Liver

Question 1

Liver is _____ gland

Answer 1

Largest and ExoEndoCrine Gland

Question 2

Functions of Liver are

Answer 2

1. It secretes bile and stores glycogen.
2. It synthesizes the serum proteins and lipids.
3. It detoxifies blood from endogenous and exogenous substances (e.g., toxins, drugs, alcohol, etc.) that enter the circulation.
4. It produces hemopoietic cells of all types during fetal life.

Question 3

Location Of Liver

Answer 3

Occupies Right Hypochondrium, upper part of Epigastrium and part of Left Hypochondrium upto midclavicular line.
It is under the cover of ribs extending upwards as far as 5th rib anteriorly on right and 5th intercostal on left both below the nipple

Question 4

Shape, Size , Color

Answer 4

Wedge shaped resembling 4 sided pyramid with base directed towards right and the apex directed towards left.

Weight
 In males: 1.4 to 1.8 kg.
 In females: 1.2 to 1.4 kg.
 In newborn: 1/18th of the body weight.
 At birth: 150 g.
 Proportional weight: In adult 1/40th of the body weight

Red Brown in Color

Question 5

Wedged shaped liver has __ well defined surfaces and __ defined borders

Answer 5

2 Surfaces ( Diaphragmatic & Visceral )
1 Border ( Inferior Border )

Question 6

Diaphragmatic Surface : Shape and texture

Answer 6

It includes the smooth peritoneal areas which face superiorly, anteriorly and to the right, and rough bare area ( devoid of peritoneum ) which faces posteriorly

Question 7

Diaphragmatic Surface : Vessels and Ligaments

Answer 7

IVC : Embedded in Deep Sulcus of Bare Area; Roofed by ligament of IVC having hepatic tissue making sulcus into tunnel

Question 8

The peritoneal ligaments are

Answer 8

Coronary, left and right triangular and falciform ligaments.

Question 9

Visceral Surface : Shape and Texture

Answer 9

The visceral surface is relatively flat or concave. It is directed downward, backward, and to the left. It is separated in front from the diaphragmatic surface by the sharp inferior border and behind from the diaphragm by the posterior layer of
coronary ligament.

Question 10

Features on the visceral surface are:

Answer 10

Fossa for the gallbladder.
Fissure for the ligamentum teres hepatis.
Porta hepatis.

Question 11

Visceral surface is covered by peritoneum except at

Answer 11

Fossa for the gallbladder

Question 12

Inferior Border features :

Answer 12

Separates diaphragmatic surface and visceral surface
Rounded laterally separating Right lateral from inferior surface
Thin and sharp where it separates anterior and inferior surface
Lies at transpyloric plane

Question 13

The 2 notches in inferior border are :

Answer 13

1. Notch for ligamentum teres or interlobar notch

2. Cystic notch

Question 14

Anatomical Lobes:

Answer 14

On Diaphragmatic Surface : Divided into two
lobes, right and left, by the attachment of the falciform ligament

On Visceral Surface : Divided into four
lobes: (a) right lobe, (b) left lobe, (c) quadrate lobe, and (d) caudate lobe by fissures and fossae present on this Surface
(Viz. fissures for ligamentum teres and ligamentum venosum, porta hepatis, groove of the IVC and fossa for the gallbladder).

Question 15

Physiological Lobes : Based on?

Answer 15

Based on the intrahepatic

distribution of branches of the bile ducts, hepatic artery, and portal vein.

Question 16

The physiological lobes are :

Answer 16

The liver is divided into right and left physiological lobes by an imaginary sagittal plane/line (Cantlie’s plane/line).

On the posteroinferior surface this plane passes through the fossa for gallbladder, to the groove for IVC.

On the anterosuperior surface of the liver, this plane passes from the IVC to the cystic notch present a little to the right of the falciform ligament

Question 17

Each lobe has its own ?

Answer 17

Primary branch of hepatic artery and portal vein and is drained in its own hepatic duct

Question 18

What are Hepatic Segments and their number

Answer 18

These are structural units of the liver and are 8 in number

Question 19

The right physiological lobe is divided in to how many segments

Answer 19

It is divided into Anterior and Posterior Segments which is further divided into Upper and Lower Segments

Therefore 4 segments

Question 20

The left physiological lobe is divided into how many segments

Answer 20

The left lobe is divided into Medial and lateral which is further divided into upper and lower segments

Question 21

Naming and numbering of Hepatic Segments

Answer 21

Medial Superior : I
Lateral Superior : II
Medial Inferior : III
Lateral Inferior : IV
Anterior Inferior : V
Posterior Inferior : VI
Posterior Superior : VII
Anterior Superior : VIII

Question 22

Couinaud’s segments:

Answer 22

According to nomenclature of
Couinaud, the hepatic segments are numbered I to VIII . I to IV in the left hemiliver and V to VIII in the right
hemiliver. According to this nomenclature, the segment I corresponds to the caudate lobe and segment IV corresponds to the quadrate lobe.

Question 23

Blood supply of Segments

Answer 23

Segment I to IV of the left lobe are supplied by the left
branch of hepatic artery, left branch of portal vein and drained by left hepatic duct.

The segments V to VIII of right lobe are supplied by right hepatic artery, right branch of portal vein and drained by right hepatic duct.

Question 24

False Ligaments

Answer 24

1. Falciform ligament.
2. Coronary ligament.
3. Right triangular ligament.
4. Left triangular ligament.
5. Lesser omentum

Question 25

True Ligaments

Answer 25

1. Ligamentum teres hepatis.

2. Ligamentum venosum

Question 26

Ligamentum Teres Hepatis is remnant of ?

Answer 26

The obliterated left umbilical vein

Question 27

Ligamentum Venosum is remnant of ?

Answer 27

The obliterated ductus venosus which in fetal life connects the left branch of the portal vein with the IVC.

Question 28

Blood supply of Liver

Answer 28

Hepatic Artery and Portal Vein ( Rich in nutrients )

80% of blood ( 1/3rd of cardiac output ) is delivered through the portal vein and 20% is delivered through the hepatic artery.

Question 29

Venous Drainage of Liver

Answer 29

(a) left hepatic vein between medial and lateral
segments of the left true lobe,

(b) middle hepatic vein
between true right and left true lobes, and

(c) right hepatic vein between anterior and posterior segments of the right true lobe.

They emerge in the upper part of the groove for IVC and open directly in the IVC, just below the central tendon of the diaphragm.

Question 30

Nerve Supply

Answer 30

The sympathetic fibres are derived from
the coeliac plexus.
The parasympathetic fibres are derived from the hepatic branch of the anterior vagal trunk.

Question 31

Factors keeping Liver in place

Answer 31

1. Hepatic veins connecting the liver to the IVC.
2. Intra-abdominal pressure maintained by the tone of abdominal muscles.
3. Peritoneal ligaments connecting the liver to the
   abdominal walls.