Abstract
This chapter deals in the first part with the anatomy of the liver, highlighting in particular the clinical anatomy and the relevant morphological aspects of practical interest to the physician, including the presence of the most frequent anatomical variations. Particular emphasis is given to the vascular organization that determines the subdivision into segments, whose understanding is fundamental in clinical diagnostics and in surgical practice. In the second part of the chapter the phenomena related to the morphogenesis of the liver are described in order to show the peculiar organization of the liver both at a macroscopic level and at a structural level. Moreover, the recent acquisitions on key signaling pathways and molecular mechanisms underlying the complex tissue interactions in hepatogenesis are briefly described. Due to the central regulatory role of the liver in many metabolic functions, this knowledge form the basis for the modern approaches to gene and molecular therapy of the liver. They may also contribute to understand how to promote liver regeneration, to engineer the replacement of functional liver tissues, or how to lead to therapeutically useful tissue for transplantation.
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Self Study
Self Study
1.1 Questions
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1.
Which statement(s) is/are true?
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(a)
The liver occupies the entire upper abdomen (right and left hypochondrium).
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(b)
Liver fixation structures are the coronary ligament, the falciform ligament, the gastrocolic ligament, the adhesion to the diaphragm and the inferior vena cava.
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(c)
In physiologic conditions the portal vein is responsible for more than 70% of the blood supply to the liver.
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(d)
A focal lesion of the VIII segment of the liver is located in the lower part of the lateral or posterior left sector.
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(e)
The extrahepatic biliary tract connects the liver with the gallbladder, pancreas and duodenum.
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(a)
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2.
Which statement(s) is/are true?
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(a)
The liver begins to develop during the third week of gestation and completes its morphological formation after birth.
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(b)
The liver develops from the primitive endoderm without the contribution of cells from other embryonic tissues.
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(c)
Undifferentiated stem cells completely disappear in the adult liver.
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(d)
Different gene expression characterizes compartmentalized zonal regions in relation to the proximity to the portal triad or the central vein.
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(e)
Hepatoblasts are bi-potential cells able to differentiate into hepatocytes and biliary epithelial cells.
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(a)
1.2 Answers
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1.
Which statement(s) is/are true?
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(a)
The liver occupies the entire right hypochondrium, and only part of the epigastrium and of the left hypochondrium.
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(b)
The main fixation structures of the liver are the adhesion to the diaphragm through the coronary ligament and the bare area, and the vena cava. Other ligaments have little significance as fixation structures, and connect the liver to other organs allowing the passage of blood vessels. The gastrocolic ligament is not properly a ligament of the liver and connects the stomach and the transverse colon.
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(c)
The portal vein is responsible for 70–80% of the blood supply to the liver in physiologic conditions (CORRECT), while the hepatic artery provides the remaining supply.
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(d)
The VIII segment of the liver is located in the anterior superior position of the right sector.
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(e)
The extrahepatic biliary tract include the gallbladder, and connects the liver with duodenum.
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(a)
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2.
Which statement(s) is/are true?
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(a)
The liver begins to develop in the middle of the third week of gestation and completes its formation at the end of the seventh week. However, it continues to acquire and increase its functions even after birth.
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(b)
In the liver there are different populations of cells that come from various embryonic tissues (certainly at least from the endoderm and mesoderm): their interactions are essential for the correct development of the organ.
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(c)
A little quote of undifferentiated stem cells, the hepatic progenitor cells, still remain in the adult liver.
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(d)
(CORRECT) The heterogeneity of most enzyme in relation to the zonal position of the cells will develop gradually during early post-natal life. This phenomenon is the basis for the metabolic zonation of the adult liver.
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(e)
Hepatoblasts are bi-potential cells that can differentiate into hepatocytes and biliary epithelial cells in relation to their position near or far to the branches of the portal vein and the extracellular matrix (CORRECT).
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(a)
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Morini, S., Carpino, G., Carotti, S., Gaudio, E. (2020). Anatomy and Embryology of the Liver. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_1
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