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Y3R6: Surgery I 👨‍⚕️ > L8: Liver Anatomy > Flashcards

L8: Liver Anatomy Flashcards

1
Q

The interior of the liver is filled with an enormous number of tiny cylinders.

A

..

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2
Q

A lobule consists of a …… in its core, surrounded by radiating sheets of cuboidal cells called ………

A
  • central vein
  • hepatocytes
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3
Q

Each plate of hepatocytes is an ……

A

one or two epithelium cells.

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4
Q

The hepatic lobules are separated by……..

A

sparse CT stroma.

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5
Q

In cross sections, the stroma is especially visible in the triangular areas ……

A

where three or more lobules meet.

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6
Q
  • Here, there is often a hepatic triad of two blood vessels and a bile ductule.
  • The blood vessels are small branches of the hepatic arteries and hepatic portal vein.
A

…..

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7
Q

Def of Hepatic Sinusoid

A

The spaces () the plates are blood-filled channels.

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8
Q

Lining of Hepatic Sinusoid

A

Lined by a fenestrated epithelium that separates the hepatocytes from the blood cells.

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9
Q

Pathway of Bile Seretion in the liver

A
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9
Q

structure of Hepatic Sinusoid

A
  • They contain phagocytic cells called hepatic macrophages (Kupffer cells), which remove bacteria and debris from the blood.
  • The hepatocytes secrete bile into the bile canaliculi (narrow channels) between the plates of the lobules → to the small bile ductules between lobules → ductules lead ultimately to the right and left hepatic ducts, which exit the inferior surface of the liver
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10
Q

Site of the Liver

A
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11
Q

The Anatomical Liver Lobes are separated by …….

The right lobe contains two small lobes: Quadrate lobe & Caudate lobe.

A
  • The attachment of the falciform ligament on anterior and superior surfaces.
  • The fissure for ligamentum teres on the inferior surface.
  • The fissure for ligamentum venosum on the posterior surface.
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12
Q

Surfaces of The Liver

A
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13
Q

Relations to the Anterior surface of the liver

A
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14
Q

Relations to the Superior surface of the liver

A
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15
Q

Relations to the Right lateral surface of the liver

A
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16
Q

Relations of the Posterior surface of the liver

A
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17
Q

Rekations of the Visceral (inferior) surface of the liver

A
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18
Q

Relations of the quadrate lobe

A
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19
Q

Fissures of the Liver

A
  • Three major fissures (main, left, and right portal fissures), contain the three main hepatic veins.
  • Three minor fissures (umbilical, venous and fissure of Gans) are visible as physical clefts of the liver surface.
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20
Q

Major fissures of the liver

A
  • Main portal fissure
  • Right portal fissure
  • Left portal fissure
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21
Q

Another name for Main portal fissure

A

Cantlie’s line

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22
Q

Describe Main portal fissure

A
  • It extends from the midpoint of the gallbladder fossa to the midpoint of the inferior vena cava
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23
Q

Content of Main portal fissure

A

contains the middle hepatic vein.

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24
Q

Significance of Main portal fissure

A

separates the liver into right and left hemi-livers

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25
Q

Significance of Right portal fissure

A
  • It divides the right hemi-liver into posterior and anterior sectors.
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26
Q

Content of Right portal fissure

A

It contains the right hepatic vein.

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27
Q

Content of Left portal fissure

A
  • It contains the left hepatic vein
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28
Q

Minor fissures of the liver

A
  • Umbilical fissure
  • Venous fissure
  • Fissure of Gans
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29
Q

what is another name of Umbilical fissure?

A

Fissure for the ligamentum teres

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30
Q

Signiicance of Umbilical fissure

A
  • Separates segment III from segment IV within the left medial sector
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31
Q

Content of Umbilical fissure

A
  • It contains a major branch of the left hepatic vein (the umbilical fissure vein).
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32
Q

Attachment of Umbilical fissure

A

It is marked anteriorly by the attachment of the falciform ligament and inferiorly by the ligamentum teres

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33
Q

Another name for Venous fissure

A

Fissure for the ligamentum venosum

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34
Q

what is the Venous fissure a contuity of?

