Portal Venous System/Liver

Question 1

The portal venous system drains what structures?

Answer 1

GI tract, spleen, pancreas, and gallbladder

Question 2

All nutrients except what kind pass through the portal system to the liver?

Answer 2

Fats

Question 3

What picks up the fats that bypass the liver?

Answer 3

Lymphatics of the small intestine (lacteals)

Question 4

What is the pathway of the portal venous system?

Answer 4

Abdominal organs (GI tract, spleen, pancreas, gallbladder) –> Tributaries of the portal vein –> Portal vein which divides into right and left branches –> liver sinusoids –> Inferior vena cava via the hepatic veins

Question 5

What is unique about the portal vein?

Answer 5

It has right and left branches, while veins usually have tributaries

Question 6

What does the caval venous system drain?

Answer 6

Everything the portal system does not

Question 7

What is the blood flow of the caval venous system?

Answer 7

Body wall and organs –> tributaries of the superior and inferior vena cava –> superior and inferior vena cava

Question 8

What forms the portal vein?

Answer 8

Formed behind the head of the pancreas by the union of the splenic and superior mesenteric vein

Question 9

What are the tributaries of the portal vein?

Answer 9

Splenic vein, superior mesenteric vein, left gastric vein, paraumbilical veins

Question 10

What are the tributaries of the splenic vein?

Answer 10

Short gastric veins, left gastro-omental vein, pancreatic veins, inferior mesenteric vein

Question 11

What are the tributaries of the inferior mesenteric vein?

Answer 11

Left colic vein, sigmoid veins, superior rectal vein

Question 12

What forms the inferior mesenteric vein?

Answer 12

Sigmoid vein and superior rectal vein

Question 13

What are the tributaries of the superior mesenteric vein?

Answer 13

Jejunal and ileal veins, ileocolic vein, right colic vein, middle colic vein, right gastro-omental vein, pancreaticoduodenal veins

Question 14

What vein of the portal system accompanies the ligaments teres to the umbilicus?

Answer 14

Paraumbilical veins

Question 15

What is cirrhosis of the liver?

Answer 15

A condition characterized by the destruction of hepatic cells and their replacement by fibrous tissue and fat

Question 16

What is unique about the paraumbilical veins?

Answer 16

Only tributary of the portal vein that doesn’t accompany artery of the same name

Question 17

How does portal hypertension occur with cirrhosis of the liver?

Answer 17

The liver becomes nodular and hard, therefore constricting the portal vein at the porta hepatis

Question 18

What are the causes of cirrhosis of the liver?

Answer 18

Alcoholism, hepatitis, chronic obstruction of the bile duct, or congestive heart failure

Question 19

What is portal hypertension?

Answer 19

Abnormal elevation of pressure within the portal system, often due to cirrhosis of the liver

Question 20

What vein is compromised in portal hypertension?

Answer 20

Portal vein

Question 21

What happens to blood flow during portal hypertension?

Answer 21

Due to the portal system’s lack of valves, the blood flow is reversed and bypasses the liver leading to back-ups in the caval system where portal-caval anastomoses occur

Question 22

What happens to these portal-caval anastomoses during back-ups due to portal hypertension?

Answer 22

Veins can become varicose and may rupture

Question 23

What are varicose veins like?

Answer 23

Dilated, tortuous, and thin-walled

Question 24

What are the three sites of portal-caval anastomoses?

Answer 24

Distal esophagus, around the umbilicus, rectum/anal canal

Question 25

What veins make up the portal-caval anastomosis of the distal esophagus?

Answer 25

Caval = esophageal, Portal = left gastric

Question 26

What veins make up the portal-caval anastomosis around he umbilicus?

Answer 26

Caval = superficial veins of the anterior abdominal wall, Portal = paraumbilical

Question 27

What veins make up the portal-caval anastomosis of the rectum and anal canal?

Answer 27

Caval = middle and inferior rectal, Portal = superior rectal

Question 28

What is the obstructive sign of portal hypertension at the distal esophagus's portal-caval anastomosis?

Answer 28

Esophageal varices

Question 29

What is the obstructive sign of portal hypertension at the portal-caval anastomosis around the umbilicus?

Answer 29

Caput medusae

Question 30

What is the obstructive sign of portal hypertension at the rectum/anal canal's portal-caval anastomosis?

Answer 30

Hemorrhoids

Question 31

What is the worst case scenario for esophageal varices?

Answer 31

They can hemorrhage with severe, often fatal, bleeding

Question 32

Are hemorrhoids diagnostic of portal hypertension when present alone?

