Liver Flashcards
(19 cards)
Features of liver
Largest gland of the body (~1.5 kg in adults).
Soft, reddish-brown, highly vascular organ.
Essential for metabolism, detoxification, digestion, and storage of nutrients.
Location of liver
Right hypochondrium, epigastrium, and extends slightly into the left hypochondrium.
Lies beneath the right dome of the diaphragm.
Protected by the lower ribs (7th–11th on the right side).
Surface of liver
- Diaphragmatic Surface – smooth, convex; related to diaphragm.
- Visceral Surface – concave, faces downward, related to abdominal organs.
- Anterior Surface – related to anterior abdominal wall.
- Posterior Surface – related to inferior vena cava (IVC).
- Inferior Surface – includes porta hepatis (hilum of the liver).
Border of liver
1 prominent order- inferior
Lobes
anatomical lobes:
1. Right Lobe (Largest)
2. Left Lobe (Smaller)
3. Quadrate Lobe
4. Caudate lobe
Functionally- right and left lobes based on vascular supply and bile drainage.
- Right Lobe (Lobus Dexter)
Largest lobe, about 5 to 6 times larger than the left lobe.
Lies in the right hypochondrium and extends to the epigastrium.
Highly vascular, performing most liver functions.
Falciform ligament (anteriorly) and left sagittal fissure (posteriorly) separate it from the left lobe.
Relations
Diaphragm (Superiorly)
Visceral Surface (Inferiorly)
Right kidney & suprarenal gland (renal impression).
Hepatic flexure of the colon.
Duodenum (near the porta hepatis).
Gallbladder (in a fossa on the inferior surface).
Subdivisions of the Right Lobe
1. Quadrate Lobe
Lies between the gallbladder and ligamentum teres.
- Caudate Lobe
Lies between the IVC and ligamentum venosum.
papillary process extending toward the porta hepatis.
- Left Lobe
Smaller, thinner, and more flattened than the right lobe.
Lies mostly in the epigastrium and left hypochondrium.
Tuber omentale or omental tuberosity
- Functional Division of the Liver
The anatomical division is different from the functional division.
The functional right and left lobes are separated by Cantlie’s Line, which runs from the gallbladder fossa to the IVC.
Blood supply liver
20 percent hepatic artery
80 percent portal vein
Both left and right divide before entering in liver, redivide to segmental vessels
Interlobular vessels, run in Portal canals
Further ramifications, in hepatic sinusoids
Both mix
No anastomoses, so end artery
Venous drainage liver
Hepatic sinusoids into interlobular vein
Reunite
Hepatic veins (R,M,L) into IVC
UPPER- R,L,M hold liver
LOWER- Small veins from R and caudate lobe
Lymphatic drainage liver
Superficial lymphatics → follow the falciform ligament to the parasternal nodes.
Deep lymphatics → drain into hepatic, celiac, and posterior mediastinal nodes.
Nerve supply liver
Sympathetic – From celiac plexus (vasoconstriction).
Parasympathetic – From vagus nerve (secretes bile).
Hepatic plexus – Autonomic supply derived from the celiac plexus.
Ligaments liver
- Falciform Ligament
A double-layered peritoneal fold.
Connects the anterior abdominal wall to the liver.
Lower part contains the ligamentum teres hepatis (round ligament of the liver), a remnant of the umbilical vein.
- Coronary Ligament
Formed by the peritoneal reflection on the superior surface of the liver.
Connects the liver to the diaphragm.
Leaves the bare area of the liver uncovered.
2 layers meet at apex and form R triangular ligament connecting R lateral surface of liver to diaphragm.
- Right and Left Triangular Ligaments
Formed by the fusion of the anterior and posterior layers of the coronary ligament.
Right triangular ligament: Connects the right lobe of the liver to the diaphragm.
Short
Left triangular ligament: Connects the left lobe of the liver to the diaphragm.
Double layer
- Ligamentum Teres Hepatis (Round Ligament of Liver)
A fibrous remnant of the umbilical vein.
Located in the inferior free margin of the falciform ligament.
- Ligamentum Venosum
A remnant of the ductus venosus (fetal circulation).
Lies between the left lobe and caudate lobe.
