Liver And Hepatobiliary System

Question 1

Liver origin and position

Answer 1

From foregut 
In right hypochondrium + epigastrium
Right side completely covered by ribs 
Left by R.A. 
connected to stomach by gastrohepatic ligament

Question 2

Liver functions

Answer 2

1. Bile
2. Detoxification
3. Glucogenesis/glycogenesis/glycogenolysis
4. Aa/fat metabolism
5. Cholesterol production
6. Immunity
7. Blood protein manufacturing
8. Stores iron

Question 3

Relations of liver

Answer 3

Falciform lig: AAW
COronary lig: inferior diaphragmatic surface
Round lig: remnant of umbilical vein on free edge of falciform
Bare area of liver in direct contact with diaphragm
Under/behind liver is subhepatic recess (collects infection when lying down)

Question 4

Organs in contact with liver

Answer 4

Gall bladder under right lobe 
Right colic flexure 
Spleen 
Stomach 
Kidneys

Question 5

Number of liver segments

Answer 5

8

Question 6

Venous drainage of liver

Answer 6

Right hepatic vein/middle/left -> IVC

Question 7

Lobes of liver, how’re they separated

Answer 7

Right /left /caudate(on TOP) / quadrate

Hunter’s H: |ligamentum venosum; - porta hepatis; | IVC

Question 8

Location of porta hepatis

Answer 8

On free edge of lesser omentum

Question 9

Percentage of blood that HPV and HA supplies to liver

Answer 9

HPV: 75%
HA: 25%

Question 10

Parts of liver not surrounded by peritoneum

Answer 10

Bare area
IVC
porta hepatis

Question 11

Ligaments of liver

Answer 11

Left triangular ligament: continuous with falciform, from coronary ligament, connects to diaphragm
Right triangular ligament: at bare area, from coronary, attaches to diaphragm
Falciform ligament : separates right/left lobes, attaches to AAW
Coronary ligament: connects to diaphragm, goes around IVC
Ligamentum venosum : remnant of umbilical vein, goes around porta hepatis; connects to lesser omentum
Round ligament: on free edge of falciform

Question 12

Portal triad constituents

Answer 12

HPV
Proper Hepatic artery
Hepatic duct

Question 13

Ductal connections

Answer 13

Right hepatic & left hepatic duct -> common hepatic

Common hepatic & cystic -> common bile duct

Question 14

Arterial connections

Answer 14

Proper hepatic-> (right gastric)/ right hepatic (-> cystic)/middle hepatic/left hepatic

Question 15

HPV connections

Answer 15

Short gastric/IMV/left gastroepiploic-> splenic
midgut/right gastroepiploic-> SMV
Right/left gastric veins
Cystic

Question 16

What if HPV is blocked

Answer 16

CAPUT MEDUSAE: Superficial epigastric veins (paraumbilical/superficial epigastric/thoracoepigastric) get engorged with blood -> blood flows away from belly b

Question 17

What happens when IVC is blocked

Answer 17

CAPUT MEDUSAE: Superficial epigastric veins (paraumbilical/superficial epigastric/thoracoepigastric) get engorged with blood -> blood flows upwards towards and away from belly b

Question 18

Gall bladder blood supply

Answer 18

Cystic artery

Question 19

Common bile duct + pancreatic duct empty into duodenum via… what’s the papilla called

Answer 19

Hepatopancreatic ampulla of vater / sphincter of oddi

Greater duodenal papilla