Answer 32

NO.

Question 33

What is the largest visceral organ and the largest gland in the body?

Answer 33

Liver

Question 34

What are the functions of the liver?

Answer 34

Bile secretion; metabolism of macronutrients; storage of glycogen, vitamins, and iron; detoxification

Question 35

What is the function of bile?

Answer 35

Fat emulsification

Question 36

What surface of the liver is superior and convex?

Answer 36

Diaphragmatic surface

Question 37

What surface of the liver is inferior and concave

Answer 37

Visceral surface

Question 38

What separates the diaphragmatic and visceral surfaces of the liver?

Answer 38

A sharp, inferior border

Question 39

What does the porta hepatis contain?

Answer 39

Common hepatic duct (right), hepatic artery proper (left), portal vein (behind)

Question 40

What significant structure does NOT pass through the porta hepatis?

Answer 40

Inferior vena cava

Question 41

What lobe of the liver contains the gall bladder in a fossa on its visceral surface with the inferior vena cava lying posterior to it?

Answer 41

Right lobe

Question 42

What lobe of the liver lies between the right and left lobes and anterior to the porta hepatis with the gall bladder to its right?

Answer 42

Quadrate lobe

Question 43

What lobe of the liver lies between the right and left lobes and posterior to the porta hepatis?

Answer 43

Caudate lobe

Question 44

What lobe of the liver lies to the left of the falciform ligament and is small than the right lobe?

Answer 44

Left lobe of the liver

Question 45

What is jaundice?

Answer 45

Yellow discoloration of the skin, sclera, and mucous membranes due to the release of bilirubin into circulation

Question 46

What is often the cause of jaundice?

Answer 46

Liver damage

Question 47

Where would the functional division of the liver be made?

Answer 47

To the right of the falciform ligament

Question 48

What hepatic segments lie in the left function half of the liver?

Answer 48

I-IV

Question 49

What hepatic segments lie in the right functional half of the liver?

Answer 49

V-VIII

Question 50

What is the area of the liver that is uncovered by visceral peritoneum?

Answer 50

Bare area

Question 51

Where is the bare area of the liver located?

Answer 51

Posterior aspect of the diaphragmatic surface

Question 52

What sits on the bare area of the liver?

Answer 52

Diaphragm

Question 53

What important venous structure lies within the bare area?

Answer 53

Inferior vena cava

Question 54

What ligament connects the liver to the diaphragm and anterior abdominal wall?

Answer 54

Falciform ligament

Question 55

What ligament is the splitting of the falciform ligament as it passes posteriorly along the diaphragmatic surface of the liver?

Answer 55

Coronary ligament

Question 56

What are the borders of the bare area?

Answer 56

Superior and inferior layers of the coronary ligament

Question 57

What ligaments are formed at the junction of the superior and inferior layers of the coronary ligament on each side?

Answer 57

Right and left triangular ligaments

Question 58

What ligament forms the free edge of the falciform ligament?

Answer 58

Ligamentum teres

Question 59

The ligamentum teres is a remnant of what structure?

Answer 59

The obliterated umbilical vein

Question 60

What ligament is located between the left and caudate lobes?

Answer 60

Ligamentum venosum

Question 61

The ligamentum venosum is a remnant of what structure?

Answer 61

The ductus venosus

Question 62

What ligament covers the inferior vena cava within the bare area of the liver?

Answer 62

Ligament of the inferior vena cava

Question 63

The fissures of the liver form what shape on its visceral surface?

Answer 63

An H

Question 64

What fissure is located between the left lobe and quadrate lobe?

Answer 64

Fissure for the ligamentum teres

Question 65

What issue is located between the left lobe and caudate lobe?

Answer 65

Fissure for the ligamentum venosum

Question 66

What fossa is located between the right lobe and the quadrate lobe?

Answer 66

Fossa for the gallbladder

Question 67

What fissure is located between the right lobe and the caudate lobe?

Answer 67

Fissure for the inferior vena cava

Question 68

What forms the crossbar of the H-shape of fissures on the liver?

Answer 68

Porta hepatis

Question 69

What makes up the liver's dual blood supply?

Answer 69

Portal vein and hepatic artery

Question 70

What is the innervation of the liver?

Answer 70

Autonomic and pain fibers are from the hepatic plexus which is an extension of the celiac plexus

Question 71

The portal vein makes up what percentage of the liver's blood supply?

Answer 71

75-80%

Question 72

The hepatic artery makes up what percent of the liver's blood supply?

Answer 72

20-25%