Clinical anatomy liver
- Hepatic Cirrhosis
- Portal Hypertension
- Liver Trauma
- Liver Tumors
- Jaundice
- Gallstones and Biliary Obstruction
- Pringle’s Maneuver
- Liver Biopsy
- Transplantation
- Resection
Relations liver
Peritoneal
Most of the liver is covered by peritoneum, except for:
Bare area (on the posterior surface)
Groove for inferior vena cava
Fossa for gallbladder
Lesser omentum
Visceral
- Anterior
Triangular and slightly convex
Xiphoid process
Anterior abdominal wall
Diaphragm (which separates it from pleura, lungs, and heart) - Superior Surface
Quadrilateral and convex
Diaphragm
Pericardium
Right and left pleura and lungs - Posterior Surface
Triangular and deeply concave
Bare area
Inferior vena cava groove
Vertebral column
Right suprarenal gland
Oesophageal impression
Diaphragm - Inferior Surface
Quadrilateral and directed downwards, backwards, and to the left
Divided into right and left lobes by the porta hepatis
Gastric impression
Colic impression (hepatic flexure of colon)
Duodenal impression (2nd part of duodenum)
Right renal impression (right kidney)
Right suprarenal impression (right suprarenal gland)
Quadrate lobe: Pyloric impression
Fossa for gallbladder - Right Surface
Quadrilateral and convex
Related to:
Diaphragm opposite 7th to 11th ribs in midaxillary line
Right pleura and lung (upper part)
Diaphragm and costodiaphragmatic recess (middle part)
Only the diaphragm (lower part)
Porta hepatis
It is a transverse fissure on the inferior surface of the liver, between the quadrate and caudate lobes.
Structures Entering:
- Portal vein (posterior)
- Hepatic artery proper (anterior left)
- Autonomic nerve plexus
Structures Leaving:
- Right and left hepatic ducts (bile ducts)
- Lymphatic vessels
Relations of Porta Hepatis
Anterior: Hepatic ducts, hepatic artery
Posterior: Portal vein
Superior: Liver parenchyma
Inferior: First part of the duodenum
The porta hepatis is enclosed by the lesser omentum (hepatoduodenal ligament), which contains the portal triad (portal vein, hepatic artery, bile duct).
Surface of liver
- Anterior Surface
Convex and smooth
Related to the anterior abdominal wall and diaphragm
Separated from the visceral surface by the inferior border
- Superior Surface
Convex, smooth, and covered by peritoneum
Related to the diaphragm, lungs, pericardium, and heart
Contains the bare area (right lobe, no peritoneum)
- Right Surface
Related to the right diaphragm, right lung, and costodiaphragmatic recess
Extends from the anterior to posterior surface
- Inferior (Visceral) Surface
Concave and irregular
Related to stomach, duodenum, gallbladder, right kidney, colon
Contains porta hepatis, ligamentum teres, ligamentum venosum
- Posterior Surface
Related to the inferior vena cava (IVC), caudate lobe, esophagus, and diaphragm
Contains grooves for IVC and ligamentum venosum
Surface marking liver
- Superior Border:
Starts at the right 5th intercostal space in the midclavicular line.
Moves to the left 5th intercostal space near the midline.
- Right Border:
Extends from the right 5th intercostal space downward to the right 10th rib in the midaxillary line.
- Inferior Border:
Starts from the right 10th rib in the midaxillary line.
Moves medially to the tip of the 9th costal cartilage.
Continues to the left 5th intercostal space near the midline.
Hepatic segments
The middle hepatic vein, which runs from the gallbladder fossa to the inferior vena cava (IVC), divides the liver into right and left functional lobes.
This functional division is different from the anatomical division, which is based on the falciform ligament.
a. Right anterior (V and VIII)
b. Right posterior (VI and VII)
c. Left lateral (II and III)
d. Left medial (I and IV)
Surgical importance
Histology liver
- The liver is covered by Glisson’s capsule.
- In pigs, the liver has hexagonal lobules with portal radicles at 3-5 corners.
- Each radicle contains:
Bile ductule
Branch of the portal vein
Branch of the hepatic artery - Central vein is in the center, surrounded by hepatocytes in laminae.
- Sinusoids are on one side of the lamina, while bile canaliculi are on the other.
- Portal lobule in humans is triangular:
Three central veins at the corners
Portal tract in the center - Liver acinus is the functional unit of the liver, defined as liver parenchyma around a preterminal branch of the hepatic arteriole between two central veins.
- Blood reaches the acinus via:
Portal vein branches
Hepatic artery branches
Sinusoids - Hepatocytes in different zones of the acinus:
Zone I (closest to preterminal branch): Best oxygen & nutrient supply
Zone II: Intermediate oxygen supply
Zone III (closest to central vein): Least oxygen, relatively hypoxic
Lesser omentum liver
A fold of peritoneum extending from the lesser curvature of the stomach to the inferior surface of the liver.
L-shaped
Vertical component: Follows the fissure for ligamentum venosum.
Horizontal component: Runs horizontally to complete the left boundary of the porta hepatis.
Right side: Continuous with the coronary ligament.
Left side: Two layers diverge to surround structures of the porta hepatis.
Development Liver
- The liver bud (hepatic diverticulum) arises from the caudal end of the foregut in the 3rd week of development.
- This hepatic diverticulum is called pars hepatica.
- Pars cystica gives rise to:
