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liver anatomy Flashcards

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1
Q

what is the largest gland in the body?

A

liver

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2
Q

where is the liver?

A

sits under the right dome of the diaphragm

mainly covered by ribcage

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3
Q

why can the liver be felt on inspiration?

A

diaphragm flattens on inspiration and flattens the liver down so the inferior border can be palpated

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4
Q

where is the liver on expiration?

A

tucked under the costal margin

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5
Q

what is the biggest lobe of the liver?

A

right lobe

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6
Q

how many lobes on the posterior surface of the liver?

A

4

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7
Q

is the liver retroperitoneal or intraperitoneal?

A

intraperitoneal

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8
Q

where is the falciform ligament found?

A

anterior abdominal wall to the liver

separates the left and right lobe of the liver

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9
Q

what does the falciform ligament split into?

A

the anterior coronary ligaments

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10
Q

where is the triangular ligament?

A

where the anterior and posterior coronary ligaments join

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11
Q

what is the bare area of the liver?

A

between the coronary and triangular ligaments

area of the liver that isnt covered by any ligaments

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12
Q

where does blood from the umbilical vein go?

A

some drains into the hepatic portal vein and the rest goes through the ductus venosus to the IVC

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13
Q

in the fetal circulation, where does blood go from the IVC?

A

2 routes

1 - IVC –> RA –> foramen ovale –> rest of the body

  1. IVC –> RV –> pulmonary trunk –> ductus arteriosus –> aorta
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14
Q

how is the ligamentum teres formed?

A

umbilical vein fibroses to form the ligamentum teres

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15
Q

what does the lesser omentum connect?

A

the liver to the stomach

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16
Q

what passes through the origin of the lesser omentum?

A

hepatic portal vein
hepatic artery proper
common bile duct (porta hepatis)

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17
Q

what is the clinical relevance of the opening of the lesser omentum?

A

if any of the vessels passing through it are bleeding then you can clamp then and the bleeding stops

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18
Q

what are the 2 different blood supplies to the liver? how much do each contribute?

A

75% - hepatic portal vein

25% - hepatic artery proper

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19
Q

where does all blood to the gut pass before it goes to the IVC?

A

goes to the liver first

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20
Q

describe the path of the hepatic portal circulation

A 
aorta
coeliac trunk
stomach (food is digested and breakdown products go into the venous blood away from the gut)
hepatic portal vein
liver
hepatic vein
IVC
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21
Q

what are the 2 main functions of the liver?

A
  • Store and release glucose as needed.

- Clearing the blood of drugs and other harmful substances.

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22
Q

what artery supplies the foregut?

A

coeliac trunk

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23
Q

what is the foregut?

A

oesophagus to the 2nd part of the duodenum

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24
Q

what artery supplies the midgut?

