Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Digestive > 15 - Liver, Biliary and Portal System > Flashcards

15 - Liver, Biliary and Portal System Flashcards

1
Q

What is the 2nd largest organ in the body?

A

Liver - makes up 2% of your body weight (1500-2000g)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some of the functions of the liver?

A
  • detoxification
  • carb and glucose regulation
  • bile drainage
  • blood circulation and filtration
  • synthesis and storage of amino acids and proteins, fats and vitamins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the livers blood supply?

A

Dual
1/4 from the hepatic artery
3/4 from the portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is the liver?

A

On the right hand side pushing up under the diaphragm at rib 5-6 (fundus of stomach is around rib 5-6 as well - liver can push a bit higher)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most anterior, superior and lateral structure?

A

The liver - all other organs are posterior and inferior to the liver i.e. oesophagus and duodenum/pylorus of stomach, right colic/hepatic flexture of the colon behind the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does the gall bladder sit?

A

Behind the inferior of the right lobule - originate from same hepatic outgrowth
> sitting at 9th costal cartilage on the RIGHT hand side in the MID clavicular plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anterior surface of the liver?

A

Large right lobe, small triangular left lobe

> falciform ligament sits between the left and right lobules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Falciform ligament?

A

sits between the left and right lobes - reminent of verntal mesogastrium that the liver grew in
> goes from the body wall to the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which lobe is bigger?

A

right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where is ligamentum teres and what is it?

A

At the free end of the falciform ligament

Reminent of an umbilical vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gross morphology of the posterior inferior surface?

A
  • IVC in middle superiorly
  • 2 extra lobes;
    > caudate lobe > IVC > right lobe
    > quadrate lobe > gall bladder > right lobe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is left to the IVC?

A

Caudate Lobe > right lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is left to the gall bladder?

A

Quadrate Lobe > right lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Structures rotating and pressing round and start to press against body wall and obliterate peritoneum (large bowel becomes retro…) … how does this occur in the liver?

A

Liver pushing against diaphragm and obliterates peritoneum and get bare area of the liver not covered in peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What area of the liver is NOT covered in peritoneum?

A

The superior posterior right lobe beneath the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Porta hepatis?

A

Doorway to liver - how structures get in and out (like hilum). In free edge of the lesser omentum (hepatoduodenal ligament) carries the portal triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The portal triad are 3 structures which enter the …

A

porta hepatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Porta hepatis??

A

Free edge of the lesser omentum attaches to the porta hepatis, carrying structures with it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What order are the structures in?

A

Portal vein - most posterior (with IVC) and inbetween artery and bilde duct
Hepatic Artery - left and anterior (like aorta)
Bile Duct - right towards liver/gall bladder and most anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do the vessels divide?

A

Split as come in to liver (bile out)

  • R & L hepatic ducts joint into the common hepatic duct as enters liver
  • portal vein splits into L & R portal vein
  • proper hepatic artery splits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What else will you find with the portal triad/porta hepatis?

A

ANS fibres and lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where are the hepatic veins?

A

Wound find them - are in the liver and have direct drainage into the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

anterior boundary of omental foramen?

A

portal triad - portal vein closest (most posterior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What shape is the liver?

A

Wedge shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where does the liver develop and why is this important?

A

In ventral mesogastrium - means it is completely covered in peritoneum (except bare area - attached to diaphragm - where it is reflected up onto the diaphragm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is the peritoneum important at the liver?

A

Potential spaces and fluid migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How are the falciform and right and left falciform ligaments formed?

A

the peritoneum folds back onto itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Falciform ligament?

A

Runs from anterior/umbilicus to the body wall in between the right and left lobes carrying with it the ligamentum teres (reminent umbilical vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Where are the triangular ligaments?

A

Where the peritoneum reflects up onto the diaphragm on the left and right sides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Ligamentum venosum?

A

Runs betwen caudate lpbe and left lobe - reminent of ductus venosus - shunt vessel straight to IVC (umbilical blood from placenta doesn’t need to go to liver as is not functional as mother detoxifies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the potential spaces?