A

Is in direct continuity with the umbilical fissure on the undersurface of the liver.

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35
Q

Content of Venous fissure

A

It contains the ligamentum venosum (The obliterated ductus venosus)

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36
Q

Site of Fissure of Gans

A

Lies on the undersurface of the right lobe of the liver behind the gallbladder fossa.

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37
Q

The liver is divided into …. surgical segments.

A

8

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38
Q

This segmentation is based on:

A
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39
Q

what are hepatic veins?

A

Right v→ right portal fissure

Middle v→ main portal fissure

Left v→ left portal fissure.

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40
Q

The Liver is divided into 2 equal right & left surgical lobes by …..

A

Cantlie’s plane (main portal fissure).

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40
Q

what divides The right surgical lobe?

A
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41
Q

What Divides The Left surgical lobe?

A
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42
Q

Segment I (caudate lobe = spigel’s lobe)

A
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43
Q

Def of Porta Hepatis

A

The hilum of the liver

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43
Q

Site of Porta Hepatis

A

Posterior part of the inferior surface () caudate and quadrate lobes

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44
Q

Blood Supply of Liver

A
  • The hepatic artery (30 %)
  • The portal vein (70%)
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44
Q

Contents of Porta Hepatis

A
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44
Q

The left hepatic artery supplies the …..

A

left half of liver (II, III, and IV).

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45
Q

The right hepatic artery supplies the ……

A

right half of liver (V, VI, VII, and VIII)

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45
Q

The proper hepatic artery bifurcates ……

A

into right and left hepatic arteries outside liver

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46
Q

Small branches from near the bifurcation of the proper hepatic artery …….

A

also supply segment I.

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47
Q

A middle hepatic branch may arise from either right or left hepatic arteries after bifurcation.

A

…

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48
Q

Bifurcation of The portal vein

A

In the hilum of the liver, the main portal vein bifurcates into: Right Portal Vein & Left Portal Vein

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49
Q

Characters of Right Portal Vein

A

Short oblique

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50
Q

Course of Right Portal Vein

A

Enters hepatic parenchyma immediately and is quick to divide into a right anterior and posterior vein

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51
Q

What Does Right Portal Vein supply?

A
  • Right anterior V → segment V, VIII
  • Right posterior V → segments VI, and VI
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52
Q

Character of Left Portal Vein

A

Longer, more transverse, and more superficial

53
Q

Course of Left Portal Vein

A

Courses to the umbilical fissure to give off medial branches and lateral branches

54
Q

What Does the Left Portal Vein supply?

A
  • Medial branches → segment IV
  • Lateral branches → segments II, and III.
55
Q

Both right and left veins give off small branches …….

A

to dually supply segment I

56
Q

Venous Drainage of The Liver

A
57
Q

The 3 major hepatic veins carry blood from the liver to the ……

A

IVC

58
Q

Site of Left hepatic vein

A

The left portal fissure

59
Q

Drainage of Left hepatic vein

A

Segments II, III and, occasionally, IV.

60
Q

Termination of Left hepatic vein

A

Middle V usually joins the left hepatic vein and terminates in the inferior vena cava as a short common trunk

61
Q

Site of Middle hepatic vein

A

The main portal fissure

62
Q

Drainage of Middle hepatic vein

A

The central part of the liver (segments IV, V and VIII)

63
Q

Termination of Middle hepatic vein

A

Middle V usually joins the left hepatic vein and terminates in the inferior vena cava as a short common trunk

64
Q

Middle hepatic vein ends as a single trunk in the inferior vena cava in fewer than 10% of individuals.

A

…

65
Q

Site of Right hepatic vein

A

The right portal fissure

66
Q

Drainage of Right hepatic vein

A

The whole of segments VI and VII, and variable proportions of segments V and VIII.

67
Q

Termination of Right hepatic vein

A

The right anterior wall of IVC.

