anatomy of the liver and gallbladder

Question 1

where is the liver?

Answer 1

right hypochondrium &epigastricareas

Question 2

what are its 2 external surfaces?

Answer 2

1. diaphragmatic (anterior superior)

2. visceral (posteroinferioro)

Question 3

is the liver intra or retroperitoneal?

Answer 3

infraperitoneal

Question 4

is the liver covered in peritoneum?

Answer 4

yes except for the ‘bare area’ on posterior surface which has direct contact with diaphragm

Question 5

what are ligaments of the liver made of?

Answer 5

double layer of peritoneum

Question 6

which ligament attaches the anterior surface of the liver to the anterior abdominal wall?

Answer 6

the falciform ligament

Question 7

describe the shape of the falciform ligament?

Answer 7

sickle shaped

Question 8

what ligament is contained within the free edge of the falciform ligament?

Answer 8

the ligamentum teres (a remnant of the umbilical vein)

Question 9

which ligament attaches the superior surface of the liver to theinferior surface of thediaphragm ? and demarcates the bare area of the liver?

Answer 9

coronary ligament

Question 10

what is the coronary ligament made of?

Answer 10

• has an anterior and posterior fold

Question 11

how are the left and right triangular ligaments formed?

Answer 11

by the union of the anterior and posterior folds of the coronary ligament

Question 12

what attachments do the left and right triangular ligaments make?

Answer 12

Right attaches right liver lobe to Diaghragm, left attaches left lobe to diaphragm

Question 13

what structure connects the liver to the lesser curvature of the stomach and 1st part of duodenum?

Answer 13

the lesser omentum

Question 14

what 2 ligaments are contained within the lesser omentum?

Answer 14

the hepatoduodenal

the hepatogastric

Question 15

which ligament surrounds the portal triad?

Answer 15

the hepatoduodenal (within lesser omentum)

Question 16

where is the liver divided anatomically into the 2 main lobes?

Answer 16

by the falciform ligament

Question 17

where is the liver divided functionally into 2 lobes?

functionally - meaning if you removed one half, the other won’t be affected

Answer 17

down gallbladder and IVC

• this means both sides have their own single portal branch, a single hepatic artery branch and a single hepatic duct tributary.

Question 18

how many independent functional segments are there in the liver?

Answer 18

8

Question 19

what are the 4 lobes of the liver?

Answer 19

right
left
caudate
quadrate

Question 20

where do the 2 accessory lobes arise from?

Answer 20

caudate and quadrate arise from right main lobe on visceral surface

Question 21

where exactly is the caudate lobe?

Answer 21

1. on upper visceral surface
2. It lies between the inferior vena cava and a fossa produced by the ligamentum venosum (a remnant of the fetal ductus venosus).

Question 22

where exactly is the quadrate lobe?

Answer 22

1. on the lower aspect of the visceral surface.

2. It lies between the gallbladder and a fossa produced by the ligamentum teres

Question 23

what is the porta hepatis?

Answer 23

where all the neurovascular structures (except hepatic veins) enter/exit the liver

it is a deep transverse fissure that separates the quadrate and caudate lobes (on inferior surface)

Question 24

what are the hepatic arteries branches from?

Answer 24

aorta -> coeliac axis -> the common hepatic -> hepatic arteries

Question 25

where does the portal vein drain into?

Answer 25

drains the whole bowel drains into the liver

Question 26

briefly outline the pathway of bile from liver to gallbladder

Answer 26

secreted by liver -> collecting ducts -> hepatic ducts -> common hepatic duct -> cystic duct -> stored in gallbladder

Question 27

briefly outline the pathway of bile from gallbladder to duodenum

Answer 27

released from gallbladder -> cystic duct -> common bile duct -> ampulla of vater (once pancreatic duct joins) -> into the duodenum via major duodenal papilla

Question 28

why is the blood supply to the liver unique?

Answer 28

its a dual blood supply from proper hepatic artery (25%) and hepatic portal vein (75%)

Question 29

describe the role of the portal vein

Answer 29

supplies majority of blood to liver by draining the bowels blood is partially deoxygenated but high in nutrients

Question 30

describe the venous drainage of the liver

Answer 30

via the hepatic veins into IVC

Question 31

describe the sympathetic innervation of the liver

Answer 31

the celiac plexus (part of hepatic plexus)

Question 32

describe the parasympathetic innervation of the liver

Answer 32

vagus nerve (part of hepatic plexus)

Question 33

what is glissons capsule?

Answer 33

the fibrous covering of the liver

Question 34

what is the innervation of the glissons capsule?

Answer 34

lower intercostal nerves - well localised pain

Question 35

what are the structural units of the liver?

Answer 35

lobules or acini (same concept but different way of displaying)

Question 36

what are each of the lobules of the liver made of?

Answer 36

- hexagonal plates of hepatocytes - portal triads at each of the vertices - a central vein

Question 37

where does the central vein of a lobule drain?

Answer 37

central vein -> interlobular vein -> hepatic vein -> IVC

Question 38

what are the 3 main structures in a portal triad?

Answer 38

1. arteriole ( branch off hepatic artery) 2. venule (branch off portal; vein) 2. bile duct

Question 39

what 2 other structures run alongside the portal triads??

Answer 39

lymphatic vessels and vagus parasympathetic fibres

Question 40

how is blood transported from portal triads (hepatic artery and portal vein) on the vertices into the central vein?

Answer 40

via sinusoids - low pressure vascular channels - mix the blood from hepatic arteries and portal veins

Question 41

describe the structure of ancinus

Answer 41

- an acinus encompasses the liver tissue that is served by a single terminal branch of the hepatic artery. - diamond-shaped in cross section, with a hepatic arteriole crossing the center and with central veins at the two opposite corners.

Question 42

make 3 direct comparisons between a lobule and acinus - shape - location of central vein - location of portal triad branches

Answer 42

hexagonal/diamond 1 in centre/2 on face corners on all 6 corners/on the 2 short corners

Question 43

histology of sinusoids: how are they separated from hepatocytes?

Answer 43

by the space of disse

Question 44

histology of sinusoids: what specialised cells do they consist of?

Answer 44

endothelial and kupffer cells