Fiser Chapter 31. LIVER Flashcards Preview

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Flashcards in Fiser Chapter 31. LIVER Deck (111)
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1

Right hepatic artery variant

Off SMA: courses behind pancreas, posterolateral to CBD

2

Left hepatic artery variant

Off L gastric artery: in gastrohepatic ligament medially

3

Falciform ligament

Separates medial and lateral left lobe, attaches liver to anterior abdominal wall, extends to umbilicus and carries remnant of umbilical vein

4

Ligamentem teres

Carries obliterated umbilical vein to undersurface of the liver, extends from falciform ligament

5

Cantlie's line separating right and left liver

Middle of gallbladder fossa to IVC (aka portal fissure)

6

Couinaud's segments

1-4 clockwise starting with caudate

5-8 clockwise (5 is inferior medial)

7

Glisson's capsule

Peritoneum that vocers liver

8

Bare area

Posterior-superior surface not covered by Glisson's capsule

9

Triangular ligaments

Lateral and medial extensions of the coronary ligament on the posterior surfact of the liver; made up of peritoneum

10

Where does portal triad enter

Segments IV and V

11

Where does the gallbladder lie

Under segments IV and V

12

Kupffer cells

Liver macrophages

13

Portal triad

CBD (lateral), PV (posterior), proper hepatic artery (medial)

14

Pringle maneuver

Clamp porta hepatic, will not stop HV bleeding

15

Entrance to lesser sac

Foramen of windslow (anterior is portal triad, posterior is IVC, inferior is duo, superior is liver)

16

What forms PV?

SMV joining splenic vein

IMV enters splenic vein

There are two portal veins in liver, and they may 2/3 of hepatic blood flow. Left goes to segments 2-4, right goes to 5-8.

17

Arterieal blood supply of liver

R, M, and L hepatic arteries (follow hepatic vein system)

Middle most commonly a branch off left hepatic

18

Most primary and secondary liver tumors are supplied by what blood flow?

Hepatic artery

19

Hepatic veins

R, M, L

R: 6-8
M: 5 and inferior 4
L: 2, 3, and superior 4

Middle HV comes into LHV before going into IVC in 80%, in remaining goes directly into IVC

20

Accessory R hepatic veins

Drain medial aspect of R lobe directly to IVC

21

Inferior phrenic veins

Drain directly into IVC

22

Caudate lobe blood flow

Receives separate R and L portal and arterial blood flow

Drains directly into IVC via separate hepatic veins

23

Where is alkaline phosphatase normal located?

Canalicular membrane

24

Where does nutrient uptake occur?

Sinusoidal membrane

25

Usual enrgy source for liver

Ketones

Glucose is converted to glycogen and stored

Excess glucose converted to fat

26

Where is urea synthesized

Liver

27

Where is vWF and factor 8 synthesized?

Endothelium

28

What does liver store?

Fat-soluble vitamins and B12

29

Most common problems with hepatic resection

Bleeding and Bile leak

30

Hepatocytes most sensitive to ischemia

Central lobular (acinar zone III)