHA trifurcation Type 2 - LHA joined to the LGA Type 3 - RHA joined to the SMA

Question 41

Where is the porta hepatis located?

Answer 41

on the visceral surface of the liver's hilum

Question 42

What's the depth of the fissure that the porta hepatis makes?

Answer 42

5cm

Question 43

How are the liver lobes subdivided into segments (Couinaud)?

Answer 43

it is according to how the hepatic artery and portal vein subdivide

Question 44

Where do sinusoids (hepatic capillaries) receive blood from?

Answer 44

branches of the hepatic artery and the portal vein carry blood into sinusoids

Question 45

What are the three types of blood vessels in the liver?

Answer 45

continuous - keeper fenestrated - gaps sinusoid

Question 46

What structures does the portal triad consist of?

Answer 46

bile ducts hepatic artery portal vein

Question 47

What is the function of continuous sinusoids?

Answer 47

to keep the blood within the vessel

Question 48

What is different about liver transplants?

Answer 48

the liver is a regenerative organ, so only about 20% of a liver is needed for full function the liver keeps regenerating after that, which is why people can have a portion of their liver removed to be transplanted into someone else

Question 49

What cells do lobulocytes contain?

Answer 49

hepatocytes

Question 50

What percentage of the liver is made up of hepatocytes?

Answer 50

60%

Question 51

What are the metabolic functions of hepatocytes?

Answer 51

synthesises plasma proteins and bile salts deaminates amacs to create ammonia converts bilirubin to bile pigment

Question 52

What happens to the blood from portal and hepatic veins in the sinusoids?

Answer 52

``` passes through the hepatocytes onto the central vein then the interlobular / sublobular vein they drain into hepatic veins which drains into the inferior vena cava ``` HEP - CENTRAL - INTERLOB - HEPATIC - HEART

Question 53

Where is the central vein located?

Answer 53

the center of a hepatic lobule

Question 54

Which vein do several central portal veins drain into?

Answer 54

the interlobular / sublobular vein

Question 55

What does the portal venous system involve?

Answer 55

blood draining the GI tract towards the liver | in this way, toxins, drugs, etc absorbed from the GI has to pass through the liver before reaching the heart

Question 56

What is portal hypertension caused by?

Answer 56

a blockage in the portal vein | the ics in pressure pushes against the vessel wall - hypertension

Question 57

What are the common presentation signs of portal hypertensions?

Answer 57

varicoses oesophageal varices caput medusa

Question 58

What were portacaval shunts originally used for?

Answer 58

to ameliorate hypertension

Question 59

What did portacaval shunts involve?

Answer 59

a connection was made between the portal vein and the IVC

Question 60

What were portacaval shunts replaced by?

Answer 60

transjugular intrahepatic portosystemic shunting

Question 61

At what rate is bile secreted by hapatocytes?

Answer 61

40 ml/ hr

Question 62

What are the two main hepatic ducts that bile canaliculi join to form?

Answer 62

the l&r hepatic ducts that drain their respective lobes

Question 63

What do the left and right hepatic duct combine to form when they emerge from the liver?

Answer 63

the common hepatic duct

Question 64

Which portal systemic anastomosis is located in the abdominal part of the oesophagus?

Answer 64

left gastric tributaries with oesophageal branches azygos

Question 65

Which portal systemic anastomosis is located in the anal canal?

Answer 65

superior rectal anastomoses with middle and inferior rectal

Question 66

Which portal systemic anastomosis is located in the umbilicus? *was an example*

Answer 66

paraumbilical veins with epigastric veins

Question 67

What does transjugular intrahepatic portosystemic shunting involve?

Answer 67

the gap between the portal and hepatic vein is bridged AAR lots of the hepatic tissue trying be perfused is not included this lessens the vasculature load reduces hypertension

Question 68

Where are celiac lymph nodes mostly located?

Answer 68

around the porta hepatis

Question 69

Why are they called celiac lymph nodes?

Answer 69

bc they are associated with the branches of the celiac artery

Question 70

Where do the coeliac nodes drain into?

Answer 70

the cisterna chyli

Question 71

What is liver trauma likely to be caused by and why?

Answer 71

fractured ribs could penetrate the liver quite easily bc the liver is close to the lower ribs penetrating wounds - anything moving through the rib cage has the potential to hit the liver

Question 72

What happens if the liver is even slightly injured and why?

Answer 72

severe haemorrhage can happen | bc it's highly vascularised

Question 73

When might portions of the liver be removed?

Answer 73

liver biopsies metastatic spread cirrhosis

Question 74

How can portions of the liver be removed?

Answer 74

bc the liver is segmental in nature

Question 75

What vessels are included under the portal triad?

Answer 75

hepatic artery proper portal vein common bile duct