Flashcards in Liver surfaces and attachments (Dave's notes) Deck (36)
What are the divisions of the diaphragmatic surface surface of the liver?
Anterior, posterior, superior and right surfaces. Covered mostly in peritoneum but peels off in places to join the diaphragm
What are the relations of the anterior surface of the liver?
Diaphragm, lung, pleura, and ribs - 6-9R and 6-7L, curves back at the superior surface
What are the relations of the superior surface of the liver?
Heart and pericardium centrally with lung and pleura laterally. The lower border sloapes up along the right rib border and then across the epigastrium (or does this mean the lower border of the liver rather than the superior surface?
Describe the position of the falciform ligament relative to the liver.
The falciform ligament lies from the centre to the ligamentum teres notch, left to the fundus of the gall bladder. It splits and sweeps to the rightas the upper layer of the coronary ligament and to the left as the left tirangular ligament
What are the relations of the right surface of the liver?
Ribs 7-11, lower 1/3rd to the ribs and diaphragm, middle 1/3rd also to pleura, upper 1/3rd also to lung
Describe the visceral surface of the liver
The visceral surface of the liver slopes downwards, forwards and to the right. Its main feature is an H-pattern of structures. Contains the portahepatis, lesser omentum extending into the ligamentum venosum and impressions of lower organs
What forms the H pattern of structures on the visceral surface of the liver?
The crosspiece of the H is the portahepatis, and is enclosed by the two layers of the lesser omentum. From the left and end these are attached to the ligamentum venosum. The lesser omentum passes down from here to enclose the stomach and the first 2cm of the duodenum. From the right end the gall bladder lies in the shallow ofassa on the downsloping surface, neck highest, fundus lowest
Describe the porta
The porta hepatis is a transverse slit perforated by the right and left hepatic ducts and the right and left branches of the hepatic artery and portal vein (VAD, ducts in front). The cystic duct lies in loose cntact with the right end of teh porta.
What constitutes the right limb of the H?
the right limb is incomplete and consists of the IVC and GB
What constitutes the left limb of the H?
The ligamentum venosum and teh ligamentum teres
The ligamentum venosum and the ligamentum teres
Describe the posterior surface of the liver
The posterior surface of the liver blends with the visceral surface of the liver. It contains the bare area, the bounding ligamnts, the right suprarenal impression, the IVC groove, the caudate lobe and process, the ligamentum venosum fissure
Describe the bare area of the liver
The bare area is triangular and lies to the right of teh IVC (its base). The sides are formed by upper and lower layers of teh coronary lifament. The apex is at the right triangular ligament. Frm here peritoneum sweeps doesn over the right kidney.
What encloses the caudate lobe?
The lower layer of the coronary ligament in the upper recess of the lesser sac
What are the relations of the caudate lobe?
In in contact with the diaphragm??? in front of the thoracic aorta, left of the IVC an dright of the oesophagus and ligamentum venosum
List the lobes of the liver
Left, caudate, quadrate, and right
What does the falciform divide?
The anatomical left and right lobes
What is the location and relations of the caudate lobe?
The caudate lobe lies between the IVC and ligamentum venosum and is connected to the right lobe via the caudate process
What is the location and relations of the quadrate lobe?
The quadrate lobe lies between the gall bladder fossa and the fissure for the ligamentum teres.
Which lobe to the caudate and quadrate belong to functionally?
The left lobe
Describe one simple way of dividing the liver into segments
Left lateral (1), left medial (2), right anterior (2), and right posterir (2)
Location of segment 1 (8 segment division)
Location of segment 2 (8 segment division)
Location of segment III (8 segment division)
Lateral part of left medial
Location of segment IV (8 segment division)
Medial part of left medial
Location of segment V (8 segment division)
Lower part of right anterior
Location of segment VI (8 segment division)
Lower part of right posterior
Location of segment VII (8 segment division)
Upper part of right posterior
Location of segment VIII (8 segment division)
Upper part of right anterior
Describe the artery and portal vein divisions
The hepatic artery division is Y-shaped, the portal vein division is T-shaped
The right hepatic artery divides into what?
Anterior and posterior branches
The left hepatic artery divides into what? What abberation may occur?
Medial and lateral branches. The commonest aberration is a left hepatic artery arising from the left gastric (20%)
What arterial mixing occurs between the left and right halves of the liver?
There is no communication between the arterial supply of the left and right halves of the liver
What venous mixing occurs between the left and right halves of the liver?
There is left, right and central venous drainage, with mixing. The central veins drain left and right, and ?? are the main structural support
Describe the lymphatic drainage of the liver
The lymphatic drainage of the liver is to nodes at the porta hepatis that drain down the hepatic artery to retropyloric and coeliac nodes.
What is the nerve supply of the liver and by what route?
Via sympathetic and vagus pathways, vagal from anterior/left branches across ???