7- Liver

Question 1

Describe the surfaces of the liver

Answer 1

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

Question 2

How is the liver secured?

Answer 2

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

Question 3

What is the round ligament?

Answer 3

Bottom of falciform ligament, contains ligamentum teres, remnant of umbilical vein

Question 4

Where are the subphrenic spaces?

Answer 4

Between diaphragm and liver, either side of falciform ligament

Question 5

Where is the subhepatic space?

Answer 5

Between inferior surface of liver and transverse colon

Question 6

Where is Morison’s pouch?

Answer 6

Posterosuperior aspect of right subhepatic space, between visceral surface of liver and right kidney

Question 7

What are the lobes of the liver?

Answer 7

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)

Question 8

Is the liver retroperitoneal or peritoneal?

Answer 8

Peritoneal, develops within ventral mesentery

Question 9

What is the portal triad?

Answer 9

At the periphery of lobules, contains arteriole, venule, duct, vagus nerve fibres and lymph vessels

Question 10

Describe the blood supply of the liver

Answer 10

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

Question 11

How does liver pathology lead to jaundice?

Answer 11

Damage reduces capacity to excrete bilirubin

Question 12

What are the consequences of liver cirrhosis?

Answer 12

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

Question 13

What causes increased aminotransferases (AST and ALT)?

Answer 13

Hepatitis
Necrotic lesions
Acute liver injury

Question 14

What causes raised conjugated and unconjugated bilirubin?

Answer 14

Cirrhosis

Question 15

What effect does billary obstruction have on liver function?

Answer 15

Raised conjugated bilirubin
Raised ALP
Raised GGT (proves its billary)

Question 16

What is the cause of pre-hepatic jaundice and what liver function results does it give?

Answer 16

Haemolysis of RBC causing excessive bilirubin, high unconjugated bilirubin

Question 17

What causes hepatic jaundice and what liver function results does it give?

Answer 17

Increased conjugated bilirubin and decreased excretion of bilirubin into bile, so both conjugated and unconjugated bile raised
Cirrhosis
Hepatitis
Alcoholic liver disease

Question 18

What causes post-hepatic jaundice and what liver function results does it give?

Answer 18

Obstruction of bile draining from liver and billary tree, from gall stones or pancreas tumours
Increased conjugated bilirubin

Question 19

How are gallstones produced?

Answer 19

Gallbladder concentrates bile produced between meals by removing Na and water, bile acids and cholesterol form precipitates

Question 20

What is biliary colic?

Answer 20

When gallstones move into gallbladder neck/ ducts causing pain

Question 21

What is cholecystitis?

Answer 21

Inflammation of gallbladder caused by the cystic duct being blocked by gallstones

Question 22

What is acute pancreatitis and what causes it?

Answer 22

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

Question 23

What is chronic pancreatitis and what causes it?

Answer 23

Chronic inflammatory disease leading to destruction and fibrosis of exocrine tissue.
Caused by chronic alcoholism

Question 24

What are the symptoms of a pancreatic head tumour?

Answer 24

Press upon bile ducts so present with symptoms of obstruction and jaundice

Question 25

Describe the passage of bile into the dudoenum

Answer 25

Secreted from hepatocytes into bile canaliculi
Into hepatic duct
Into cystic duct for storage in gallbladder
Common bile duct
Ampulla of Vater
Sphincter of Oddi controls flow of bile into duodenum