The Liver and Gall bladder Flashcards
The liver is an embryological derivative of the foregut and develops in the ventral 26
mesentery. In the adult this ventral mesentry becomes
the lesser omentum and the various ‘ligaments’ which hold the liver in close relation to the right dome of the diaphragm
Most of the surface of the liver is covered by peritoneum but one area of the liver has no peritoneal covering and lies in direct contact with the diaphragm this is the
The bare area of the liver
The liver receives all of the venous blood from the bowel via
the hepatic portal vein.
The liver becomes enlarged if blood flow though it is impeded by such conditions as
congestive heart failure, cirrhosis, tumours, or viral infections (hepatitis)
The gall bladder is closely applied to the surface of the liver, the ducts carrying bile from the liver and/or gall bladder can become blocked by
by stones (gall stones) leading to considerable discomfort and may result in jaundice.
the portal triad
hepatic artery, portal vein and bile duct
What is the epiploic foramen
the entrance to the lesser sac, immediately behind this is the aorta on the left and inferior vena cava on the right.
Define the aorta and inferior vena cava on the posterior abdominal wall, note that the IVC forms the posterior wall of the
epiploic foramen
The fundus of the gall bladder lies against the under surface of the diaphragm. Disease of the gall bladder may cause rubbing on the diaphragm. The pain produced will be carried by the phrenic nerve into the 3, 4 and 5 cervical nerve roots. where will the patient feel the pain
The patient will feel the pain in the skin supplied by the 3, 4 and 5 cervical nerve roots. This is over the right shoulder.
The liver (normally) receives all venous blood from the bowel. Ingested proteins which are digested and absorbed by the bowel often consist of chains of three or more amino acids. The short chain protein are toxic to the brain as they can act as neurotransmitters. The liver removes all these proteins and reconfigures them into ‘safe’ molecules. In liver disease this process may fail or blood may bypass the liver through a
a porto-systemic shunt.
The patient will develop neurological disease as a result, hepatic encephalopathy (opathy – disease, .encephalo - of the inside of the head, hepatic - due to the liver).
Which artery is the cystic artery a branch of?
It is usually the right hepatic artery but it can be the left hepatic or the hepatic artery.
Which structures can be found in the porta hepatis?
Macroscopically; portal vein, right and left hepatic artery, right and left hepatic duct
Microscopically, lymphatics branches of the vagus and greater splanchnic nerves
What structure degenerates to form the ligamentum venosum?
The ductus arteriosis; an embryological bypass for the liver which exists before the
liver has fully formed.
Where is the bare area of the liver?
Under the central tendon of the right side of the diaphragm
What is the surface marking of the fundus of the gall bladder?
The tip of the ninth costal cartilage. Where the midclavicular line crosses the costal
margin. The most lateral attachment of the rectus abdominis onto the costal margin. (These are all the same place and just different ways of saying the same thing).
