Which abdominal regions is the liver situated in
Right Hypochondrium
Epigastrium
Right Lumbar
Left Hypochondrium (sometimes)
What is the weight of the liver?
- 4 - 1.8kg ::: males
1. 2 - 1.4kg ::: females
What are the surfaces of the liver?
Diaphragmatic and Visceral
What are the relations of the anterior diaphragmatic surface of the liver
Diaphragm separates it from:
- 6-10 costal cartilages on Right
- 7-8 costal cartilages on Left
Has falciform ligament
What are the relations of the superior diaphragmatic surface of the liver
Diaphragm separates it from:
- Lung on Right
- Heart on Left
Has:
- Bare area
- IVC
What are the relations of the posterior diaphragmatic surface of the liver
Lies against vertebral column
What are the main features on the visceral surface of the diaphragm
Porta hepatis Gall bladder IVC Fissure for Ligamentum Teres Hepatis Fissure of Ligamentum Venosum
What are the structures going through the Porta Hepatis
Hepatic A (Right and Left) Portal V Hepatic Ducts (Right and Left) Lymphatics Hepatic nerve plexus
What does the ligamentum teres hepatis develop from?
Remnant of Umbilical Vein
What does the ligamentum venosum develop from?
Remnant of Ductus Venosus
What are the anatomical lobes as seen on the visceral surface of the liver?
Right
Left
Caudate
Quadrate
Which side of the liver does the Gall Bladder lie
In a fosssa on the anterior side of the liver
Regarding the caudate and quadrate lobes of the liver, which lies posterior and which lies anterior
cadate - posterior
quadrate - anterior
Which is the line that divides the liver into left and right functional halves?
cholescysto-vena-caval line
Describe the functional division system of the liver?
Couinaud’s segments divide the liver into independent functional lobes.
Each lobe has an independent:
- Bile Duct
- Portal Vein
- Hepatic Artery
What are the impressions of the visceral surface of the liver?
Impressions for:
Stomach Pyloric Duodenum (1st/sup. part) Transverse Colon Rt Colic (hepatic) Flexure Rt kidney and adrenal gland
What are the ligaments that attach to the liver?
Falciform ligament
Round ligament of liver (Ligamentum teres hepatis)
Coronary Ligament (Ant. and Post.)
Triangular Ligaments (Right and Left)
Describe the Ligamentum Teres Heaptis
AKA Round ligament of liver
1: Runs on the lateral side of the caudate lobe
2: Runs to Umbilicus
Describe the course of the Falciform Ligament
1: Runs on Ant. surface of Liver
2: Splits Liver into Medial and Lateral surfaces
3: Encloses Round Ligament along its margin
4: Runs along inner/posterior Right RA sheath
5: Ends at Umbilicus
Describe the blood supply of the Liver
Left and Right Hepatic Artery (20%) Portal Vein (80%)
Right and Left Hepatic Vein (runs in Parenchyma to connect with IVC)
IN 25% OF CASES, SMA CONTRIBUTES TO ARTERIAL SUPPLY OF THE LIVER
Explain the lymphatic drainage of the liver
Superficial vessels: (in sub-serosa areolar tissue) -hepatic LN -coeliac LN -para-aortic LN ALL DRAIN INTO THORACIC DUCT
Deep vessels:
-End in nodes around the IVC
Explain the nerve supply of the liver and its course
Nerve supply comes from: Hepatic Plexus (from Coeliac Plexus)
This plexus accompanies hepatic artery and its branches
What shape is the Gallbladder
Piriform-shaped
What is the size of the Gallbladder
Length: 7-10cm
Breadth: 3cm (at widest point)
Capacity: 30-50ml
What are the parts of the gallbladder? Also, explain their relations
Fundus:
- Projects beyond inferior border of liver
- Related to Ant. Abd. Wall
- Posteriorly, related to Transverse Colon
Body:
- Upper surface related to liver
- Underside related to Transverse Colon and Duodenum
Neck:
-Sometimes, a small pouch projects at the junction between the Neck and Cystic Duct called “Hartmann’s Pouch”
Describe the anatomy of the cystic duct
3-4cm long
Runs inferio-posteriorly from Neck of GB to join Common Hepatic Duct forming the Bile Duct
Mucous membrane from Neck to Bile Duct contains 5-6 oblique projections into lumen
-Called “Spiral Folds” or “Valves of Reister”
Describe the arterial supply of the Gallbladder
Cystic Artery (from Right Hepatic A. - or Common Hepatic A. or Gastroduodenal A.): -Supplies Gallbladder and Cystic Duct
Right Hepatic Artery
-Supplies Hepatic Ducts and upper part of Common Bile Duct
Describe the venous drainage of the Gallbladder
Cystic Veins:
-Run into Liver directly OR -Run into Hepatic Vein OR -Run into veins draining upper part of Bile Duct
What is the nerve supply to the Gallbladder
Coeliac Plexus
What is the lymphatic drainage of the Gallbladder
Hepatic LN
Cystic LN
What is the failure of canalization of the Bile Duct called?
Congeintal Atresia
OR
Stenosis
What can cause obstruction of the Gallbladder
Tunours in Pylorus or Pancreas causing Pressure
Gallstone formation
Which part of the duodenum does the Bile Duct drain?
Descending (2nd part)