68
Q

Right hepatic vein is the largest and the longest

A

….

69
Q

Segment I is drained through …..

A

at least 2 constant veins directly into IVC

70
Q

Lymphatics of the posterior part of the liver

A

Follow IVC to end in the diaphragmatic LNs around the upper end of IVC in the thorax.

71
Q

Lymphatics of the remaining part of the liver

A

Follow hepatic artery → the celiac LNs around celiac trunk → Cisterna chylii → thoracic duct.

72
Q

Site of nerve supply of the Liver

A

From hepatic plexus at porta hepatic

73
Q

sympathetic Supply Of the Liver

A

Sympathetic fibers from greater splanchnic nerve.

74
Q

Parasympathetic Supply Of the Liver

A

Parasympathetic fibers from hepatic branch of vagus.

75
Q

Peritoneal Ligaments of the Liver

A
  • Falciform ligaments
  • Coronary Ligaments
  • Triangulars Ligaments
  • Lesser Omentum
76
Q

Def of Falciform Ligament

A

Fold of peritoneum, which connects anterior abdominal wall to the liver.

77
Q

Apex of Falciform Ligament

A

At the back of the umbilicus.

78
Q

Base of Falciform Ligament

A
79
Q

Superior border of Falciform Ligament

A

Attached to the anterior abdominal and the under surface of the diaphragm

80
Q

Inferior border of Falciform Ligament

A

Free and concave

81
Q

VIP

The Rt & Lt layer of Falciform Ligament

A
82
Q

VIP

  • contents of Falciform Ligament
A
83
Q

Def of Coronary Ligament

A

Fold of peritoneum, which connects the diaphragm on to the superior and posterior surfaces of the right lobe of the liver.

84
Q

Layers of Coronary Ligament

A

Formed of superior and inferior layers

85
Q

Superior & Inferior reflection of Superior Coronary Ligament

A
86
Q

Superior & Inferior reflection of Inferior Coronary Ligament

A
87
Q

What is found between both superior & Inferior Coronary Ligaments?

A

A large triangular area of liver devoid of peritoneal covering called ‘bare area’ of the liver

87
Q

Termination of both superior & Inferior Coronary Ligaments on the Right

A

The two layers of the coronary ligament converge laterally to form the right triangular ligament.

88
Q

Termination of both superior & Inferior Coronary Ligaments on The left

A

The two layers become closely applied and form the left triangular ligament.

89
Q

Parts of Triangular Ligament

A
  • left triangular ligament
  • right triangular ligament
90
Q

Def of Lt. Triangular Ligament

A

Is a double layer of peritoneum that extends over the superior border of the left lobe of the liver.

91
Q

Anterior Leaf of Lt. Triangular Ligament

A

Medially, it is continuous with the left layer of the falciform ligament

92
Q

Posterior Layer of Lt. Triangular Ligament

A

Medially, it is continuous with the left layer of the lesser omentum.

93
Q

Def of right triangular ligament

A

a short structure that lies at the right lateral limit of the ‘bare area’ of the liver

93
Q

what does right triangular ligament represent?

A

It represents the meeting of the
two layers of the coronary ligament.

94
Q

Superior attachment of Lesser Omentum

A
  • Lips of the porta hepatis.
  • Bottom of the fissure for ligamentum venosum.
94
Q

Inferior attachment of Lesser Omentum

A
  • Lesser curvature of the stomach.
  • Upper border of the first inch of the duodenum
95
Q

Attachment of the Lt side of Lesser Omentum

A

To the diaphragm between the liver and the lower end of the esophagus.

96
Q

Attachment of the Rt side of Lesser Omentum

A
  • Form the free margin of the lesser omentum.
  • It forms anterior boundary of the opening into the lesser sac.
97
Q

Except over its bare area (in direct contact with the right hemidiaphragm), the serous surfaces of the liver and diaphragm are side by side and separated by a potential space

A

..

98
Q

Suprahepatic space is divided into RT and LT spaces by …….

