GA - Mihaila - Liver & Biliary System - 2/16

Question 1

Describe the peritoneal structures related with the liver

Answer 1

• falciform lig.
• Ligamentum teres
• Ligamentum venosum
• Coronary ligaments
• Triangular ligaments

Question 2

The portion of the liver that contacts the undersurface of the diaphragm and that has no peritoneum, is called __

Answer 2

bare area

Question 3

The visceral peritoneum of the liver is connected to the stomach by the __1__ formed by the __2__ and the __3__ ligaments. The visceral peritoneum of the liver is attached to the anterior body wall by the __4__ ligament

Answer 3

1. lesser omentum
2. hepatogastric
3. hepatoduodenal
4. falciform

Question 4

Vestiges of the embryonic circulatory system that are found in the adult liver include __1__ and __2__

Answer 4

1. ligamentum venosum

2. ligamentum terres

Question 5

What is an anatomic liver lobe? And a functional liver lobe? How many of each do most of us have?

Answer 5

We have 4 anatomic lobes, regions of the liver delineated by specific anatomical landmarks (falciform ligament demarcates right and left anatomical lobe, on diaphragmatic surface; gallbladder fossa, fossa for IVC, ligamentum venosum and ligamentum terres separate caudate and quadrate lobes from right and left lobes, on visceral surface). We have 2 functional lobes, determined by the branching of the hepatic portal triad.

Question 6

How does the location of a normal infant’s liver differ from a normal adult’s liver? What is the significance of an adult liver that extends below the rib cage more than 4cm?

Answer 6

A normal infant liver DOES extend below the margin of the rib-cage. Normal livers in adults DO NOT extend below the costal margin. A liver that can be palpated 4cm below this costal margin is abnormally enlarged, and indicative of liver pathology.

Question 7

What is the porta hepatis? What are the components of the liver triad? What does each of these components carry?

Answer 7

Porta hepatis = door to the liver, located on the visceral surface. Its components include the hepatic portal vein (carries nutrient-rich and toxin- rich blood TO the liver), proper hepatic artery (carries well-oxygenated arterial blood TO the liver) and common hepatic duct (carries bile AWAY from the liver).

Question 8

What is a portal system? If venous blood flow through the liver is impeded, portal vein pressure increases and blood may be rerouted to the heart via porto-caval anastomosis. Name 3 such connections. What symptoms would indicate that these channels are being used?

Answer 8

A portal system is a blood vessel system in which a vessel carries blood between TWO CAPILLARY BEDS before routing that blood to the heart.

a. Azygos v. (caval) - lower esophageal & short gastric veins (portal) = esophageal varices & ascites
b. Sup.hemorrhoidal veins (portal) -middle and/or inferior rectal veins (caval) = hemorrhoids & ascites
c. Paraumbilical veins (portal) – superficial, superior and inferior epigastric veins (caval) = caput medusa & ascites
d. Right and left colic veins (portal)–retroperitoneal parietal veins (caval) = retroperitoneal hemorrhages & ascites

Question 9

Both biliary and pancreatic secretions empty into the __1__, via the __2__

Answer 9

1. 2nd part of the duodenum

2. ampulla of Vater

Question 10

Describe the origin and course of the common bile duct and the major pancreatic duct.

Answer 10

Common Bile Duct: right and left hepatic ducts – common hepatic duct; common hepatic duct + cystic duct (from gallbladder) = common bile duct; CBD empties into ampulla of Vater, and (via sphincter of Oddi) into 2nd part of duodenum.
Major Pancreatic Duct: empties into ampulla of Vater, together with common bile duct; ultimately drains into 2nd part od duodenum, just like CBD.