Liver and Biliary Flashcards
(21 cards)
Liver role
Detoxification, carbohydrate & glucose regulation, Bile drainage, blood circulation and filtration, synthesis and storage of a/acids, proteins, fats and vitamins
Liver blood supply
¼ Hepatic artery
¾ Portal vein
Liver and gallbaldder surface anatomy and relations
R Hypochondrium, into epigastric region
Sup boundary = Rib 5/6 level
Post. Surface = Oesophagus, Stomach, Duodenum, R. Colic flexure, R. Kidney, R Supra-renal gland, Gallbladder
Gallbladder = R 9th Costal Cart. Level
Gross morphology of the liver (anterior and posterior)
-lobes
-gallbladder location
- ligaments
Anterior: Right lobe
Left lobe
Gallbladder is under the right lobe
Falciform ligament between lobes
Ligamentum teres is the outcropping of the falciform ligament.
Posterior:
Left lobe
Right lobe
Bare area
Caudate lobe
Quadrate lobe
Gallbladder
Inferior vena cava
What is in the portal triad and specific locations of each component
What is porta Hepatis
Porta Hepatis
Free edge of lesser omentum attaches here (carrying structures with it)
Hepatic artery = Ant. & LHS
Bile duct = Ant. & RHS
Portal vein = Posterior (between)
Portal triad
what does each element split into?
Portal Vein = Largest
Splits inside Liver into L & R Portal veins
(Flow INTO liver)
Proper Hepatic Artery
Splits into R & L Hepatic arteries
(Flow INTO liver)
Common Hepatic Duct
Receives R & L Hepatic ducts
(Flow OUT of liver)
Peritoneum
- What type covers the liver and what areas of the liver does it NOT cover
- how are ligaments formed?
- 2 ligaments of the liver and purpose
Apart from area attached to diaphragm (bare area) and the fossa for the Gall Bladder, the Liver = covered in visceral peritoneum
Peritoneum folds back on itself to make ligaments of the liver
Falciform ligament passes to the umbilicus and contains the ligamentum teres (the remnants of the umbilical vein)
What are the 6 peritoneal ligaments?
Right triangular ligament
Left triangular ligament
Anterior coronary ligament
Posterior coronary ligament
Falciform ligament
Ligamentum teres
Difference between arterial and portal blood supply and how is the blood taken to the liver
Arterial = oxygenated,
Portal = nutrient rich
Arterial & venous blood are conducted to central vein of each liver lobule by sinusoids
What other veins in liver other than portal
central hepatic vein drains into Left and right hepatic which then goes to IVC
Further, right and left portal vein in liver
Functional liver segments
-label diagram
-features of each segment
-how are the segements formed?
-is there communication between left and right halves of liver?
Halves / Segments physiologically defined: each has own branch of the portal triad
Segments geographically / physically determined by position of Hepatic & Portal veins
No arterial communication between Left & Right Halves of the Liver!
Label radiology for liver
Lecture Slide (2 images)
Lymphatic drainage and ANS and where is pain felt?
Nodes at porta hepatis to coeliac nodes @T12
ANS
Visceral supply from Coeliac plexus
- Parasymp. via the Vagus [X]
- Symp. from greater splanchnic nerves (T5-9)
Pain = referred to epigastric region
(Small amount via diaphragm to
Right Shoulder/Chest)
Overview of Blood, Vein, Nerve and lymph of the liver
Blood:
Arterial Supply – 25% - Hepatic Artery Proper
Venous Supply – 75% - Portal Vein
Venous Drainage – Hepatic Veins into IVC
Nerve – ANS via Celiac Plexus
- Parasymp = Vagus [X]
- Symp = Greater Splanchnic T5-9
Lymph – Pre-Aortic / Celiac Nodes @ T12
Gallbladder GROSS morphology
- 3 sections
F = fundus hangs below liver (top)
B = body contacts visceral surface of liver (middle)
N = neck joins cystic duct (base aka closest to pancreas end)
Gallbladder covered in?
Gallbladder Role?
When and how does gallbladder release bile
visceral peritoneum
Job = Store and concentrate bile
- Internal folds and microvilli
Fat in duodenum – releases cholecystokinin (from small intestine mucosa) - causes GB to contract
Smooth muscle at distal end bile duct and ampulla relax = bile into duodenum to emulsify fat
Biliary tree
- path of bile from gallbladder to sphnicter of oddi
Bile secreted by liver and stored by gall bladder
enters the common Bile duct with the common hepatic duct to form the common bile duct which ends by piercing medial wall of 2nd part of duodenum
Joined by main pancreatic duct and open into Hepatopancreatic Ampulla (of Vater)
Ampulla opens into duodenum via Major Duodenal Papilla / Sphincter of Oddi
Blood/Nerve (and pain region)/Lymph of GALLBLADDER
Arterial =
- Cystic artery (from R Hepatic artery)
Passes through the “Hepatobiliary Triangle”
Nerve:
ANS via the Coeliac Plexus
- pain to epigastric region
Lymph:
Cystic nodes = hepatic = celiac
Describe the flow of artery from aorta to Right branch of proper hepatic
LEcture slide
Aorta
Celiac trunk (splenic, left gastric, common hepatic)
Common hepatic
- right gastric
- gastroduodenual
Proper hepatic
Left and right branch (cystic)
What is the CD, CHD, CBD
Right and Left hepatic ducts combine to form the common heaptic duct. Cystic duct comes from gallbladder which connects with the common hepatic duct. These merge to create the common bile duct
How to find the cystic artery
Triangle of cystic duct, CHD, Liver
