Liver

1) Makes an impact on...

2) anterior surface

3) posterior inferior surface

4) bare area:  Attachments.  Location.

5) intra or extra peritoneal?

1) Impact on R Lung, R dome of diaphragm, URQ of abdom cavity.

2) Diaphragmatic surface

3) visceral surface approaching other organs in that area: large bowel, R kidney, duodenum

4) part of posterior diaphragmatic surface.  NOT covered by visceral peritoneum.  Attached to diaphragm by reflection of serous membrane.

5) Intraperitoneal

Bare Area of Liver

1) location and what it is.

1) immediately adjacent to diaphragm.

not covered by visceral peritoneam.

Hepatorenal recess

1) where and what?

2) what and where can accumulate?

1)  Recess of peritoneal cavity btwn liver & kidney.

1)  Fluids can accumulate in lumber curve of vertebral colun, most posterior part of cavity while supine.

1) Rectovesical pouch:

*what is vesicular?

2) Rectouturerine pouch

1) *vesicular= bladder. 

In males btwn rectum and urinary bladder.

2) In females between rectum and uterus.

fluid may collect while lying down

Liver:

1) attached to.....via....

2) Superior border (R,L) of neutral position.  Orientation?

3) R lobe, sup border, on expiration

4) R lobe, sup border, on inspiration

5) Protection

1) resp diaphragm via serous membrane

2) (at anterior mcl)R= 5th ICS; L= 6th ICS.  OBLIQUE

3) 4th ICS

4) Inferior to costal margin.

5) Not completely protected by ribs

Liver:

1) Location

2) Falciform Ligament

3) Relationship of size of lobes

4) Smooth outer membrane

5) Vital?

6) gallbladder (*stores bile) location

7) Round ligament

1) intraperitoneal, except for bare area

2) boundary btwn L/R lobes

3) R>L

4) Viceral peritoneum

5) yes

6) protrudes inferiorly from R lobe of liver.  IN URQ.

7) non functional, remnant of embryologic umbilical vein, attached to anterior wall of abdom cavity

IVC and liver:

1) IVC is physiclly attached to...

2) path to heart from here.

3) What drains into IVC (in relation to liver)?

1) most superior of liver. 

2) passes up through resp diaphragm at T8, then immediately enters RA of heart.

3) Veins of the liver

Portal Triad

1) point of entry of liver

2) contents

1) porta hepatis

2) hepatic portal vein, hepatic a., bile passages associated with papilliary system

Visceral surface of liver:

**Pattern shape?

1) Structures more R and in line w/ each other

2) Structes more medial 2

3) structure btwn #1 & #2

4) Gastric area.  Approximates...

5) colic area.  which flexure here?

6) R kidney recess: name and location

**H pattern

1) IVC (sup) & gallbladder (inf)

2) caudate lobe (sup) & quadrate lobe (inf)

3) porta hepatis

4) Sup L lobe, approximates lesser curve of stomach which may extend over.

5) inferior portion.  Flexure of ascedning and transverse colons

6) superior portion on R.  Hepatorenal recess.

Duct system of Liver/Pancreas/Gallbladder:

1) R & L hepatic ducts form...

2) Common hepatic duct drains...

3) cystic duct: function of origin organ.

4) Common Bile duct formed by...

5) pancreatic duct joins...enters....

6) bile flows...

1)from liver.  Join to form common bile duct.

2) drains entire liver of bile

3) from gall bladder ( stores bile, making it more concentrated).

4) cystic and common hepatic ducts uniting

5)common bile duct....part 2 of duodenum at hepatopancreatic ampulla

6) both ways

1) Liver lobules:

2) shape

3) center feature

4) periphery structures (3):  direction of flow via...

5) sinusoid structure, function, flow.  What branch drains into sinusoid?

6) hepatocytes function

1) microscopic divisions of liver

2) hexagonal

3) central vein

4) branches of portal triad:

Hepatic a and hepatic portal vein flow INTO liver via central vein via sinusoid.

Bile duct flows OUT of liver via bile canaliculi: ¨capillaries¨of biliary system run btwn hepatocytes of bile.  Flows to periphery of lobule.

5) functional ¨capillaries¨ of liver (enlarges) with simple endolthelium for a wall, which allows movement of materials and waste across its membrane. Not true capillary.  Flow into central vein of lobule.

6) make bile, detoxification

Portal triad flow in Liver lobule:

1) INTO LIVER

1a) branch of hepatic portal vein drains....

1b) Components of blood in sinusoid

1c) central vein leads to...

2) OUT OF LIVER

**3) definition of portal system

1) Braches of hepatic a and hepatic portal vein on periphery of lobule drain blood to central vein via sinusoids.

1a) digestive system and spleen

1b) MIXED: Venous blood from digestive tract (low O2, high CO2, + freshly digested nutrients) and

 richly oxygenated blood from hepatic a.

1c) hepatic veins

2) bile caniliculi are smallest vessels of bilary system.  Run btwn hepatocytes and flow to periphery of lobule.

**3) system of veins between 2 capillary beds

the h. portal vein is between cniculi and capilary of digestive

Hepatic Portal Vein:

1) formed by what 2 veins

2) what does each drain

3) inferior mesenteric v comes from....drains into...

1) superior mesenteric v & splenic v.

2A) superior mesenteric drains small intestine and proximal part of large intestine

2B) splenic vein drains spleen and stomach, pancreas & inferior mesenteric vein

3) Comes from distal large bowel....drains into splenic vein....

 Distal lg intestine>Inferior mesenteric v>splenic v.

Small intestine & proximal lg intestine>superior mesenteric v. >hepartic portal v.

Spleen & stomach> splenic v. > hepatic portal v

Union of inf mesenteric v with splenic v & junction of splenic v. and sup mesenteric v.

form....

occur on....

hepatic portal vein

posterior side of pancreas

In cirrhosis of the liver, venous flow

Anastomoses with vessels around umbilicus to get to IVC. we see vericose veiins in stoomach around umbilicus