MEDI7302 Study Guide - Final Guide: Biliary Tract, Venule, Aflatoxin B1
Hepatic
Learning
objectives
Outline the physiology of the liver, particularly in regards to synthetic function
Describe the enterohepatic circulation of bile salts
Understand the difference between portal venous, hepatic arterial and hepatic venous
blood flow
Contrast the clinical and biochemical features of jaundice due to hepatocellular failure
with biliary obstruction
Produce a brief list of lesions producing a mass in the liver
Why does portal hypertension develop and how can it manifest
How does a hydatid cyst develop in the liver and briefly describe investigation and
management options
Liver Liver is the largest gland in body/ largest visceral structure in abdominal cavity &
positioned in the RUQ abdomen (right hypochondrium and epigastric areas, slightly extends into left
hypochondrium)
Anatomy
Liver surfaces Diaphragmatic surface (anterosuperior)
Smooth, convex, sits in curvature of diaphragm
Bare area - posterior aspect of diaphragmatic
surface, no visceral peritoneum & has direct contact to diaphragm
Visceral surface (posteroinferior)
All covered by peritoneum except gallbladder fossa
& porta hepatis
Irregular, flat (due to being moulded by
surrounding organs)
Direct contact with right kidney, right adrenal
gland, right colic flexure, transverse colon, first part of the
duodenum, gallbladder, oesophagus and the stomach
Ligaments Falciform
Attach anterior liver surface <-> anterior abdominal
wall
Natural division between L and R liver lobes (but
not real division)
Free edge of this ligament contains ligamentum
teres (umbilical vein remnant)
Coronary (anterior + posterior folds)
Attach superior liver surface <-> inferior diaphragm
surface
Demarcation of bare area
Anterior and posterior folds unite to form
triangular ligaments on R and L liver lobes
Triangular
L triangular
oUnion of anterior and posterior folds of
coronary ligament at liver apex
oAttach L liver lobe <-> diaphragm
R triangular
oUnion of anterior and posterior folds of
coronary ligament at liver apex, adjacent to bare area
oAttach R liver lobe <-> diaphragm
Lesser omentum
Components - hepatoduodenal ligament,
hepatogastric ligament
Attach liver <-> lesser curvature of stomach + D1
duodenum
find more resources at oneclass.com
find more resources at oneclass.com
Recesses Subphrenic space
Location - between diaphragm & anterior and
superior liver aspects
Falciform ligament divides it into R and L parts
Subhepatic space
Location - between inferior liver aspect &
transverse colon
Morrison's pouch
Potential space between visceral liver surface & R
kidney
Deepest part of peritoneal cavity with patient
supine; pathologic abdominal fluid (blood, ascites) will most likely collect
in this region
Macroscopic
anatomy
Liver is covered by Glisson's capsule (fibrous layer)
Liver segment division
Couinaud classification of liver anatomy divides
liver into 8 functionally independent segments (each has own vascular
inflow, outflow and biliary drainage via portal triad)
oCantlie's line divides liver into L and R
lobes according to Couinaud's functional liver segmentation
L lobe = II, III, IVa, IVb
R lobe = V, VI, VII, VIII
oFalciform ligament divides liver L lobe into
medial and lateral segments
Vertical dissections
oFalciform ligament runs along plane of L
hepatic vein
oCantlie's line runs along plane of middle
hepatic vein
oR hepatic vein runs vertically between
segment V and VIII <-> segment VI and VII
Transverse dissections
oAdjacent line to portal hepatis (hepatic
artery & portal veins) - L portal vein/ L hepatic artery separates IVa
find more resources at oneclass.com
find more resources at oneclass.com
and IVb and R portal vein/ R hepatic artery separates V and VII/VIII
Components
R and L lobe (liver divided by falciform ligament to
create these)
Two accessory lobes on R lobe - caudate lobe
(upper part of visceral surface) and quadrate lobe (lower part of visceral
surface)
Porta hepatis is a transverse fissure separating
caudate and quadrate, containing all vessels/nerves/ducts entering or
leaving liver with exception of hepatic vein
Sulcus of Rouviere (82% livers)
Important anatomical landmark in laparoscopic
cholecystectomy to avoid injuring CBD
2-3cm cleft that indicates plane of CBD accurately
-> cystic duct and artery lay superior to sulcus vs CBD lays posterior to
suclcus
All dissections should be kept to a level above/
anterior to sulcus to avoid CBD injury
Hepatoduodenal ligament (portion of lesser omentum)
extends between porta hepatis (liver) and D1 superior duodenum
Portal triad runs inside it (hepatic artery, portal
vein, CBD)
Portal vein lies most posteriorly, CBD on anterior L
side, hepatic artery on anterior R side
Microscopic
anatomy
Structural unit of liver is a lobule (hexagon-shape) that has
the following components …
Cells Hepatocyte - functional liver
cells
Hepatic stellate cells/
perisinusoidal cells/ Itlo cells - quiescent cells, sit in
perisinusoidal space/ space of Disse, vitamin A storage,
wound healing
Endothelial cells - blood
vessel lining
Kupffer cell - macrophage
Portal triad Bile ductule - exits liver
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Outline the physiology of the liver, particularly in regards to synthetic function. Understand the difference between portal venous, hepatic arterial and hepatic venous blood flow. Contrast the clinical and biochemical features of jaundice due to hepatocellular failure with biliary obstruction. Produce a brief list of lesions producing a mass in the liver. Why does portal hypertension develop and how can it manifest. How does a hydatid cyst develop in the liver and briefly describe investigation and management options. Liver is the largest gland in body/ largest visceral structure in abdominal cavity & positioned in the ruq abdomen (right hypochondrium and epigastric areas, slightly extends into left hypochondrium) Bare area - posterior aspect of diaphragmatic surface, no visceral peritoneum & has direct contact to diaphragm. Direct contact with right kidney, right adrenal gland, right colic flexure, transverse colon, first part of the duodenum, gallbladder, oesophagus and the stomach. Natural division between l and r liver lobes (but.
