Location of liver
Not palpable on normal exam except on inspiration with inspiration deliver moves downward and is palpable below the right costal margin
Liver specs
Weighs 1.4 kg 3 pounds for 1400 g largest gland of the body second largest organ in the body located in right upper quadrant behind right costal margin diaphragm superiorly adherent to liver
Liver anatomy
Covered by connective tissue also known as glistens capsule it has four loves right left Caudate and quadrate the right and left lobes are divided by falciform ligament
Portal system
Carries blood between two capillary network’s without going to the heart first G.I. capillaries go to the sinusoids of the liver with the deoxygenated blood full of nutrients liver metabolizes stores modifies before sending to general circulation
Villi of gut
Food medications passed through liver prior to general circulation this is called first pass metabolism as a result medications can be activated or in activated in the liver before creating any systemic effects dosage should be adjusted
Liver blood supply
Hepatic artery 30% and portal vein 70%
Hepatic artery
Branches off the Celiac artery and contains high oxygen from aorta
Portal vein
Formed by mesenteric and splenic vein contains poorly oxygenated blood and is high in nutrients from the gut
Portal Triad
Portal vein hepatic artery common bile duct
Common bile duct
Forward by cystic and common hepatic ducts empties into duodenum
Lobule
Functional unit of the liver
Hepatocytes
Each lobule made up of these
Lobules are arranged around a
Central vein
Sinusoids
Instead of capillaries these carry blood throughout the lobule they carry mixed blood
Bloodflow through lobules
Blood flows into lobules via portal veins blood exit lobules via central vein the central veins drain into the hepatic veins hepatic veins drain into IVC
Functions of liver
Produce bile detoxify chemicals or drugs storage of glycogen and blood pigment breakdown
Liver transplants
Second most common transplant performed approximately 6000 done in the US every year
Survival rates for liver transplants
First month 95% first year 86% 3rd year 79%.58% chance of surviving to 15 years failure rate approximately 10 to 15%
Diseases lead into liver transplantation
Hepatitis with cirrhosis biliary cirrhosis biliary atresia hepatocellular carcinoma alcoholism Wilson’s disease and hemochromatosis
Liver anastomosis sites
Superior vena cava inferior vina cava bile duct hepatic artery portal vein duodenum
Test clamp
Done to see if patient has enough collateral flow to sustain hemodynamic stability without the use of Vino Vino bypass the inferior and superior Ivc is clamped and portal vein is clamped