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Chapter 22: Liver

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The obliterated ductus venosus

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(A) Divides the left lateral and left medial sections of the liver

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(B) Joins the left portal and left hepatic veins

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(C) Anchors the liver to the retroperitoneum

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(D) Travels within the falciform ligament

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(E) Can recannulate with portal hypertension

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(B) The ligamentum venosum, or Arantius’s ligament, is formed early in infancy by the obliteration of the ductus venosus, which shunts blood from the left umbilical vein via the left portal vein to the IVC via the left hepatic vein. It travels within a deep visceral surface plane, attaching to lesser omentum and dividing the caudate lobe (segment 1) from the left lateral section (segments 2 and 3). The ligamentum teres hepatis, or round ligament, forms from obliteration of the umbilical vein. It travels within the falciform ligament and divides left lateral (segments 2 and 3) and left medial (segments 4A and 4B) sections. Under pressure, such as that observed in portal hypertension, the ligamentum teres hepatis can recannulate. The inferior portion of the coronary ligament, as it extends beyond the right triangular ligament to the right kidney, anchors the peritoneum in the posterior, inferior aspect to the retroperitoneum.

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BIBLIOGRAPHY

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Blumgart LH, Hann LE. Surgical and radiologic anatomy of the liver, biliary tract, and pancreas. In: Jarnagin WR, Belghiti J, Büchler MW, et al., eds. Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas. 5th ed., Vol. 1. Philadelphia, PA: Saunders; 2012: Chapter 1B.

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Cheng EY, Zarrinpar A, Geller DA, Goss JA, Busuttil RW. Liver. In: Brunicardi FC, Andersen DK, Billiar TR, et al., eds. Schwartz’s Principles of Surgery. 10th ed. New York, NY: McGraw-Hill; 2015: Chapter 31.

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Skandalakis JE, Branum GD, Colborn GL, et al. Liver. In: Skandalakis JE, Colburn GL, Weidman TA, et al., eds. Skandalakis’ Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery. Athens, Greece: Paschalidis Medical Publications; 2004.

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In the most common variant of hepatic arterial anatomy,

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(A) The affected artery passes posterior and lateral to the portal vein

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(B) All hepatic arterial supply is received via branches from the superior mesenteric artery

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(C) All hepatic arterial supply is received via branches from the celiac trunk

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(D) 50% of hepatic blood flow is arterial

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(E) The left liver receives hepatic arterial blood via branches from the left gastric artery

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(A) The hepatic arterial supply is ...

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