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DS > Lecture 15 > Flashcards

Lecture 15 Flashcards

1
Q

What is the 2nd largest organ in the body?

A

Liver.

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2
Q

How much does the liver weigh?

A

1500-2000g (2% body weight).

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3
Q

What are the functions of the liver?

A
  1. Detoxification.
  2. Carbohydrate and glucose regulation.
  3. Bile drainage.
  4. Blood circulation and filtration.
  5. Synthesis and storage of amino acids, proteins, fats and vitamins.

Both endocrine and exocrine function.

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4
Q

What is the blood supply to the liver?

A

Dual blood supply:

1/4 Hepatic artery.
3/4 Portal vein.

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5
Q

What is the superior boundary of the liver in terms of surface anatomy?

A

Rib 5/6 level.

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6
Q

What is on the posterior surface of the liver in terms of surface anatomy?

A

Oesophagus, stomach, duodenum, R.Colic flexure, R.Kidney, suprarenal gland, gall bladder. All these structures sit behind the liver (well some parts of these structures).

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7
Q

What is the surface anatomy of the gall bladder?

A

9th costal cartilage level.

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8
Q

How many lobes are in the anterior view?

A

2 lobes. Right (large) and left (small).

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9
Q

What divides the right and left lobes of the liver?

A

Falciform ligament. It also connects to the body wall.

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10
Q

What runs in the falciform ligament?

A

Ligamentum teres, which is a remnant of the umbilical vein.

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11
Q

How many lobes are in the posterior view?

A

4 lobes. Right (large), left (small), quadrate (between gall bladder and left lobe anteriorly) and the caudate lobe (between the IVC and the left lobe).

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12
Q

What is the porta hepatis?

A

Free edge of lesser momentum attaches here carrying three structures with it: hepatic proper artery, portal vein and bile duct.

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13
Q

Where is the hepatic artery proper situated in the porta hepatis?

A

Anterior and LHS.

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14
Q

Where is the bile duct situated in the porta hepatis?

A

Anterior and RHS.

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15
Q

Where is the portal vein situated in the porta hepatis?

A

Posterior (between).

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16
Q

What is the bare area?

A

Where the liver presses up against the diaphragm. And there is no peritoneum.

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17
Q

What is the largest structure in the porta hepatis?

A

Portal vein.

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18
Q

What does the common hepatic duct split into?

A

Right and left hepatic ducts. This happens once the bile duct gets into the porta hepatis.

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19
Q

What does the proper hepatic artery do once it gets into the porta hepatis?

A

Splits into 2. Drag ANS fibres and lymphatics.

N.B. you will not find hepatic veins (direct drainage into IVC).

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20
Q

What is the liver covered in?

A

Visceral peritoneum bar the bare area.

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21
Q

How is the falciform and right and left triangular ligaments formed?

A

Peritoneum folds back on itself. Falciform ligament passes to the umbilicus and contains the remnants of the umbilical vein (ligamentum teres). Right layer of falciform creates coronary ligament and left layer forms left triangular ligament.

22
Q

How many peritoneal ligaments are there?

A

5:

R.Triangular ligament.
Coronary ligament.
L.Triangular ligament.
Falciform ligament.
Ligament venous.
23
Q

What spaces does the peritoneum create?

A

R.Suprahepatic space.
R.Subhepatic space.
L.Suprahepatic space.
L.Subhepatic space.

24
Q

What is the blood supply to the liver?

A 
25% = Hepatic Artery - oxygen rich blood.
75% = Portal Vein - nutrient rich blood from the whole digestive system.

Arterial and venous blood are conducted to central vein of each liver lobule by sinusoids (leaky areas in which blood and other substances can transfuse across).

Central veins drain to R, L and central hepatic veins -> IVC.

25
Q

How many segments are in the liver?

A

8: Couinaud Classification (physiological lobes)

i - caudate
ii - superior left lateral
iii - inferior left lateral
iv - left medial
v - inferior right anterior
vi - inferior right posterior
vii - superior right posterior 
viii - superior right anterior
26
Q

How are the segments divided?

