Liver, Biliary and Portal System Flashcards Preview

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Flashcards in Liver, Biliary and Portal System Deck (36):
1

Liver

2nd largest organ
1-5-2kg
Exocrine and endocrine function

2

Functions of the liver

Detoxification
bile drainage
synthesis & storage of nutrients
blood filtration

3

What is the dual blood supply to the liver?

1/4 hepatic artery
3/4 portal vein

4

Where is the liver located?

Right hypochondrium, into the epigastric region

Sup: ribs 5-6
post to liver: oesophagus, duodenum, R kidney, gall bladder

5

Where is the gall bladder located

9th costal cartilage

6

What separates the lobes of the liver? Where does it come from

Left and right (larger) separated by the 'falciform ligament'. Remnant of the ventral mesogastrium in which the liver grew, runs down body wall to umbilicus

7

What does the falciform ligament contain. How is it formed

Ligamentum teres, remnant of the umbilical cord/vein.

8

What can you see on the posterior surface of the liver

Right/left lobe
Quadrate lobe
Caudate Lobe
IVC
Gall bladder
porta hepatis
bare area

9

What are caudate and quadrate both doing?

Sitting between a structure and the left lobe

10

Bare area?

Where the liver is posteriorly pressed up against the diaphragm and the peritoneum has be obliterated

11

Porta Hepatis? Where is this?

'doorway to liver' where structures enter / exit
Hepatic Artery Proper (ant & LHS)
Bile Duct (ant & LHS)
Portal Vein (posterior) largest

Found where the free edge of lesser omentum attaches. Behind the hepatoduodenal ligament

12

The lesser Omentum is split into...

Two ligaments
1) Hepatogastric (stomach > liver)
2) Heptoduodenal (liver > duodenum)

13

What happens at the porta hepatis?

Common hepatic (bile) duct splits > Right & left hepatic ducts

Proper Hepatic artery splits

14

Will you find hepatic veins at the Porta Hepatis

NO, they come in later and directly drain liver to IVC

15

How does the liver affect the lungs spatially?

Fills up a huge amount, displaces the lungs. During inflation the diaphragm pulls down the liver, allowing lung inflation.

16

What is the liver covered in

Visceral Peritoneum (*except for the bare area)
so it is INTRAPERITONEAL (gall bladder is also)

17

What forms the falciform ligament and Right/Left triangular ligaments

Peritoneum (past ventral mesogastrium) that has folded back on itself

18

Right layer of FL forms

Coronary and R. triangular ligaments

19

Left layer of FL forms

Left triangular ligament (lips back on itself)

20

Ligament Venosum

Embryological remenant of Ductus venosus ( a shunt that would direct blood ti the IVC)

21

The wrapping of peritoneum over structures and then folding over on itself creates spaces. What are these called?

Right and left Suprahepatic (above liver)
Right and left subhepatic (below liver)

22

Blood supply to Liver consists of? what does this drain to?

25% Hepatic artery (oxygenated)
75% Portal Vein (nutrient-rich)

blood conducted to liver> branches until it reaches sinusoids > reaches central veins of liver lobule.

Central veins > R & L hepatic veins > IVC

23

Sinusoids

'leaky areas' that blood and other substances can leak across

24

Difference between central veins and central hepatic veins

Central Veins: found in every liver lobule
Central hepatic vein: only the one, drains directly to IVC

25

Couinaud Classification. What does this mean about liver transplantation

8 segments of physiologically lobes, important radiologically.
There is no arterial communication between left and right halves of the liver!

Each lobe has its own portal triad of vessel supplying it. Therefore you can remove/transplant a lobe without affecting the rest of the liver

26

Hepatic Venous drainage of the liver? what is different about the caudate lobe?

Right, left and central hepatic veins drain to IVC
(central drains both left and right lobes)

CL has its own vein draining straight to IVC

27

Lymphatic Drainage of liver

Lymph from liver = 1/3 to 1/2 of total lymph

Nodes at porta hepatis, that flow to 'coeliac nodes @T12'

**small amount passes through diaphragm to posterior mediastinum

28

ANS of liver

visceral supply from coeliac plexus @T12
PS: vagus [X]
S: greater splanchnic nerves (T5-9)

Pain referred to epigastric region
**small amount via diaphragm to right shoulder due to some AN fibres

29

What can happen in the spaces caused by the peritoneum

Fluid can accumulate.
If the fluid remains there long enough, you get pseudomembranes that start to contain themselves >> ABSCESS

Pain will present when these push against the body wall

30

The biliary tree contains

Liver > L&RHD > CHD > GB

When we eat
GB > Cystic Duct > BD (8cm)
Bile duct joins with Pancreatic Ducts to form Ampulla of vater, which pierces the 2nd part of the duodenum via the sphincter of Oddi

31

Gross morphology of Gall bladder

Fundus : hangs below liver
Body: contacts visceral surface of liver
Neck: joins cystic duct

Covered in visceral peritoneum
Stores and concentrates bile

32

Arterial supply to liver comes from?

Abdominal aorta > coeliac axis > CHA (gastroduodenal branch) > HA proper > LHA and RHA(cystic branch)

33

The cystic artery (from RHA) passes through the...
What does the CA supply?

Triangle of Calot
Formed by RHA, inferior liver and GB/CD.
Supplies the gallbladder

34

GB venous drainage?
ANS?
Lymph?

Venous : cystic vein (to portal vein)
ANS: via coeliac plexus > pain to epigastic

Lymph: cystic nodes > hepatic > coeliac

35

Cholelithiasis? Types?

Gall stones: crystalline bodies made from bile components

Size from grain of sand > golf ball

Cholesterol = green/yellow
Pigment stones = bilirubin and calcium salts, small and dark

36

Gallstones specifically in the common bile duct

Choledocolithiasis