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NME > Anatomy of the Liver > Flashcards

Anatomy of the Liver Flashcards

1
Q

What is the largest gland in the body?

A

Liver

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2
Q

What is the second largest organ in the body?

A

Liver

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3
Q

Liver: Location:

A
  • upper right quadrant
  • right hypochondrium, epigastrium, left
    hypochondrium
  • ribs 7-11, mid axillary line
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4
Q

Location of Liver:
superior:
lateral:
medial:
posterior:
inferior:

A

superior: diaphragm
lateral: diaphragm and thoracic wall
medial: stomach
posterior: IVC, abdominal aorta, right kidney
inferior: duodenum

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5
Q

Location of Liver:

A
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6
Q

Subphrenic recess

A

superior extension of the greater sac

inferior surface of diaphragm and diaphragmatic surface of liver, divided into left and right by falciform ligament

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7
Q

Hepatorenal recess

A

posterosuperior extension of subhepatic space

right visceral surface of liver and right kidney and suprarenal gland

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8
Q

Subhepatic recess

A

supracolic compartment of the greater sac

right visceral surface of liver and right kidney and suprarenal gland

communicates anteriorly with the subphrenic recess

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9
Q

Liver Location: Recesses:

A
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10
Q

The liver has how many surfaces and describe them

A
  • two surface
  • diaphragmatic: smooth, domed
  • visceral: fissures, visceral impressions in the formalin
    fixed liver
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11
Q

Liver surface diagram

A
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12
Q

visceral surface diagram

A
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13
Q

Fissures of the Liver (3):

A
  • Right sagittal: groove for IVC and gallbladder fossa
  • Left (umbilical) sagittal: ligamentum teres hepatis,
    ligamentum venosum
  • Porta hepatis (transverse): structures enter/exit the
    liver
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14
Q

Ligamentum teres hepatis:
- remnant of
- purpose embryologically
- which fissure of the liver?

A
  • remnant of the left umbilical vein
  • drains oxygenated blood from small venules of placenta
    into growing fetus and drains into ductus venosus
  • Left (umbilical) sagittal fissure
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15
Q

Ligamentum venosum:
- remnant of
- purpose embryologically
- which fissure of the liver?

A
  • remnant of ductus venosus, which shunts a portion of
    umbilical blood directly to the IVC, allowing
    oxygenated blood from the placenta to bypass the
    liver
  • left (umbilical) sagittal fissure
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16
Q

Porta Hepatis is the —— and —— of the liver containing:
Porta Hepatis is enclosed by

A

Porta Hepatis is the hilum and root of the liver: portal triad, lymphatics, nerve plexus

Enclosed by lesser omentum

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17
Q

Liver fissures

A
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18
Q

What are the anatomical lobes of the liver?

A

Left and right lobe

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19
Q

What are accessory lobes?

A

functionally part of the left lobe of the liver, anatomically part of the right lobes of the liver

20
Q

Quadrate lobe of liver:
- type
- location
- between

A
  • accessory lobe
  • inferior and anterior
  • between ligamentum teres hepatis and gallbladder
21
Q

Caudate lobe of the liver:
- type
- location
- between

A
  • accessory lobe
  • superior and posterior
  • between IVC and ligamentum venosum
22
Q

Label lobes and fissures

A
23
Q

Label and describe what the bare area of the liver is
Additionally, label the recesses of the liver

A

Bare area: part of the diaphragmatic surface not
covered by visceral peritoneum, groove for
IVC

24
Q

Where is the apex of the liver?

