Liver Anatomy/Functions, & Vasculature

main functions of the liver

carbs, fat, amnio acid metabolism

remove waste products

vitamin/mineral storage

drug inactivation

synthesis/secretion of bile

blood reservoir

lymph production

detox

liver function tests

albumin decrease

Increase:

ALP

ALT
AST
LDH
Serum bilirubin
AFP

9 quadrants

Rt hypochondriac epigastric Lt hypochondriac

Rt lumbar umbilical Lt lumbar

Rt iliac hypogastric Lt iliac

what covers the liver surface

Glisson capsule

3 lobes of liver

right

left

caudate

sometimes quadrate (b/w GB fossa & round ligament/teres)

Couinauds classification

divided by hepatics & portals

hepatics: intersegmental (between the segments)

portals: intrasegmental (inside the segements)

Lt lobe: 2, 3, 4a, 4b

Rt lobe: 5, 6, 7, 8

separating the liver segments

lt hepatics divides lt lateral & lt medial lobe

middle hepatic divides rt & lt lobe

rt hepatic divides ant & post rt lobe

lt & rt portal veins separate superior & inferior (in TRV plane):

superior- 2, 4a, 8, 7

inferior: 3, 4b, 5, 6

what else can be sued to separate rt & lt lobe

falciform ligament

ligamentum teres

what to hepatics vs portal veins do

hepatics drain blood from liver into IVC

portal vein is majority of oxygenated blood perfusion of liver along with common hepatic artery from the celiac trunk

main portal vein division & normal flow

enters through porta hepatis from the confluence of SMV & splenic vein

< 13 mm (enlargement indicates portal hypertension)

splits into rt and lt portal veins

Rt splits into ant & post

lt splits into lateral & medial

normal flow: hepatopetal & monophasic w respiratory changes

hepatic normal flow & enlargement indications

triphasic & hepatofugal

enlarged hepatics & IVC = rt sided heart failure

occlusion/narrowing of at least 2 hepatics = budd-chiari syndrome

porta hepatis

mickey mouse- MPV, CBD, hepatic artery

normal flow: low resistance

umbilical vein

in utero provides blood to fetus via ductus venosus shunt

after birth:

ductus venosus becomes ligamental venosum

umbilical vein connects to LPV & becomes ligamentum teres (round ligament)

recanalixation can occur w/portal hypertension