A

Formed by the peritoneum folding around the liver
2x suprahepatic
2x subhepatic
> the right sub-hepatic space (pouch of Morrison) is most clinically important. Separates liver from right kindey and is important in finding fluid in the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What do you need to know about every organ?

A

Blood, nerve, lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Blood supply to liver?

A

25% hepatic artery proper (O2 rich)

75% portal vein (nutrient rich)

34
Q

How is the blood conducted to the liver?

A

The hepatic artery PROPER and portal vein blood is conducted to the central vein of each liver lobule by SINUSOIDS

35
Q

Sinusoids?

A

Bloods vessels containing the mixed blood of the hepatic artery and portal vein. Feed into the central vein
> from the left and right branches of the veins and arteries
> leaky areas of the liver where blood is filtered

36
Q

Where do the central veins drain to?

A

The left, right and central hepatic veins and then DIRECTLY into the IVC

37
Q

How many veins are there going into the liver and how many coming out?

A

Right and left portal veins in, right, left and central hepatic veins coming out into IVC

38
Q

How many segments/physiological lobes can you divide the liver into?

A

8 segments

39
Q

Is there communication between the left and right sides of the liver?

A

NO
> hepatic artery comes in and splits into R&L there is now NO COMMUNICATION between the sides supplied by each of these arteries
> each segment will have 1 bracnh of the bile duct, artery and vein and they DO NOT COMMUNICATE

40
Q

How is the fact each segment does not communicate with another clinically important?

A

Own branch of artery, vein and bile duct. They are functionally distinct and independent. Basis of liver transplant - can remove and wont affect function of other segments (don’t interrupt blood flow)
Also contains infections and tumours

41
Q

Caudate Lobe venous system?

A

Drains straight back into IVC NOT the hepatic veins

42
Q

Where IS there some mixing between the right and left lobes?

A

During venous drainage - the right, left and central hepatic veins DRAIN the liver into the IVC
> the central hepatic vein drains BOTH the left and the right

43
Q

ANS supply?

A

Follows blood supply - from the Coeliac trunk so ANS is from the Coeliac plexus
> parasympathetic from vagus and sympathetic from greater splanchnic nerves T5-T9 (ALL FOREGUT)
> pain refers to the epigastric region and small amount via diaphragm to the right shoulder/chest

44
Q

Where does pain in the liver refer to?

A

Foregut so to the epigastric band (and small amount via diaphragm to the right shoulder/chest)
> right upper quadrant
> main gut tube centralises at the band, liver can be focused more to right as have 2 chains of sympathetic ganglia so get innervation into one side of column so registers more to one side
(still in epigastric band but more focused to right side)

45
Q

Lymphatic drainage of the liver?

A
  • lymph from the liver makes up 1/3 - 1/2 of the total body lymph
  • nodes at the porta hepatis to the coaliac nodes at T12 (where artery came off - foregut)
  • very little amount through diaphragm with IVC
46
Q

For the liver, why can you also get pain referred to the right shoulder/chest as well as the epigastric area

A

Because it is pushing up against the diaphragm and irritates the phrenic nerves (C3-C5 dermatome)

47
Q

Potential spaces?

A

ability for fluid to migrate and cause problems

48
Q

Pseudo-membranes?

A

Fluid/pus/blood gathers in a spot > pseudo membranes > abscess > protects from outside world > can keep growing if bacteria as protected by wall of dead blood cells

49
Q

Should there be a space between liver and diaphragm/kidney?

A

No. Have free fluid in abdomen - abscess?

50
Q

Ans via

A

Coeliac plexus

51
Q

Parasympathetic via

A

vagus (X)

52
Q

Sympathetic

A

Great splanchnic T5-T9 (MAKES SENSE TO DERMATOME AND PAIN REFERRAL)

53
Q

Lymph to

A

Celiac nodes at T12

54
Q

3 parts of the gall bladder?

A

Fundus - hangs down below liver
body - contacts visceral surface of the liver
neck - joins the cystic duct

55
Q

Is the gall bladder covered in peritoneum?