A

Left extremity

25
Q

Portal triad

A
26
Q

Label the ligaments and peritoneal folds of the liver

A
27
Q

Falciform ligament:

A
  • anterior abdominal wall to diaphragmatic hepatic
    surface
  • free edge contains ligament teres hepatis
28
Q

Coronary ligaments (liver):

A
  • inferior diaphragmatic surface to diaphragmatic
    hepatic surface
  • anterior, posterior lamina
29
Q

Triangular ligaments (liver):

A
  • inferior diaphragmatic surface to diaphragmatic
    hepatic surface
  • right, left
30
Q

Liver: Arteries:

A
  • coeliac trunk (T12) arises from the abdominal aorta
  • coeliac trunk divides into 3 main branches: left gastric
    artery, splenic artery and common hepatic artery
  • common hepatic artery gives off gastroduodenal
    artery and right gastric artery leaving hepatic artery
    proper
  • Hepatic artery proper (20-25%)
  • divides into right and left hepatic artery
  • right hepatic artery also gives of the cystic artery
    (supplies gallbladder)
31
Q

Venous nutrient rich blood supplied to liver by:

A
  • portal vein (75-80%)
  • Two veins that form the portal vein are:
    • splenic vein: inferior mesenteric vein drains into
      the splenic vein
    • superior mesenteric vein
  • left gastric vein is also a tributary of the portal vein
32
Q

Venous drainage of the liver

A

3 hepatic veins:
- right hepatic
- intermediate/middle hepatic veinn
- left hepatic vein

All drain into the IVC!

33
Q

Blood supply to liver

A
34
Q

Portal vein

A
35
Q

venous drainage of liver

A
36
Q

Lymphatic Drainage of the liver:

A
  • superficial = capsular drainage
  • deep = deep connective tissue
  • anterior aspects drain to hepatic nodes into coeliac
    nodes and then into cisterna chyli, which is the origin
    of the thoracic duct
  • posterior aspects drain into phrenic nodes, into
    posterior mediastinal nodes, into the right lymphatic
    duct or the thoracic duct
37
Q

Lymphatic Drainage of the Liver

A
38
Q

Innervation of the Liver:

A

Hepatic Plexus:
- sensory innervation: to capsule hence pain due to
stretch - intercostal nerves T6-T9
- sympathetic: greater splanchnic nerve (T5-9), lesser
splanchnic nerve (T10-T11)
- parasympathetic: vagus nerve (CNX)

39
Q

Innervation of the Liver:

A
40
Q

Referred hepatic pain: dermatomes

A

T6-T9: epigastrium, right hypochondrium
C3-C5: shoulder and neck

41
Q

Referred pain

A
42
Q

Porto-systemic anastomoses:
- is
- 3 main sites

A
  • collateral route for venous return to the right atrium
  • gastro-oesophageal junction
  • peri-umbilical region
  • anal canal
43
Q

Porto-systemic anastomoses:
- is
- clinical relevance

A
  • blood can drain via portal vein through the liver back
    to the heart or via a more systemic route directly back
    to the right atrium
  • if a pathology in the liver is causing portal hypertension, creates a backpressure in venous drainage of portal system
  • at porto-systemic anastomoses, dilations will occur
    causing varicosities, hence blood will return via the
    systemic route due to the increased pressure
44
Q

Porto-systemic anastomoses: Gastro-oesophageal junction:

A
  • can drain via the left gastric vein ( a small tributary of
    the portal system) or the azygous system
  • portal hypertension can lead to oesophageal varices
    due to dilatations in the veins and can bleed profusely
45
Q

Porto-systemic anastomoses: Peri-umbilical region:

A
  • can drain via the para-umbilical vein (portal system)
    or via the superficial veins of the abdo wall
  • can cause caput medusae (head of medusa), belly
    button looks like head of medusa and veins are
    squiggly looking like snakes, if portal hypertension
    causes dilatation
46
Q

Porto-systemic anastomoses: Anal canal:

A
  • can drain via the superior rectal ( which drains into
    the inferior mesenteric vein and into portal system) or
    the middle or inferior rectal veins (systemic)
  • internal haemorroids if portal hypertension causes
    dilatations
47
Q

Functional Hepatic Divisions:

A
  • 4 hepatic divisions
  • further divided into 8 surgically resectable hepatic
    segments
  • divisions and segments: independent branches of the
    portal triad

NME (52 decks)

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