303: Hepatobiliary System

Liver

What is the largest gland in the body?

after joining circulation

when are lipids processed by the liver?

Liver

What processes all digested materials & venous blood from spleen & pacnreas

Secretes bile for emulsification of lipids, waste products

What does the exocrine gland of the liver do?

Serum albumin, lipoproteins, thyroid hormone (active form) etc.

What does the endocrine gland of the liver do?

IVC

diaphragm

what two structures suspend the liver?

R. triangular ligament

Identify the structure at #1?

L. triangular ligament

Identify the structure at #2?

Visceral peritoneum

Identify the structure at #3?

Coronary ligament

Identify the structure at #4?

coronary ligament

this ligament helps suspend the liver to the posterior abdominal wall at the "bare area" (adventitia)

right lobe

the bare area is located on the posterior surface of which liver lobe?

liver

what structure is palpable right under the xiphoid process?

Foregut

Are the liver and gall bladder part of the foregut, midgut, or hindgut?

2nd part

The liver, gall bladder & pancreas develop from an outgrowth from what part of the duodenum?

Celiac artery

Which artery is primarily associated with the foregut, supplying blood to the liver, gall bladder, and pancreas?

Superior mesenteric artery

Which artery primarily supplies blood to the midgut, including the small intestine and part of the large intestine?

Inferior mesenteric artery

Which artery primarily supplies blood to the hindgut, including the distal part of the colon and rectum?

2nd part (this explaining the common duct system opening at this location in the adult)

The liver, gall bladder, and pancreas share a common duct system that opens into which part of the duodenum?

Major duodenal papilla (opening for bile duct & main pancreatic duct)

Identify the structure the larger arrow points to

celiac trunk

what main artery supplies the liver?

mesentery

double layer of peritoneum between body wall (usually posterior) and organ

In the mesentery (between two peritoneal layers)

How do neurovascular structures pass to organs?

ligament

double layer of peritoneum between organs or between an organ and the abdominal wall

omentum

double layer of peritoneum between the stomach and another organ

ventral mesentery

The developing liver forms within a...

lesser omentum

the double layer of peritoneum between the stomach and liver:

ventral mesentery

the adult lesser omentum develops from the:

ventral mesentery

the falciform ligament develops from the:

hepatogastric ligament

hepatoduodenal ligament

what two ligaments does the lesser omentum comprise of:

hepatoduodenal ligament

the portal triad travels through what part of the lesser omentum?

Probe in epiploic foramen (of Winslow) = opening into lesser sac

What is shown at #1?

Tip of probe in lesser sac (omental bursa)

What is shown at #2?

Lesser omentum

What is shown at #3?

Hepatogasatric ligaments

What is shown at the red *

Hepatoduodenal ligaments

What is shown at the white *

Portal triad

What is the ring around?

portal vein

hepatic artery

common bile duct

list the components of the portal triad:

posterior to stomach

where is the lesser sac located?

lesser sac

patient has an ulcer on the posterior side of the stomach that has resulted in fluid accumulation. While standing, where would this fluid accumulate?

hepatorenal recess (pouch of Morrison)

patient has an ulcer on the posterior side of the stomach that has resulted in fluid accumulation. While laying supine, where would this fluid accumulate?

Epiploic foramen (foramen of winslow)

what is the name of the opening to the lesser sac?

umbilical vein

during fetal life, what structure ran on the inferior border of the falciform ligament?

ductus venosus

what fetal structure allowed blood to pass through the liver straight into the IVC?

ligamentum venosum

the ductus venosus obliterates and becomes the:

ductus venosus

what is now the ligamentum venosum was the former:

ligamentum teres hepatis (round ligament)

the umbilical vein obliterates and becomes the:

umbilical vein

what is now the ligamentum teres hepatis was the former:

Ductus venosus

What structure is at #1?

Ligamentum venosum

What structure is at #2?

Ligamentum teres hepatis

What structure is at #3?

Falciform ligament

What structure is at #4?

falciform ligament

what structure divides the liver into right and left lobes?

Falciform ligament (from ventral mesentery)

What are the arrows all pointing to?

caudate lobe

which lobe on the posterior surface of the liver sits to the left of the IVC?

quadrate lobe

which lobe on the posterior surface of the liver sits to the left of the gallbladder?

Ligamentum venosum

Ligamentum teres hepatis (round ligament)

What makes up the umbilical fissure?

Right lobe of the liver

Identify the structure

Left lobe of the liver

Identify the structure

Caudate lobe of the liver

Identify the structure

Quadrate lobe of the liver

Identify the structure

True - functional lobes are defined by their dual blood supply

T/F: Functional liver lobes diver from these morphological lobes

1/2 left hepatic a.

1/2 right hepatic a.

the caudate lobe receives blood from what artery:

alcohol abuse

hepatitis infection

autoimmune disease

industrial solvents

list 4 causes of irreversible cirrhosis

irreversible cirrhosis

patient presents with splenomegaly (due to portal hypertension) and ascites. Liver has "hobnail" appearance. Patient is a long time factory worker and has hep B. what is the diagnosis?

hepatic portal v.

patient presents with esophageal varices. These veins are compensating for what structure?

Esophageal varices

This esophagoscope shows what disease?

ascending and descending colon

retroperitoneal varices will present on what structure?

Rectal v.

A patient presents with anorectal varices. Which vein is most likely involved in this condition?

Paraumbilical v.

A patient presents with dilation of periumbilical veins (caput medusa). Which vein is most likely involved in this condition?

hepatic portal v.

venous supply to the liver travels via the:

venous

the majority (75%) of blood that travels to the liver is:

arterial

the minority (25%) of blood that travels to the liver is:

left hepatic a.

the quadrate lobe receives arterial blood from the:

right hepatic a. (Cystic artery)

the gallbladder receives arterial blood from the:

caudate lobe

which liver lobe receives arterial blood from both (50:50) left and right hepatic artery?

right

anatomically, the caudate lobe is a part of the ______ liver

right

anatomically, the quadrate lobe is a part of the ______ liver

Hepatic portal vein

Identify the structure

Splenic vein

Identify the structure

Inferior mesenteric vein

Identify the structure

Superior mesenteric vein

Identify the structure

False - all are valveless

T/F - All veins have valves to the liver

Hepatic artery proper

Identify the structure at #1

Bile duct

Identify the structure at #2

Portal vein

Identify the structure at #3

Gastroduodenal artery

Identify the structure at #4

Right hepatic artery

Identify the structure at #5

Left hepatic artery

Identify the structure at #6

Celiac trunk

Identify the structure at #7

Common hepatic artery

Identify the structure at #8

The liver is divided by hepatic arteries, portal

veins (& bile ducts) horizontally and hepatic veins vertically, giving rise to 8 segments

How many segments does the liver have?

True

T/F Left or right lobe may be used for lobectomy or segmentectomy

70 - regrowth to original size occurs in months

As much as ________% of donor liver can be removed without complications

ligamentum teres hepatis (round ligament)

paraumbilical veins run along what structure?

esophageal v.

rectal v.

retroperitoneal v.

paraumbilical v.

- Chronic shunting may lead to additional pathology

list 4 protocaval anastamoses that can be used during portal hypertension (thus reduced blood flow):

gallbladder

what structure lies between the right and quadrate lobe of the liver?

Gall bladder

Where is the storage and concentration of bile?

IVC

what structure lies between the right and caudate lobe of the liver?

bile canaliculi

what bile structures run in between hepatocytes?