Liver, Biliary and Portal System

Question 1

Liver

Answer 1

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

Question 2

Functions of the liver

Answer 2

Detoxification
bile drainage
synthesis & storage of nutrients
blood filtration

Question 3

What is the dual blood supply to the liver?

Answer 3

1/4 hepatic artery

3/4 portal vein

Question 4

Where is the liver located?

Answer 4

Right hypochondrium, into the epigastric region

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

Question 5

Where is the gall bladder located

Answer 5

9th costal cartilage

Question 6

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

Answer 6

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

Question 7

What does the falciform ligament contain. How is it formed

Answer 7

Ligamentum teres, remnant of the umbilical cord/vein.

Question 8

What can you see on the posterior surface of the liver

Answer 8

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

Question 9

What are caudate and quadrate both doing?

Answer 9

Sitting between a structure and the left lobe

Question 10

Bare area?

Answer 10

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

Question 11

Porta Hepatis? Where is this?

Answer 11

'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

Question 12

The lesser Omentum is split into…

Answer 12

Two ligaments

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

Question 13

What happens at the porta hepatis?

Answer 13

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

Proper Hepatic artery splits

Question 14

Will you find hepatic veins at the Porta Hepatis

Answer 14

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

Question 15

How does the liver affect the lungs spatially?

Answer 15

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

Question 16

What is the liver covered in

Answer 16

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

Question 17

What forms the falciform ligament and Right/Left triangular ligaments

Answer 17

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

Question 18

Right layer of FL forms

Answer 18

Coronary and R. triangular ligaments

Question 19

Left layer of FL forms

Answer 19

Left triangular ligament (lips back on itself)

Question 20

Ligament Venosum

Answer 20

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

Question 21

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

Answer 21

Right and left Suprahepatic (above liver)

Right and left subhepatic (below liver)

Question 22

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

Answer 22

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

Question 23

Sinusoids

Answer 23

‘leaky areas’ that blood and other substances can leak across

Question 24

Difference between central veins and central hepatic veins

Answer 24

Central Veins: found in every liver lobule

Central hepatic vein: only the one, drains directly to IVC

Question 25

Couinaud Classification. What does this mean about liver transplantation

Answer 25

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

Question 26

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

Answer 26

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

Question 27

Lymphatic Drainage of liver

Answer 27

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

Question 28

ANS of liver

Answer 28

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

Question 29

What can happen in the spaces caused by the peritoneum

Answer 29

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

Question 30

The biliary tree contains

Answer 30

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

Question 31

Gross morphology of Gall bladder

Answer 31

Fundus : hangs below liver Body: contacts visceral surface of liver Neck: joins cystic duct Covered in visceral peritoneum Stores and concentrates bile

Question 32

Arterial supply to liver comes from?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

GB venous drainage? ANS? Lymph?

Answer 34

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

Question 35

Cholelithiasis? Types?

Answer 35

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

Question 36

Gallstones specifically in the common bile duct

Answer 36

Choledocolithiasis