Module 1: Chapter 1-2 Flashcards
In adults, a normal liver measures:
In adults, a normal liver measures 8-12 cm in the mid
clavicular line and 4-8 cm in the mid sternal line
Inflammation in the liver or gall bladder is most frequently felt in the
right upper quadrant (RUQ) or
epigastrium (area below the sternum or breast bone)
Where would you find referred liver pain
right shoulder
Viewed from the back, the liver wraps around
the ______
Inferiorly, you will find the ____ and
the ______, which contain the main
_____ vein, ____ (HA),
and _____ (BD)
Viewed from the back, the liver wraps around
the inferior vena cava (IVC)
• Inferiorly, you will find the gallbladder (GB) and
the portal hepatis, which contain the main
portal vein (PV), common hepatic artery (HA),
and common bile duct (BD)
the liver is divided into ___ ___ ___ lobes
The liver is divided into the right lobe, left lobe, and the caudate lobe
The ____ lobe is an area on the under surface of the right lobe between the fossa of the
umbilical vein, the porta hepatis and the gallbladder
The quadrate lobe is an area on the under surface of the right lobe between the fossa of the
umbilical vein, the porta hepatis and the gallbladder
The reflection of the peritoneum to form the____ ____ (which holds the liver in place)
means that posteriorly there is part of the liver which does not have a peritoneal lining.
• This so called ___ ____ can be important in that tumours or abscesses in this area are more
likely to directly invade the diaphragm
The reflection of the peritoneum to form the coronary ligament (which holds the liver in place)
means that posteriorly there is part of the liver which does not have a peritoneal lining
• This so called “Bare Area” can be important in that tumours or abscesses in this area are more
likely to directly invade the diaphragm
outline the plumbing of the liver
- HA: hepatic artery brings arterial blood
- PV: portal vein brings blood from gut and spleen for processing
- CBD: common bile duct: flows in opposite direction to the HA and PV. the bile ducts drain into the CBD which enters the second part of the duodenum. these three make up the hepatic portal triad.
- HV: Hepatic vein (Right and left). deoxygenated Blood from liver leaves central veins to the hepatic veins which flow into the IVC back to the heart.
which lobe drains directly in to the IVC
caudate
The ___ vein (drains the spleen), ____ ____ vein (drains the left colon) and the
____ _____ vein (drains the small
bowel, right and transverse colon) come
together to form the main portal vein
The splenic vein (drains the spleen), inferior
mesenteric vein (drains the left colon) and the
superior mesenteric vein (drains the small
bowel, right and transverse colon) come
together to form the main portal vein
Explain what portal hypertension is
When the liver becomes scarred (cirrhosis),
blood has trouble flowing through the liver and
the pressure within the portal vein increases
This portal hypertension is responsible for
many of the clinical manifestations and
complications of cirrhosis
With portal hypertension patients may develop
splenomegaly, leading to sequestration of
platelets, which is an important cause of thrombocytopenia (low platelets)
describe the functional unit of the liver
acinus which
starts at the terminal afferent vasculature and bile
ductule branches (zone 1) and ends at the terminal
hepatic venules or central veins (zone 3)
However, histology & pathology of the liver is
typically described by the hepatic lobule, with a
central vein surrounded by several portal spaces,
which is similarly broken down into Zone 1 (oxygen
rich area around portal triad), Zone 2 (in the
middle), and Zone 3 (oxygen depleted area around
the central vein)
General structure:
The portal triad is composed of the thin walled portal vein (PV), the thicker walled hepatic
artery (HA) and the bile duct (BD), which is lined by ____ ____ cells called ____
• The portal triad is supported by ___ ____ and is delineated from the pink liver cells
(hepatocytes) by the “___ ____”
• The hepatocytes are arranged in sheets of cells which are normally one cell thick
• Blood from the PV and HA flow by the hepatocytes in the sinusoids toward the ___ ___
• Bile produced by the hepatocytes flows in the opposite direction through _____ toward the
____ ___
The portal triad is composed of the thin walled portal vein (PV), the thicker walled hepatic
artery (HA) and the bile duct (BD), which is lined by cuboidal epithelial cells (cholangiocytes)
• The portal triad is supported by connective tissue and is delineated from the pink liver cells
(hepatocytes) by the “limiting plate”