A

superior mesenteric artery

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25
what is the midgut?
3rd part of the duodenum, jejenum, ileum, cecum, appendix, ascending colon and then 2/3 along the transverse colon
26
what artery supplies the hindgut
inferior mesenteric artery
27
what is the hindgut?
from 2/3 transverse colon to the rectum (not to the anus)
28
what level does the coeliac trunk come off?
T12
29
what arteries does the coeliac trunk give rise to and what do they supply?
Left gastric (supplies lesser curvature of the stomach) Splenic artery (behind the stomach to the spleen) Common hepatic artery (towards the right to the liver)
30
what does the common hepatic artery split into?
gastroduodenal artery (runs behind the duodenum) right gastric artery (runs to the lesser curvature of the stomach)
31
where does the greater curvature of the stomach get its blood supply from?
gastroepiploic artery
32
where do the right and left gastroepiploic artery come from?
Right gastroepiploic from the gastroduodenal artery Left gastroepiploic from the splenic artery
33
what happens to the common hepatic artery after it splits?
becomes hepatic artery proper | splits into R and L and then goes to supply the liver
34
what branches does the left gastric artery give off?
oesophageal branches
35
where does the superior mesenteric artery run?
behind the head of the pancreas
36
what branches does the SMA give off?
ileal and jejenal middle colic right colic ileocolic
37
what branches does the IMA give off?
3x branches | left colic, sigmoid arteries and the superior rectal artery
38
what drains into the splenic vein?
All blood from the stomach, spleen and lower part of the oesophagus
39
what does the splenic vein join?
mesenteric veins to form the hepatic portal vein
40
what is the portal venous drainage and systemic venous drainage of the oesophagus?
PVD - left gastric vein | SVD - azygous vein
41
what is the portal venous drainage and systemic venous drainage of the rectum?
PVD - superior rectal vein | SVD - inferior rectal vein
42
what is the portal venous drainage and systemic venous drainage of the anterior abdominal wall?
PVD - paraumbilical veins | SVD - intercostal and inferior epigastric
43
what is the portal venous drainage and systemic venous drainage of the retro-peritoneal?
PVD - duodenal, pancreatic, right and left colic veins | SVD - lumbar veins
44
what is cirrhosis? what is it characterised by?
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to loss of liver function.
45
how does portal hypertension occur?
instead of having smooth channels in the sinusoids, the channels get broken up and distorted so you increase resistance to blood flow through the liver --> increase BP in the portal vein
46
where do oesophageal varices occur?
occur at the anastomoses of left gastric vein with oesophageal veins at gastro-oesophageal junction
47
why are oesophageal varices the most clinically relevant?
lowest pressure needed for these to form
48
how do oesophageal varices present?
haematemesis
49
how are oesophageal varices treated?
Can be treated with oesophageal banding – elastic bands around the oesophagus so they stop bleeding
50
what is caput medusa?
recanalised umbilical vein within the faliciform ligament. | • Paraumbilical veins radiate superiorly to IC veins and inferiorly to epigastric vein
51
what is ascites?
fluid in the peritoneal space
52
what can cause ascites?
portal hypertension hypoalbuminemia aldosterone related renal sodium retention, with consequent blood volume expansion (further exacerbated by additional pressure on kidneys)
53
explain how portal hypertension can cause ascites?
Increased portal hypertension  increased cap pressure  increased lymph fluid  increased ascites
54
how do vasodilators contribute to ascites?
Also makes more vasodilators  arterial vasodilation  reduction in blood pressure  triggers activation of SNS and RAA system  sodium and water retention  increased plasma volume  increases peritoneal fluid
55
what does the superior rectal vein drain into?
superior mesenteric vein
56
what is the inferior rectal vein a branch of?
internal pudendal vein which is a branch of the internal iliac vein
57
what causes splenomegaly?
Consequence of increased HPP: blood gets backed up into the hepatic portal system. Goes directly into the spleen  increased blood volume in the spleen  splenomegaly
58
what do the L and R hepatic duct join to form?
common hepatic duct
59
what branches off the common hepatic duct?
cystic duct
60
where does the cystic duct go?
gallbladder
61
what joins to form the common bile duct?
joining of the common hepatic duct and cystic duct
62
where is bile produced?
liver
63
where is bile stored and released from?
the gallbladder
64
when are gallstones asymptomatic?
when they're just sitting in the gallbladder not blocking anything
65
what happens when gallstones get stuck in the neck of the gallbladder? how does this present?
stone blocks bile leaving the gallbladder when gallbladder contracts, URQ pain biliary colic
66
how does acute cholechystitis occur?
if gallstones are stuck in the gallbladder for long enough it causes inflammation
67
how is acute cholechystitis tested for?
Murphy’s sign which is when you put your hand under the costal margin, get the patient to inhale. Push the liver down and pushes on the gallbladder  pain if inflammation
68
what happens if the gallstone blocks bile leaving the gallbladder and the liver?
So bilirubin in bile is not able to be broken down and so accumulates in blood causing jaundice and biliary colic.
69
what happens if the gallstoe blocks the bile and pancreatic ducts?
stops flow of bile and pancreatic enzymes | causes biliary colic, jaundice and pancreatitis

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