Anatomy of the liver and biliary system

Anatomy of the liver

Ligaments and prietoneal reflections:

• The left triangular ligament

• The right triangular ligament

• The falciform ligament

• The lesser omentum

Liver blood supply:

• Hepatic artery ( a branch of the coeliac trunk ) à 20 %

• The portal vein à 80 %

Structures in the hilum of the liver:

The hepatic A., portal V., and bile duct are present within the free
edge of lesser omentum:

• The bile duct; within the free edge

• The hepatic A.; ant. & med.

• The portal V.; post.

• The venous drainage of the liver:

• Is via the hepatic veins into the IVC.

• IVC lies within a groove in the posterior wall of the liver.

Lobes of the Liver:

Surgical lobes Anatomical lobes

The hepatic lobule:

• The functional unit of the liver.

• Consists of hepatocytes separated by the sinusoids that carry blood

from the portal tracts toward the central veins
• In an opposite direction, bile drain toward the bile duct tributaries
within the portal tracts.

The gall bladder and bile ducts :

 The gall bladder:

• Pear-shaped,

• 7.5 – 12 cm long

• 5 ml capacity, but
capable of
considrable
distension

• Divided into: a
fundus, a body,
and a neck that
tterminate in a
narrow
infundibulum

: The wall of the gall bladder

• The muscle fibers in the wall are arranged in a criss-

cross manner, particularly well developed in the neck.

• The mucus membrane contains indentations that sink

into the muscle coat, these are the crypts of Luschka.
The cystic duct:

• About 3 cm in length but variable

• Its lumen diameter is usually 1-3 mm

• The mucosa is arranged in spiral folds known as the valves

of Heister.

• The muscle fibers form a sphincteric structure called the

sphincter of Lutkens

•
• In 80 % of cases, the cystic duct joins the common hepatic
duct in its supraduodenal segment

• It may extend to retroduodenal or retropancreatic part

• Occasionally, it may join the right hepatic duct

• The common hepatic duct is less than 2.5 cm long

• The common bile duct is about 7.5 cm long

The common bile duct:

• It’s divided into four parts:

• The supraduodenal portion, about 2.5 cm long, running in

the free edge of the lesser omentum

• The retroduodenal portion,

• The infraduodenal portion, lies in a groove or a tunnel on

the post. surface of the pancreas

• The intraduodenal portion, passes obliquely through the

wall of the 2nd part of the duodenum, where it’s surrounded
by the sphincter of Oddi, and terminates by opening of the
ampulla
The Arterial supply of the gallbladder and the bile duct:

• Cystic A.: a branch of Rt. hep. A.

• Pass behind the common hep duct ( >80%)

• In 15%, pass in front

• The most dangerous anomaly:

tortuous hep. A. on the front of the origin of cystic duct or

tortuous Rt. Hep. A. & short cystic A

* post.op. comp.: ischemia à stricture

* * damage to Rt. Hep A ( laparoscopically )