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Flashcards in Liver Deck (46):
1

Size of the liver compared to other glands/organs

Largest gland
Second largest organ behind skin

2

How are nutrients absorbed from the digestive tract conveyed to the liver

Portal venous system

3

What quadrant does the liver occupy

Right upper quadrant

4

What protects the liver

Rib cage and diaphragm

5

Describe the location of the liver

Deep to ribs 7-11 on the right side
Crosses the midline towards the left nipple
Inferior to diaphragm
Anterior to foregut derived organs (oesophagus, stomach, gall bladder, proximal duodenum)

6

Which abdominal regions does the liver occupy

Right hypochondrium
Upper region of the epigastrium
Extends into the left hypochondrium

7

What affects the position of the liver

Breathing - moves with the excursions of the diaphragm
Gravity - located more inferiorly on standing

8

What is the convex side of the liver

Diaphragmatic surface (anterior, superior, some posterior)

9

What is the concave side of the liver

Visceral surface (posteroinferior)

10

What separates the visceral and diaphragmatic surfaces of the liver

Separated anteriorly by the sharp inferior border

11

What does the inferior border follow

The right costal margin

12

Why is the visceral surface irregular

Moulded by shape of surrounding organs:
Oesophagus, right kidney, right adrenal gland, right colic flexure, duodenum, gall bladder and stomach

13

What is the bare area of the liver

Section of the diaphragmatic surface not covered by visceral peritoneum

14

What and where is the ligamentum teres/round ligament

Remnant of the umbilical vein
Contained within the free edge of the falciform ligament

15

What do the left and right coronary ligaments attach

Superior surface of the liver to the diaphragm

16

What do the left and right triangular ligaments attach

Superior surface of the liver to the diaphragm

17

Where is the inferior vena cava in relation to the liver

Runs through a deep groove in the bare area
It is secured hepatic veins and fibrous tissue

18

What are hepatic recesses

Spaces between the liver and surrounding structures

19

What are subphrenic spaces

Superior extensions of the greater peritoneal sac between the diaphragm and anterior and superior aspects of the diaphragmatic surface of the liver

20

What is the subhepatic space

Extension of the greater peritoneal sac between the inferior aspect of the liver and the transverse colon

21

What and where is morison's pouch (hepatorenal recess)

Posterosuperior aspect of the right subhepatic space
Between the visceral surface of the liver and the right kidney

22

Cause of a subphrenic abscess

Accumulation of pus in the subphrenic space as a result of peritonitis

23

Which side do subphrenic abscesses more commonly occur and why

Right
Increased frequency of appendicitis and ruptured duodenal ulcers

24

What marks out the bare area

Reflection of the peritoneum from the diaphragm to the bare area as the anterior and posterior layers of the coronary ligament

25

What makes up the right triangular ligament

Anterior and posterior layers of the coronary ligament converge on the right side of the liver

26

What makes up the left triangular ligament

Near the apex, anterior and posterior layers of the coronary ligament converge on the left side of the liver

27

What covers the entire liver

Glisson's capsule (fibrous)

28

What are the lobes of the liver

Anatomical - let and right
Accessory - caudate and quadrate

29

What divides the liver into the left and right lobes

Falciform ligament (peritoneal fold that attaches liver to anterior abdominal wall)

30

Where is the visceral surface not covered in peritoneum

Fossa for the gallbladder
Porta hepatis

31

What is the porta hepatis

Transverse fissure where the hepatic portal vein, hepatic artery proper and bile duct enter and leave the liver

32

Where are the accessory lobes located

Visceral surface on the right lobe

33

Which fissures divide the right lobe into accessory lobes

Left and right sagittal fissures
Porta hepatis

34

Where is the caudate lobe

Superior to porta hepatis and between the inferior vena cava and fossa for the ligamentum venosum

35

Where is the quadrate lobe

Inferior to porta hepatis and between the gall bladder and fossa for the ligamentum teres

36

What are hepatocytes arranged into

Hexagonal lobules with a central vein

37

What's at the periphery of each lobule

Portal triad:
Arteriole - branch of hepatic artery proper
Venule - branch if hepatic portal vein
Duct - branch of bile duct
Lymphatic vessels
Vagus nerve

38

Venous drainage of the liver

3 hepatic veins which drain into the IVC
(Hepatic portal vein is the main blood supply to the liver parenchyma)

39

Innervation of liver parenchyma

Hepatic plexus which contains:
Sympathetic fibres - from the coeliac plexus
Parasympathetic fibres (vagus nerve)

40

Innervation of Glisson's capsule

Branches of the lower intercostal nerve therefore distension of the capsule results in well localised pain

41

Where are hepatic lymph nodes

Along hepatic vessels and ducts in the lesser omentum

42

What do the hepatic lymph nodes drain into

Coeliac lymph nodes

43

When is a percutaneous liver biopsy required

Abnormal LFTs of unknown cause
Hepatitis C - assessment of disease progression
Following liver transplantation

44

Describe a percutaneous liver biopsy

Liver is located by ultrasound
Local anaesthetic is injected on the mid-axillary line where on percussion there is dullness
Needle biopsy is taken during held expiration to avoid lung damage

45

What biopsy is used if the patient has abnormal clotting

Transvenous liver biopsy

46

Describe a transvenous liver biopsy

Internal jugular vein is cannulated
Biopsy needle is passed through the hepatic veins