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Terms in this set (46)
how many lobes does the liver have?
caudate-nect to inf venacava
quadrate-next to gallbladder
what does the portal triad consist of?
hepatic artery-supplies oxy blood to liver
bileduct-bile produced in liver-stored in gallbladder, secreted into small intestine(via vile duct)
(liver recieves dual blood supply)
what drains into the portal vein?
blood from GIT, pancreae, spleen (this blood is oxygen poor but rich in nutrients-Git, blood products-spleen, secretions from endocrine pancrease)
what does the porta hepatis consist of?
going anti-clockwise starting from left: portal vein-hepatic artery-hepatic duct
where is the quadrate lobe found?
between the gall bladder and round ligament(remnant of umbilcal vein)
where is the caudate lobe found?
next to the venacava
coronary ligament attaches to the?
what are the ligaments of the liver from front?
round ligament(extends from falciform ligament)-has umbillical vein
coronary ligament-(hold liver to inferior surface of the diaphragm).
ligamentum venosum- (fetal ductus venosus)
where can you find ligamentum venosum?
between left lobe and caudate lobe
what does hepatic vein do?
drain blood from central vein(liver) to inferior venacava
where is the liver situated?
right hypochondrium, epigastrium, left hypochondrium
superior surface of the liver has which ligament?
coronary ligament- left triangular ligament
ligamnetum teres is also known as?
from the anterior view, which surfaces of liver can you see?
superior, anterior, right
from posterior view, which surfaces of liver can you see?
posterior and inferior
what are the borders of the liver?
superior surface of the liver has____impression
what are the relations of the superior surface of the liver?
-base of the corresponding lung and pleura above the diaphragm
-above the central tendon -pericardium and the heart
what are the relations of the anterior part of the liver?
1)Right part-right costal margin, diaphragm, 6th to 10th ribs
2)Left part- left costal margin, diaphragm , 7th and 8th costal cartilages
3)Intermediate part-xiphoid process anterior abdominal wall
what are the relation of right surface?
-anteriorly-right costal margin, diaphragm, 6th to 10th ribs
-Between ribs and diaphragm the following structures intervene
•Lung upto the 8th rib-midaxillary nerve (upper third)
•Costodiaphragmatic recess of pleura upto the 10th rib-mid axillary nerve
•Diaphragm in the lower third
how is liver biopsy approached?
thru the right 10th intercostal space in the mid axillary line during the phase of forced expiration to avoid injury to the lung.
what are the relations of posterior surface of the liver?
-middle part is concave for the vertebral column
-Other relations from right to left
1.The Bare area- diaphragm , right suprarenal gland
2.Groove for Inferior vena cava-pierced by hepatic veins
3.Caudate -2 processes: Caudate process - at the lower right margin
Papillary process-at lower left margin
4.Fissure for Ligamentum Venosum: remnant of Ductus venosus of
foetal life-connecting left branch of Portal vein to left hepatic vein or directly to the IVC- shunting left umbilical vein to IVC by passing hepatic circulation
5. Groove for oesophagus
what are the relations of inferior surface of the liver?
Features from left to right:
1.Gastric impression: antero superior surface of fundus, body of stomach
2.Tuber omentale: rounded elevation- directed towards the tuber omentale of the pancreas
3.The fissure for the Ligamentum Teres hepatis: obliterated left umbilical vein-from umbilicus to left branch of portal vein-conveying oxygenated blood from placenta to foetus
4.The Quadrate lobe: related to lesser omentum, the pylorus, first part of duodenum.
5.The fossa for the Gall bladder
7.Duodenal impression: junction of 1st and 2nd part of duodenum
8.Colic impression: right colic flexure
9.Renal impression: for right kidney
esophageal impression is on ____ lobe of the liver?
where is porta hepatis situated?
situated on inferior surface of right lobe of the liver(between caudate lobe above and quadrate lobe below
-lips of porta hepatis provide attachment to lesser omentum)
Structures in the Porta hepatis:
-Portal vein, Hepatic artery and Hepatic plexus of nerves enter the liver thru the Porta hepatis
-Right and left hepatic ducts and lymphatics leave thru porta hepatis
Non Peritoneal areas of the liver are?
