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Abdomen > Liver A&P Review (Online One) > Flashcards

Liver A&P Review (Online One) Flashcards

1
Q

What is the Glisson’s Capsule

A

Fibro elastic and protective capsule surrounding the liver

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2
Q

Is the liver an intraperitoneal or retroperitoneal area

A

Intraperitoneal

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3
Q

How many ligaments hold the liver in place?
Name them

A

7 ligaments
2 Triangular
2 Coronary
1 Falciform
2 Ligaments of Lesser Omentum - Hepatogastric & Hepatoduodenal

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4
Q

Which ligament connects the liver to the anterior abdominal wall

A

Falciform Ligament

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5
Q

What is the Reidel’s lobe

A

Tongue like extension of right lobe and extends inferior to right kidney

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6
Q

What is the important of dividing the liver into segments

A

Division is needed when any liver resection is performed

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7
Q

In Couinaud’s divisonal anatomy, how many segments divide the liver

A

8 segments

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8
Q

How many lobes are in the liver
Name them

A

3 lobes
Left lobe
Caudate lobe
Right lobe

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9
Q

The lobes are further divided into segments.
Name the segments within these lobes

A

5 segments
1. Right naterior and posterior segments
2. Left lateral and medial segments
3. Caudate lobe

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10
Q

What structure divides the liver into right and left lobes?
What courses through this structure?

A

Main lobar fissure
MHV courses within the fissure

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11
Q

What fissure divides the left lobe into segments?
What structures run through this fissure?

A

Left intersegmental fissure
LHV, ascending branch of LPV, and falicform ligament

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12
Q

What fissure divides the right lobe into segments?
What structure runs through this fissure?

A

Right intersegmental fissure
RHV

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13
Q

Where is the caudate loe located

A

Located on posterior surface of the left lobe

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14
Q

What structures border the caudate lobe anterior, posteriorly, and inferiorly

A

A - Ligamentum Venosum
P - IVC
I - MPV

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15
Q

Name the vessels that drain blood from the liver.
Are these vessels intersegmental or intrasegmental

A

Intersegmental
Hepatic veins & IVC

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16
Q

Name 2 normal variants of the vessels of the hepatic veins

A

30% of people have more than 3 hepatic veins
MHV may join the LHV prior to entering the IVC

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17
Q

What vessels supply 70-90% of blood to the liver?
Where does this vessel arise from?

A

Portal veins
Arises from splenic vein, superior & inferior mesenteric veins

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18
Q

What is the job of the portal vein?
Are these vesels intersegmental or intrasegmental?

A

Intrasegmental
Allows for secondary flow of blood to remove bacteria from bloodstream & prevent harmful agents from entering the general circulation

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19
Q

What vessel supplies 25% of blood supply to liver?
How does this vessel originate?

A

Hepatic arteries
Originates from celiac axis and gastroduodenal artery

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20
Q

What is the porta hepatis

A

Area at the enterance of the liver

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21
Q

How can you define which structure is intrahepatic or extrahepatic

A

I - Any structure within Glisson’s capsule
E - Any structure outside the liver parenchyma and Glisson’s capsule

22
Q

Name a structure that is extrahepatic

A

Gallbladder
MPV

23
Q

What are lobules

A

Functional units of the liver

24
Q

What are sinusoids

A

Capillary-like connections in lobules traveling between columns of hepatocytes

25
Q

Name the functioning cells that surround the sinusoids

A

Hepatocytes

26
Q

What are the cells that are scattered along the walls of the sinusoids?
What is their purpose?

A

Kupffer cells
Ingest bacteria from the bloodstream

27
Q

Describe the flow of blood through the liver beginning with the inflow

A

PV & HA –> Through branches into sinusoids where Kupffer cells ingest bacteria –> Hepatocytes remove needed substances –> Lymph material and fluid goes into spaces of Disse –> Blood flows into central vein –> HV –> IVC

28
Q

The liver has many functions. Name the primary important functions.