A

Yes - grew in ventral peritoneum and is covered in visceral peritoneum (intrap.)

56
Q

Function of gall bladder?

A

Store and concentrate bile

57
Q

Why doesn’t rat have gall bladder?

A

Constantly eats and releases liver into gut tube to emulsify fat. We do not usually eat regularly. Have enough bile to emulsify digest the fat in your meal

58
Q

What stimulates the gall bladder to contract and release bile into the duodenum?

A

Fat in the duodenum stimulates cholecystokinin release which stimulates contraction
> the smooth muscle at the distal end of the bile duct at the ampulla relax allowing bile into the duodenum

59
Q

can you live without a gall bladder?

A

yes not as efficient - just releases bile directly from liver

60
Q

Where is bile made?

A

Liver > connected by pipes to gall bladder where it is stored and both connected to duodenum

61
Q

How long is the bile duct?

A

8cm

62
Q

How does the bile duct end?

A

Pierces 2nd part of duodenum where original hepatic stalk came off

63
Q

How do the biliary tree and pancreatic system join?

A

The main pancreatic duct opens into the hepatopancreatic ampulla of Vater
> opens into the duodenum by the major doudenal papilla (sphincter of Oddi)

64
Q

Where do the joint pancreatic and biliary systems enter into the duodenum?

A

The hepatopancreatic ampulla of vater opens into the SECOND part of the duodenum by the major duodenal papilla/sphincter of Oddi

65
Q

Where does the bile duct travel?

A

BEHIND the duodenum

66
Q

Blood/nerve/lymph to gall bladder?

A

CYSTIC (‘fluid filled sac’)
Arterial: Cystic artery from right hepatic artery passing through the Triangle of Calot
Venous: Cystic vein into portal vein
Nervous: ANS via Coeliac plexus pain to epigastric
Lymph: Cystic nodes > hepatic nodes > coeliac nodes at T12

67
Q

Arterial supply to GB

A

Cystic artery from the right hepatic artery which passes through the triangle of calot

68
Q

Venous GB

A

Cystic vein to portal vein

69
Q

ANS of GB

A

Via coeliac plexus pain to epigastric

70
Q

Lymph to GB

A

Cystic nodes > hepatic nodes > coeliac nodes at T12

71
Q

What forms the triangle of calot and what passes through it?

A

Common hepatic duct, cystic duct and liver

> cystic artery passes through

72
Q

What colour are cholestrol gallstones?

A

Creamy yellow/green

73
Q

What are gallstones called?

A

cholelithiasis

74
Q

What are gallstones?

A
  • crystalline bodies made from bile components

- can be pigment stones i.e. bilirubin and calcium salts, usually small and dark

75
Q

Bilirubin?

A
  • pigment stones
  • normal breakdown product of RBC
  • abnormal liver behaviour > won’t break down > too much bilirubin > yellow in jaundice/yellow green bruising > gallstones
76
Q

CholeDOCOlithiasis?

A

Gallstones in the common bile duct

77
Q

Portal system?

A

IMV joins splenic v joins SMV forming portal vein

78
Q

Where is the portal vein formed?

A

behind the neck of the pancreas at the L1 plane/L1 transpyloric plane (where pylorus of stomach, 1st part of duodenum, SMV/SMA

79
Q

What plane is the transpyloric plane on and what sits on it?

A

L1 - SMV/SMA, pylorus of stomach, first part of duodenum, portal vein behind the neck of the pancreas

80
Q

What do all of the abdominal viscera drain to (incl spleen)? Why is this important?

A

Portal vein

Portal system fails > backflow of blood due to pressure changes

81
Q

What are the 3 main shunts of of the porto-systemic system during portal hypertension

A

Forces blood to find another path through the systemic system
1. Bottom half of the oeosophagus through left gastric veins > SVC
> oesophageal varices
2. Around umbilicus via ligamentum teres/umbilical vein > epigastric veins > IVC
> caput medusa
3. Anus via the inferior mesenteric and superior rectal veins back into iliacs/femoral and IVC
> anorectal varices

Digestive (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions