Liver

Anatomy

100

What is the normal length and weight of liver?

1400-1600grams 13-17cm

200

What week does liver, gallbladder, and bile duct system develop?

4th week; 6th week right lobe becomes bigger and caudate lobe develops from it

300

Right lobe: inferfior/posterior surfaces are marked by 3 fossae which are....

porta hepatis (opening where portal veins+hepatic arteries enter and hepatic ducts exit) gallbladder fossa IVC fossa

400

What is the dense, fibroelastic, connective tissue layer that covers the liver? What does it not cover? What is the caudate lobe covered by?

Glisson's Capsule Bare area lesser sac

500

A) What is Riedel's lobe? B) Where does the caudate lobe receive blood from?

A) anterior projection of the liver and may extend to iliac crest. "handle or tongue like projection" on right lobe. First appearance is hepatomegaly B) both right and left portals (independent blood supply)

Portal and Hepatic Venous Anatomy

100

What percent of total blood flow to the liver does the portal system supply? What are the 3 tributaries of the portal confluence?

75% 1. Splenic vein 2. SMV 3. IMV (these form the main portal vein)

200

Main portal vein divides at the porta hepatis into a right and left branch which further branch into....? Are these divisions intersegmental or intrasegmental?

Left-medial and lateral Right-anterior and posterior intrasegmental

300

What percent of blood supply is unfiltered coming from the stomach, intestines, and pancreas? Portal veins branch (vertically/horizontally) toward the (porta hepatis/IVC). Hepatic veins branch (longitudinally/transversely) toward the (porta hepatis/IVC).

80% horizontally, porta hepatis longitudinally, IVC

400

Right Hepatic vein: seperates and drains ______ and ______ segments of the ____ lobe. Left Hepatic vein: seperates and drains ______ and ______ segments of the ____ lobe. Middle Hepatic vein: seperates and drains ______ and ______ ____ liver lobes.

anterior and posterior of the right lobe medial and lateral of the left lobe right and medial left liver lobes

500

Hepatic veins subdivide further into the superior and inferior groups. What does the inferior veins drain? Common Hepatic artery: what percent is clean oxygenated blood? The hepatic artery is visualized normally on (long/transverse) scans at the level of what ligament?

the caudate lobe and the posteriormedial portion of the right lobe 20% transverse, heptoduodenal ligament

Ligaments and Fissures

100

Right Intersegmental fissure divides right lobe into_____ and ______ segments. What's the landmark to find this? Left intersegmental fissure divides left lobe into ______ and _____ segments.

anterior and posterior; right hepatic vein medial and lateral

200

What are the 7 ligaments that connect the liver to the undersurface of the diaphragm, the anterior wall of the abdomen, the lesser curvature of the stomach, and the retroperitoneum?

Coronary, falciform, ligamentum teres, triangular (left and right), gastrohepatic, hepatoduodenal

300

What is the gastrohepatic? Where does it begin and travel to?

AKA lesser omentum which begins on visceral surface of liver and travels caudally to attach to the lesser curvature or the stomach and 1st portion of duodenum.

400

The ligamentum teres comes off what ligament and continues as what ligament which seperates what segments of the left lobe and the caudate lobe?

falciform ligament, continues as ligamentum venosum. seperates medial and lateral segments. note: ligamentum venosum is a remnant of the fetal ductus venosus-the shunted oxygenated blood from the umbilical vein to the IVC.

500

Downward displacement of the liver is often caused by...? Elevation can be caused by the dilation of the...?

tumor infiltration, cirrhosis, or a subphrenic abscess colon, ascites, or abdominal tumors

Function

100

What are main functions of liver?

metabolism, detoxification, storage site, conversion of dietary sugars, produces proteins, metabolism of fats.

200

Cellular level: what line the vascular sinusoids? What phagocytizes bacteria and foreign materials? What synthesize, metabolize and excrete a variety of compounds?

Biliary Epithelial Kupfer cells hepatocytes

300

What does albumin function as in the bloodstream? Is it ionic or nonionic?

transport medium for a variety of molecules. draws water into the vascular system from tissue spaces and helps maintain oncotic pressure. nonionic

400

What is oncotic pressure? What percent of oncotic pressure is Albumin?

the pressure exerted by plasma on the capillary walls. 70%

500

what is Osmotic? Plasma down to a loss into the urine or malnutrition=??

Hydrostatic pressure "fluid". Tissues ability to comply with interstitial volume. oncotic pressure goes down

Function tests/Hepatic Enzymes

100

What are the 7 function tests?

1. AST 2. ALT 3. LDH 4. Alk Phos 5. Bilirubin (indirect, direct, and total) 6. Prothrombin time 7. Albumin and globulin's

200

What is AST? What is ALT?

an enzyme present in tissues that have a high rate of metabolic activity (liver). more specific than AST; elevation of ALT suggests a hepatic cause

300

What is bilirubin? What is direct bilirubin? Indirect bilirubin?

a product of the breakdown of hemoglobin in tired red blood cells. the liver converts these byproducts into bile pigments. conjugated bilirubin. excreted into the bile after reaching the liver and is conjugated with glucoronide unconjugated bilirubin. elevation indicates increased RBC destruction