liver handouts

what is the largest organ in the ABDOMINAL cavity

liver

where is the liver found

the right hypochondrium, the greater part of the epigastrium, and the left hypochondrium as far as the mamillary line

does the liver lie superior or inferior to the diaphragm

inferior

in the epigastric region the liver extends ___ ____ below the xiphoid process

several inches

what is the covering the goes around the liver called

glissons capsule

how much does the liver measure in transverse

21-22 cm (8.3 inches)

how long does the liver measure vertically

13-17.5 cm (6-6.5 inches)

how big is the livers depth

10-12.5 (4-4.5 inches)

how much does the liver weight

1400-1600 grams (3-3.5 lbs)

what is a landmark to find the liver

upper border area of the nipple or lower border 8th or 9th rib

what is the largest lobe of the liver

right lobe

how many segments are found in the liver and what are these used for

8 and surgery

what is segment 1

caudate lobe

what are segments 2 and 3

left superior and inferior lateral segments

what are segments 4a and b

medial segments of the left lobe

what are segments 5 and 6

caudal to the transverse plane

what are segments 7 and 8

cephalad to the transverse plane

what separates the right and left lobes

main lobar fissure

what separates the left lobe of the liver and the caudate lobe

ligamentum venosum

the right hepatic vein courses within the right intersegmental fissure to divide what

the right lobe into anterior and posterior segments

the middle hepatic vein courses within the main lobar fissure to separate what

the anterior segment of the right lobe from the medial segment of the left lobe

the left intersegmental fissure separates what

the medial segment of the left lobe from lateral segment

the left intersegmental fissure further divides into what

cranial, middle, and caudal sections in the left lobe

what represents the boundary of the cranial third, the middle third, and what forms the caudal division of the left lobe

1. left hepatic vein

2. left portal vein

3. ligamentum teres

the main branches of the portal veins run ___ within the ___

intrasegmental; segments

what is posterior to the caudate lobe

IVC

what is anterior to the caudate lobe

ligamentum venosum

what does the caudate lobe drain directly into

IVC

why does ligaments and fissures show as echogenic or hyperechogenic

because of collagen and fat around them

what area does the glissons capsule not cover

bare area

what connects the GB and portal vein

main lobar fissure

what is found within the main lobar fissure

mid hepatic vein

what is the ligament that attaches the liver to the front body wall

falciform ligament

what ligament separates the right and left lobe of the liver

falciform ligament

what does the falciform ligament contain

ligamentum teres

what is also known as the round ligament

ligamentum teres

where is the falciform ligament found

a degenerative string of tissue that extends from the free edge of the falciform ligament

what was the ligamentum teres once known as

the left umbilical vein

what may the ligamentum teres recanalize with

portal hypertension

is the ligamentum teres hyperechoic

yes

what separates the left lobe and the caudate lobe

ligamentum venosum

does the ligamentum venosum recanalize in adults

no

why does the ligamentum venosum lie within the fissure

for ligamentum venosus

what takes blood to the liver

hepatic artery and portal vein

what does the hepatic artery carry from the aorta

oxygen rich blood

how much oxygen does the blood have that the portal vein carries from the intestines

80%

where does the main portal vein become larger

portal hepatis

what does the main portal vein divide into

the right (larger) and left portal veins

what does the right portal vein divide into

anterior and posterior branches

what does the left portal vein divide into

anterior and cranial branches

what drains the blood from the liver to the IVC

hepatic veins

is the veins or arteries more echogenic

veins

do the hepatic veins become smaller or larger as they go toward the diaphragm and IVC

larger

where does the right hepatic vein enter the LVC

on the right lateral aspect

where does the mid hepatic vein enter the IVC

anteriorly or to the right anterior aspect

where does the left hepatic vein enter the IVC

left anterior aspect

is the portal vein hepatopedal or hepatofugal

hepatopedal

what does the liver form

bile

what forms the bile in the liver

hepatocytes

how do the excretory products of the liver get to the duodenum

by bile ducts

what is bile made of

water, bile pigments, and bile salts

what is the function of bile

to emulsify fats and the removal of waste products

what is the process of bile being formed

formed by hepatocytes → collects in the bile canaliculi → goes to the gut via bile ducts

what are the functions of bile

1. emulsification of intestinal fat

2. removal of waste products excreted by the liver

what does sludge result from

bile stasis

are portal veins or hepatic veins more echogenic

portal veins

what all join together to make the portal venous system

hepatic veins, splenic vein, and inferior mesenteric vein

explain the right hepatic vein

1. largest

2. courses in the right intersegmental fissure

3. enters right lateral aspect of the IVC

explain the middle hepatic artery

1. courses in the main lobar fissure

2. enters the anterior or right anterior IVC

explain the left hepatic artery

1. smallest

2. enters left anterior surface of the IVC

what does the liver convert dietary sugars (carbohydrates) to

glucose

what does the liver metabolize

fats

dietary fats are converted in ____ to ____

hepatocytes; lipoproteins

what are the main functions of the liver

1. metabolism - glucose and proteins, fats, and carbs

2. digestion - bile

3. storage - iron and certain vitamins

4. detoxification - drugs and poisons

what are the liver cells called

hepatocytes

what happens during hepatocellular disease

the hepatocytes are the immediate problem

how is hepatocellular disease treated

usually medically with supportive measures and drugs

when bile excretion is blocked how is it treated

typically surgical

what are the 8 labs that need to be done for the liver

1. AST

2. ALT

3. lactic acid dehydrogenase

4. alkaline phosphate

5. bilirubin

6. prothrombin time

7. albumin and globulins

8. AFP

What does aspartate aminotransferase test

the enzymes in the tissues of the liver

what can cause the aspartate aminotransferase (AST) to rise

death or injury to the tissues enzymes that gets released to the blood stream

what can elevated AST levels mean (pathology)

acute hepatitis cirrhosis, hepatic necrosis, mono

what does an alanine aminotransferase test measure

an enzyme found in the liver

if the alanine aminotransferase (ALT) is slightly increased what pathology can that mean

acute cirrhosis, hepatic metastasis, and pancreatitis

when the ALT is mildly increased what pathology can that mean

jaundice

is the ALT level lower or higher when having alcoholic hepatitis

higher

when there is a moderate to high increase seen in the ALT levels what pathology can that mean

hepatocellular disease and infection or toxic hepatitis

where is lactic acid dehydrogenase found

kidney, heart, skeletal muscle, brain, liver, and lungs

does injury/death cause an increase or decrease in the levels of lactic acid dehydrogenase

increase

in a moderate increase of lactic acid dehydrogenase levels what pathology can that mean

mono

in a mild increase in the lactic acid dehydrogenase levels what pathology can that mean

hepatitis, cirrhosis, and obstructive jaundice

what is the lactic acid dehydrogenase levels used to detect

PI or pulmonary infarct

what is alkaline phosphatase produced by

the liver, bone, intestines, and the placenta

what can an increase in the alkaline phosphate mean (pathology)

intra or extra hepatic obstruction, carcinoma, abscess, cirrhosis, hepatitis

what is an important substance detoxified through the liver

bilirubin

what does the level of bilirubin measure

the breakdown of hemoglobin in tired red blood cells

how many days does the average red blood cell survive

120 days

where does the breakdown of red blood cells by reticuloendothelial cells take place

spleen

what do bilirubin attach to before entering the blood and traveling to the liver

albumin

what is an increase in bilirubin count be caused by

RBC destruction, malfunctioning liver cells, and ductal blockages that cause jaundice