Flashcards in Fiser Chapter 31. LIVER Deck (111)
Right hepatic artery variant
Off SMA: courses behind pancreas, posterolateral to CBD
Left hepatic artery variant
Off L gastric artery: in gastrohepatic ligament medially
Separates medial and lateral left lobe, attaches liver to anterior abdominal wall, extends to umbilicus and carries remnant of umbilical vein
Carries obliterated umbilical vein to undersurface of the liver, extends from falciform ligament
Cantlie's line separating right and left liver
Middle of gallbladder fossa to IVC (aka portal fissure)
1-4 clockwise starting with caudate
5-8 clockwise (5 is inferior medial)
Peritoneum that vocers liver
Posterior-superior surface not covered by Glisson's capsule
Lateral and medial extensions of the coronary ligament on the posterior surfact of the liver; made up of peritoneum
Where does portal triad enter
Segments IV and V
Where does the gallbladder lie
Under segments IV and V
CBD (lateral), PV (posterior), proper hepatic artery (medial)
Clamp porta hepatic, will not stop HV bleeding
Entrance to lesser sac
Foramen of windslow (anterior is portal triad, posterior is IVC, inferior is duo, superior is liver)
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.
Arterieal blood supply of liver
R, M, and L hepatic arteries (follow hepatic vein system)
Middle most commonly a branch off left hepatic
Most primary and secondary liver tumors are supplied by what blood flow?
R, M, L
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
Accessory R hepatic veins
Drain medial aspect of R lobe directly to IVC
Inferior phrenic veins
Drain directly into IVC
Caudate lobe blood flow
Receives separate R and L portal and arterial blood flow
Drains directly into IVC via separate hepatic veins
Where is alkaline phosphatase normal located?
Where does nutrient uptake occur?
Usual enrgy source for liver
Glucose is converted to glycogen and stored
Excess glucose converted to fat
Where is urea synthesized
Where is vWF and factor 8 synthesized?
What does liver store?
Fat-soluble vitamins and B12
Most common problems with hepatic resection
Bleeding and Bile leak