A
  1. Bile formation
  2. Metabolic function
  3. Carbohydrate metabolism
  4. Fat metabolism
  5. Amino acid synthesis
  6. Protein synthesis
  7. Detoxification of blood
  8. Storage site
  9. Phagocytosis
  10. Blood Reservoir
  11. Sources of body heat
  12. Formation of lymph fluid
29
Q

What 2 enzymes are important for assessing liver function?
Where are these enzymes usually found?

A

AST & ALT
Found in liver cells and only minimally detected in the blood

30
Q

What happens to these enzymes when there is acute hepatocellular disease?
Are they affected significantly by biliary obstruction?

A

Blood levels of AST & ALT both rise
Not significantly by biliary obstruction

31
Q

Name the primary proteins synthesized in the liver?
What are these proteins responsible for in the body?

A

Albumin - Regulating fluid balance in the body
Globulin - Related to immune system
Fibrinogen, Prothrombin, Thrombin - Blood clotting proteins

32
Q

What are LFT’s?

A

Liver function tests
Measures blood, and enzymes to ensure liver is functioning properly

33
Q

Does total protein increase or decrease with liver dysfunction?

A

Decrease with liver dysfunction

34
Q

What acute conditions are present when max elevations of liver enzymes occur?

A
  1. Acute viral hepatitis
  2. Drug induced liver damage
  3. Severe liver congestion
35
Q

What is alkaline phosphatase?

A

Liver enzyme that is normally excreted into bile

36
Q

What happens to the alkaline phosphatase serum levels in post-hepatobiliary obstruction?

A

Serum levels increase

37
Q

What is prothrombin time?
What does an increased PT indicated?
What is the normal/average prothrombin time?

A

Normal time -12 seconds
Measurement of time to take sample of blood clot when plastothrombin is added
Increased PT can indicated decrease in prothrombin production in the liver

38
Q

What is bilirubin

A

Yellow bile pigment formed from the hemoglobin portion destroyed by RBC’s

39
Q

Describe the different between unconjugated/indirect bilirubin and conjugated/direct bilirubin.

A

U/IB - Not water soluble that must be carried through the bloodstream by albumin
C/DB - Water soluble bilirubin

40
Q

What converts indirct bilirubin into direct bilirubin?

A

Liver cells or Hepatocytes

41
Q

What is jaundice?
Name the 2 types.

A

Elevated levels of bilirubin in the blood and tissues
1. Medical/Non-obstructive
2. Surgical/Obstructive

42
Q

What is hemolytic jaundice?

A

Abnormally large # of RBC’s being destroyed

43
Q

What is hepatocellular jaundice?

A

Hepatocyte inflammation or fibrosis bile cannot be properly excreted into the bile canaliculi

44
Q

What happens to bilirubin with surgical jaundice?

A

Direct bilirubin is elevated

45
Q

What is Alpha-fetoprotein (AFP)?
Where is it normally found in the body?

A

Protein normally formed in fetal liver or yolk sac
Normally found in trace amounts after birth

46
Q

What does an elevated AFP indicated in a non-pregnant individual?

A

Hepatocell Carcinoma

47
Q

Describe the normal sonographic appearance of the liver.

A
  1. Homogeneous
  2. Echogenic margins
  3. Medium level echoes
  4. Easy visualization of vessels and diaphragm
48
Q

Compare the echogenicity of the liver to the spleen, pnacreas, and renal cortex.

A

Spleen - Isoechoic or hypoechoic
Pancreas - Hypoechoic
Renal Cortex - Isoechoic, minimally hyper echoic

49
Q

Describe the order of structures seen int he transverse plane of the liver.

A
  1. Diaphragm
  2. Dome of the liver
  3. Hepatic vein confluence
  4. Ascending LPV
  5. MPV/RPV
  6. Falciform Ligament
  7. GB
50
Q

Describe the order of structures seen in the longitudinal plane of the liver.

A
  1. Lateral tip of left lobe
  2. Left liver/aorta/gastroesophageal junction
  3. Caudate lobe/ligamentum venosum/IVC
  4. RPV/GB/MLF
  5. Liver/right kidney
  6. Lateral margin of right lobe

Abdomen (10 decks)

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