7- Liver Flashcards
(25 cards)
Describe the surfaces of the liver
Diaphragmatic surface - anterosuperior, part of it not covered by visceral peritoneum
Visceral surface - posteroinferior, in contact with oesophagus, right kidney, right adrenal gland, right colic flexure, duodenum, gallbladder and stomach
How is the liver secured?
Posterior surface secured to IVC by hepatic veins
Falciform ligament attach anterior surface of liver to abdominal wall
Coronary and triangular ligaments attach superior surface to diaphragm
Lesser omentum - hepatoduodenal and hepatogastric ligaments secure liver to viscera
What is the round ligament?
Bottom of falciform ligament, contains ligamentum teres, remnant of umbilical vein
Where are the subphrenic spaces?
Between diaphragm and liver, either side of falciform ligament
Where is the subhepatic space?
Between inferior surface of liver and transverse colon
Where is Morison’s pouch?
Posterosuperior aspect of right subhepatic space, between visceral surface of liver and right kidney
What are the lobes of the liver?
Divided into right and left lobes by falciform ligament
Caudate lobe, between IVC and ligamentum venosum
Quadrate lobe, between ligamentum teres and gallbladder
Caudate and quadrate lobes seperated by porta hepatis (transmit all vessels but hepatic veins)
Is the liver retroperitoneal or peritoneal?
Peritoneal, develops within ventral mesentery
What is the portal triad?
At the periphery of lobules, contains arteriole, venule, duct, vagus nerve fibres and lymph vessels
Describe the blood supply of the liver
Dual blood supply:
Hepatic artery proper - derived from coeliac trunk
Hepatic portal vein - inferior and superior mesenteric vein and splenic vein contribute to supply liver with deoxygenated blood that carries nutrients
How does liver pathology lead to jaundice?
Damage reduces capacity to excrete bilirubin
What are the consequences of liver cirrhosis?
Hepatocytes replaced by fibrous scar tissue
Reduced billary flow, increasing plasma bilirubin
Increased pressure in portal vein - portal hypertension - fluid accumulates in peritoneal cavity (ascities) and portalsystemic anastomosis
What causes increased aminotransferases (AST and ALT)?
Hepatitis
Necrotic lesions
Acute liver injury
What causes raised conjugated and unconjugated bilirubin?
Cirrhosis
What effect does billary obstruction have on liver function?
Raised conjugated bilirubin
Raised ALP
Raised GGT (proves its billary)
What is the cause of pre-hepatic jaundice and what liver function results does it give?
Haemolysis of RBC causing excessive bilirubin, high unconjugated bilirubin
What causes hepatic jaundice and what liver function results does it give?
Increased conjugated bilirubin and decreased excretion of bilirubin into bile, so both conjugated and unconjugated bile raised
Cirrhosis
Hepatitis
Alcoholic liver disease
What causes post-hepatic jaundice and what liver function results does it give?
Obstruction of bile draining from liver and billary tree, from gall stones or pancreas tumours
Increased conjugated bilirubin
How are gallstones produced?
Gallbladder concentrates bile produced between meals by removing Na and water, bile acids and cholesterol form precipitates
What is biliary colic?
When gallstones move into gallbladder neck/ ducts causing pain
What is cholecystitis?
Inflammation of gallbladder caused by the cystic duct being blocked by gallstones
What is acute pancreatitis and what causes it?
Inflammation of the pancreas due to enzymes produced by acinar cells being prematurely activated in pancreatic ducts
Due to obstructed outflow of pancreas, such as gallstones
What is chronic pancreatitis and what causes it?
Chronic inflammatory disease leading to destruction and fibrosis of exocrine tissue.
Caused by chronic alcoholism
What are the symptoms of a pancreatic head tumour?
Press upon bile ducts so present with symptoms of obstruction and jaundice