A

There is a right and left lobe, however they are physiological lobes. Due to arterial supply splitting into right and left branch of hepatic artery. After this point no communication between right and left half.

27
Q

Describe the venous drainage of the liver?

A

Hepatic veins drain into the IVC.
Left, right and central hepatic veins. Some mixing between the halves at this point as central drains both left and right.

N.B. Caudate lobe has separate vein draining straight to IVC.

28
Q

What is the lymphatic drainage of the liver?

A

Lymph from liver = 1/3-1/2 of total body lymph. Nodes at porta hepatis - coeliac nodes at T12.

(Small amount passes through diaphragm to post.mediastinum).

29
Q

What is the ANS of the liver?

A

Visceral supply from coeliac plexus:

  • Parasympathetic via the Vagus Nerve [X].
  • Sympathetic from greater splanchnic nerves (T5-T9).
30
Q

What is pain referred to regarding the liver?

A

Epigastric region.

(Small amount via diaphragm to right shoulder).

31
Q

What secretes bile?

A

Liver.

32
Q

What stores bile?

A

Gall bladder.

33
Q

How long is the bile duct?

A

8cm long.

34
Q

Where does the bile duct end?

A

Piercing medial wall of 2nd part of duodenum. It is joined by main pancreatic duct and open into hepatopancreatic ampulla (of Vater). Ampulla opens into duodenum via major duodenal papilla (sphincter of oddi).

35
Q

Explain the biliary tree and the ductile system?

A

The right and left hepatic duct anastomose and form the common hepatic duct. The common hepatic duct then anastomoses from the cystic duct (comes from the gall bladder) and form the bile duct.

36
Q

Describe the gross morphology of the gall bladder?

A 
Fundus = hangs below the liver.
Body = body contacts visceral surface of the liver. 
Neck = neck joins the cystic duct.

All covered in visceral peritoneum.

37
Q

What is the function of the gall bladder?

A

Store and concentrate bile - folds and microvilli.

38
Q

Describe how the gall bladder helps to emulsify fat?

A

When there is fat in the duodenum, the duodenum will release cholecystokinin (from the mucosa), this will cause the gall bladder to contract. The smooth muscle at the distal end of the bile duct and the ampulla then relax. This will cause bile to be released into the duodenum to emulsify fat.

39
Q

What is the blood supply of the gall bladder?

A

Cystic artery (branches from R.Hepatic Artery). It passes through the Triangle of Calot.

40
Q

What is the venous drainage of the gall bladder?

A

Cystic vein (into portal vein).

41
Q

What is the nervous of the gall bladder?

A

ANS via the coeliac plexus (pain to the epigastric region).

42
Q

What is cholelithiasis?

A

Gallstones.

43
Q

What are gallstones?

A

Crystalline bodies made from bile components. The size can range from sand grain to golf ball, can have one or many.

44
Q

What colour are cholesterol gallstones?

A

Green or yellow/white. People with high fatty diets.

45
Q

What colour are pigment stones?

A

Bilirubin and calcium salts usually make small and dark stones.

46
Q

What is choledocolithisais?

A

Where the gallstone is in the Common Bile Duct.

47
Q

What veins form the portal vein?

A

Splenic vein (inferior mesenteric vein goes to splenic vein) + superior mesenteric vein.

48
Q

What is the porto-systemic shunting?

A

Portal hypertension - there is loss of liver function, this causes the blood going to the liver to find another pathway (systemic system) as pressure has built up in the liver.

49
Q

What are the 3 main shunts of the system?

A
  1. Bottom 1/3 of oesophagus - causes oesophageal varices. Goes through left gastric vein.
  2. Around umbilicus - caput medusae (umbilical vein into superficial veins).
  3. Anus - anorectal varices (superior rectal veins into inferior and middle rectal veins).
50
Q

Describe oesophageal varices?

A

Extremely dilated sub-mucosal veins - lower 1/3 of oesophagus. Portal hypertension -due to cirrhosis. It can lead to bleeding in the oesophagus.

DS (32 decks)

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