• The hepatocytes are arranged in sheets of cells which are normally one cell thick
• Blood from the PV and HA flow by the hepatocytes in the sinusoids toward the central vein (CV) • Bile produced by the hepatocytes flows in the opposite direction through canaliculi toward the
bile duct (BD)
The major cell of the liver is the ____
The _____ is the epithelial cell which lines the bile ducts
____ cells are the macrophage of the liver and are a very important part of the innate
immune system •
The ____ ____ ___ (HSC), in the inactivated form is also known as the ____ cell, and is responsible for fat storage, but when activated the HSC is responsible for the production of ____ which leads to scarring in the liver
• The liver is also populated by stem cells, which have a role in liver regeneration, as well as a
potential role in the development of hepatic malignancies
• The hepatocyte is the most important cell within the liver and is responsible for manufacturing,
metabolism, detoxification and the production of bile
• It contains glycogen and the organelles found in any nucleated cell
• Blood travelling within the sinusoids can
easily come in contact with the
hepatocytes as the endothelium is
____ (has holes)
• Between the sinusoids and the
hepatocytes lies the ___ space,
also known as the Space of ____,
containing the ____ cells (liver macrophage) and____ ___ ___(HSC) • On the basolateral surface of the hepatocyte is the bile canaliculus, where bile and its
components are exported and travel toward the bile ducts
The major cell of the liver is the hepatocyte • The cholangiocyte is the epithelial cell which lines the bile ducts • Kupffer cells are the macrophage of the liver and are a very important part of the innate
immune system • The hepatic stellate cell (HSC), in the inactivated form is also known as the Ito cell, and is
responsible for fat storage, but when activated the HSC is responsible for the production of
fibrosis which leads to scarring in the liver • The liver is also populated by stem cells, which have a role in liver regeneration, as well as a
potential role in the development of hepatic malignancies • The hepatocyte is the most important cell within the liver and is responsible for manufacturing,
metabolism, detoxification and the production of bile • It contains glycogen and the organelles found in any nucleated cell • Blood travelling within the sinusoids can
easily come in contact with the
hepatocytes as the endothelium is
fenestrated (has holes) • Between the sinusoids and the
hepatocytes lies the perisinusoidal space,
also known as the Space of Disse,
containing the Kupffer cells (liver macrophage) and hepatic stellate cells (HSC) • On the basolateral surface of the hepatocyte is the bile canaliculus, where bile and its
components are exported and travel toward the bile ducts
Red Blood Cell Metabolism
Hemoglobin is broken down to globin and heme, which is then metabolized into _____ and
subsequently then to ____ bilirubin
This \_\_\_\_\_ bilirubin is transported to the liver bound to \_\_\_\_\_ In the hepatic sinusoids, bilirubin is released from albumin and is taken up by the hepatocyte through transporters
Within the hepatocyte, bilirubin is____ by the___ enzymes to make
bilirubin more ______. Conjugated bilirubin is then ready for excretion into the bile through special transporters on the bile___
Conjugated bilirubin flows down the bile duct and enters the____. Bacteria in the colon, act upon bilirubin to form____ (makes stool brown in colour) and_____ which is absorbed and taken to the kidneys, where it is converted to urobilin
(makes urine yellow in colour
Some conjugated bilirubin, which is water
soluble, can be excreted by the kidneys
Hemoglobin is broken down to globin and heme, which is then metabolized into biliverdin and
subsequently then to unconjugated bilirubin
This unconjugated bilirubin is transported to the liver bound to albumin In the hepatic sinusoids, bilirubin is released from albumin and is taken up by the hepatocyte through transporters
Within the hepatocyte, bilirubin is
conjugated by the UGT enzymes to make
bilirubin more water soluble. Conjugated bilirubin is then ready for excretion into the bile through special transporters on the bile canaliculus
Conjugated bilirubin flows down the bile duct and enters the duodenum. Bacteria in the colon, act upon bilirubin to form stercobilin (makes stool brown in colour) and
urobilinogen which is absorbed and taken to the kidneys, where it is converted to urobilin
(makes urine yellow in colour
Some conjugated bilirubin, which is water
soluble, can be excreted by the kidneys