A

falciform ligament.

99
Q

What are two suprahepatic spaces?

A

Left & Right suprahepatic space

100
Q

Site of Lt suprahepatic space

A
101
Q

Site of RT suprahepatic space

A
102
Q

what are two infrahepatic spaces?

A
  • The right infrahepatic space (hepatorenal space, pouch of Morison)
  • The left infrahepatic space.
103
Q

Other names of The right infrahepatic space

A

(Hepatorenal space, pouch of Morison)

104
Q

Superior & Anterior realtions of The right infrahepatic space

A
  • The right lobe of the liver.
  • It is limited superiorly by the inferior layer of the coronary ligament.
105
Q

Posterior relations of The right infrahepatic space

A

by the anterior surface of the upper pole of the right kidney.

106
Q

Lateral relations of The right infrahepatic space

A

Right lateral abdominal wall.

107
Q

Inferior relations of The right infrahepatic space

A
  • Opens into the general peritoneal cavity.
  • Partly limited by the hepatic flexure, transverse mesocolon, 2nd part of the duodenum, and head of pancreas
108
Q

Medical Importance of The right infrahepatic space

A
  • The hepatorenal pouch (of Morison) is the most dependent in the supine position.
  • It is a site where a pathological fluid collection may develop.
109
Q

Divisions of The Left infrahepatic space

A

Study Extraperitoneal spaces

110
Q

Parts of Extrahepatic biliary system

A
  • Gall bladder.
  • Duct System.
    1) Common hepatic Duct.
    2) Cystic Duct.
    3) CommonBileDuct.
111
Q

Site of Gall Bladder

A

Fossa of gall blader within the substance of liver.

112
Q

Shape of Gall Bladder

A

Pear shaped

113
Q

Parts & Peritoneal Covering of Gall Bladder

A
114
Q

Relations of the fundus of Gall Bladder

A
114
Q

Arterial supply of Gall Bladder

A

Cystic artery.

  • From RT hepatic art.
  • Passes behind the cystic duct.
115
Q

Relations of the body & Neck of Gall Bladder

A
116
Q

Venous drainage of Gall Bladder

A

Cystic vein.

  • Drains into the right branch of portal vein.
117
Q

Lymphatic drainage of Gall Bladder

A

Lymph nodes at the porta hepatis

118
Q

Another name of Calot’s Triangle

A

Cystohepatic Triangle

119
Q

Def of Calot’s Triangle

A

Small anatomical space located at the porta hepatis of the liver.

120
Q

Boundaris of Calot’s Triangle

A
121
Q

Contents of Calot’s Triangle

A
122
Q

Medical Importnace of Calot’s Triangle

A

The triangle of Calot is of clinical importance during laparoscopic cholecystectomy

123
Q

Duct system of biliary tree

A

1) Cysticduct.
2) Common hepatic duct.
3) Commonbileduct

124
Q

Characters of Cystic duct

A
125
Q

Begging & Termination of Common hepatic duct

A
  • Formed by union of right & left hepatic ducts at the porta hepatis.
  • Ends by joining cystic duct to form the common bile duct
126
Q

Length of Common bile duct

A

7.5 cm

127
Q

Formation of Common bile duct

A

By union of cystic & CHD at porta hepatis.

128
Q

Site & Relations of Common bile duct

A
129
Q

Common bile duct

  • At free border of lesser omentum
A

Left: hepatic artery.

Posteriorly: portal vein.

130
Q

Common bile duct

  • Behind the 1st part of duodenum
A

Left: gastroduodenal artery.

Posteriorly: portal vein.

131
Q

Common bile duct

  • Behind head of pancreas
A

Posteriorly: IVC

132
Q

Termination of Common bile duct

A
  • Unite with major pancreatic duct in the wall of duodenum to form ampulla of Vater.
  • Opens on the major duodenal papilla.
  • Guarded by sphincter of Oddi.
133
Q

Done

A

..

Y3R6: Surgery I 👨‍⚕️ (30 decks)

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