1.The Bare area- limited by upper and lower layers of Coronary ligament and by the right triangular ligament
2.Cardiac impression- due divergence of layers of Falciform ligament
3.The groove for Inferior vene cava
4.The fossa for Gall bladder
5.Floor of fissures- Ligamentum teres and Venosum
6. Porta hepatis
what are the true and false ligaments of the liver
Peritoneal Ligaments(false ligaments)
•Ligamentum teres hepatis
peritoneal ligaments/ false ligaments characteristics
-connects liver to the undersurface of diaphragm and anterior abdominal wall
-convex margin is attached to diaphragm and anterior abdominal wall
-concave margin is attached to anterior surface of liver between anatomical right and left lobes
-free margin extends from umbilicus to inferior border of liver-contains ligamentun teres hepatis
-connects the bare area of liver to the diaphragm
-superior and inferior layer
3)Right triangular ligament
-connects right lateral surface to the diaphragm
-forms apex of the bare area
4)Left triangular ligament
-connects upper surface of left lobe of liver to the diaphargm
characteristics of lesser omentum
Lesser omentum -two layers -connects lesser curvature of stomach and proximal 2.5 cm of first part duodenum to the liver
-hepatic attachment is J shaped -vertical limb attached to floor of fissure for ligamentum venosum and horizontal limb to the two lips of porta hepatis - right free margin contain-portal vein, bile duct , hepatic artery, hepatic plexus of nerves and lymphatics
Right layer of Falciform ligament forms?
superior layer of Coronary ligament
Right Triangular ligament forms
inferior layer of Coronary ligament
what is the blood supply of the liver?
Liver receives 20% of blood supply thru hepatic artery branch of coeliac trunk
-80% thru Portal vein
-both hepatic artery and portal vein divide into right and left branches before entering the liver
what is the venous drainage of liver?
-hepatic veins which drain into the IVC
-hepatic sinusoids-interlobular veins-sublobular veins-hepatic veins
-two groups: upper- right , left, middle
lower: variable small veins
-attachment of these veins to IVC help to keep the liver in position
what is the lymph drainage of the liver?
hepatic,left gastric,cystic,phrenic, lumbar, mediastinal lymphnodes
nerve supply of the liver?
-Hepatic plexus- sympathetic fibers from celiac plexus and parasympathetic fibers from anterior and posterior vagal trunks
-hepatic plexus accompany vessels and ducts of portal triad
what are the supports of the liver?
•Attached to the Inferior venacava by the hepatic veins.
•Tone in the anterolateral abdominal muscles.
-Liver is divided into right and left functional lobes (except caudate lobe) based on the primary division of portal vein, hepatic artery and biliary ducts into right and left branches
-The plane between the right left lobe being the main portal fissure in which the middle hepatic vein lies
-On the visceral surface, this plane is demarcated by the Right Sagittal Fissure
-On the diaphragmatic surface by an imaginary line-the Cantlie line- running from the cystic notch to the IVC
-Right & left lobes are subdivided into medial and lateral divisions. Each division receives a secondary branch of the portal triad
-Hepatic veins are intersegmental in position
what is the use of hepatic segments?
•Hepatic segmentectomy makes it possible to resect only those segments that have sustained severe injury or affected by a tumor are removed
•The intersegmental hepatic veins serve as guides to the planes between hepatic divisions
how do you know when liver is enlarged?
inferior edge maybe palpated below the right costal margin & may even reach the pelvic brim in the right lower quadrant of the abdomen
Cirrhosis of the liver
-Is progressive destruction of hepatocytes & replacement by fat & fibrous tissue
-Most common in chronic alcoholics
the common site of metastatic carcinoma is? why?
due to drainage by the portal system of veins
what are the Indications for liver transplantation in children?
Congenital hepatic fibrosis
Inherited disorders of metabolism
Indications for liver transplantation in adults?
Primary biliary cirrhosis
Secondary biliary cirrhosis
Primary sclerosing cholangitis
Chronic hepatitis with cirrhosis
Hepatic vein thrombosis
Primary hepatocellular carcinoma
what is Riedel's Lobe?
what is BILIARY APPARATUS
-passages thru which hepatic bile and gall bladder bile are conveyed to the second part of the duodenum
what partition of the muscle divides the heart into the left and right sides
What active transport is in the PCT?
What is the accumulation of blood between the dura mater and the skull?
What are 2 factors that affect Cardiac output?
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