TABLE E: GROSS ANATOMY

OF THE LIVER &

BILIARY SYSTEM
Abdominopelvic Viscera Part 1

Rachel Harrington & Lyndsay Ruckle

 Anatomy of the Liver – Lobes & Bare Area
1. Right Lobe:
• Largest lobe
5
2. Left Lobe:
• Smaller than the right lobe
1 2
• “Left lobe is little”

3. Caudate Lobe:
• Located on the poster-superior surface of the
right lobe

• Lies between the inferior vena cava and the

fissure for the ligamentum venosum

4. Quadrate Lobe:
• Located on the anterior-inferior surface of the
right lobe

5
• Lies between the gallbladder and the fissure for
the ligamentum teres (round ligament)
3

5. Bare Area:
• Area on the surface of the liver that is not covered
with visceral peritoneum
4
• Lies in direct contact with the diaphragm

• Important in regards to referred pain; referred pain

from the biliary system will be in the shoulder
 Anatomy of the Liver - Ligaments
1. Coronary Ligament:
• Anterior (upper) and posterior (lower) layers

• Run along the top margin of both lobes

• Anchor the liver to the diaphragm

3 1
2
2. Triangular Ligaments:
• Right and left triangular ligaments

• A continuation of the coronary ligament

• Connect the posterior, upper surface of the

corresponding lobe to the diaphragm

3. Falciform Ligament:
• Attaches the liver to the superior-anterior portion 2.
of the abdominal wall
2
• Divides the liver into right and left lobes

5
• Encloses the round ligament

3
4. Round Ligament:
• “Ligamentum Teres”
4
• A fibrous fetal remnant of the umbilical vein

5. Ligamentum Venosum:
• “Ductus Venosus” during fetal development

• Fetal remnant which allowed blood to bypass the

liver; shunts oxygenated blood from the umbilical Falciform ligament ! Coronary ligament ! Triangular ligaments
vein to the inferior vena cava
Each is a continuation of the ligament before it
• Sits in fossa next to the caudate lobe
 Anatomy of the Liver – Blood Vessels
1. Porta Hepatis:
• Transverse fissure
4
• Contains the hepatic portal vein, proper 4
hepatic artery, lymphatic vessels, hepatic
nerve plexus, and hepatic ducts

• Where these enter and leave the liver

2. Hepatic Portal Vein:

• Short, wide vein that is formed from the
superior mesenteric and splenic veins

3. Proper Hepatic Artery: 2

• A branch of the common hepatic artery
3

4. Hepatic Veins:
• Right, intermediate (middle), and left

• Drain directly into the inferior vena cava

1 Porta Hepatis 5 Cystic Artery

5. Cystic Artery:
• Lies along the cystic duct

 Biliary System– Gallbladder Anatomy

1. Fundus: 3
• Wide, blunt end

• Projects from the inferior border of the liver at

the tip of the right 9th costal cartilage

2
2. Body:
• Main portion that contacts the visceral surface
of the liver, transverse colon, and superior part
of the duodenum

1
3. Neck:
• Narrow, tapering end

• Opposite of the fundus and directed toward

the porta hepatis

• Usually makes an S-shaped bend and joins

the cystic duct

 Liver and the Biliary System - Ducts

1. Right and Left Hepatic Duct:
• Drain the right and left portions of the liver
1 1

2. Common Hepatic Duct: 3 2

• Right and left hepatic ducts come together to
create the common hepatic duct

3. Cystic Duct:
• Connects the gallbladder to the common bile duct

4. Common Bile Duct: 4

• Formed by the combination of the cystic duct and
common hepatic duct

• Forms in the free edge of the lesser omentum

• Length varies from 5 to 15cm

• Lies in a groove on the posterior surface of the

head of the pancreas

Bile Production and Flow:

• Bile is continuously produced by the liver; between
meals it accumulates and is stored in the
gallbladder. Bile passes from the liver through the
right and left hepatic ducts, into the common
hepatic duct, and into the bile duct.
Biliary System– Cystohepatic Triangle

Cystohepatic Triangle:
• Borders are the common hepatic duct,
cystic duct, and the liver

• Important surgical landmark

• Usually contains the cystic artery and

Calot’s lymph node
 Biliary System– Entrance Into the Small Intestine

1. Hepatopancreatic Ampulla:
• “Ampulla of Vater”

• Formed by the union of the

pancreatic duct and the
common bile duct

2. Hepatopancreatic Sphincter:
• “Sphincter of Oddi”

• Controls secretion from the

ampulla

3. Major Duodenal Papilla:

• Opening in the second part
of duodenum where
hepatopancreatic ampulla
enters
3
1
Hepatopancreatic Sphincter
2 (Sphincter of Oddi)
(Ampulla of Vatar)
Clinical Applications – Cirrhosis of
Liver
• Progressive destruction of hepatocytes, leading
to the replacement of these cells by fibrous
tissue and fat cells = “scarring”

• Most often present in chronic alcoholics, though

may be caused by chemicals or Hepatitis B & C
infections

• Cirrhosis can lead to hepatic hypertension,

ascites (accumulation of fluid in the peritoneal
cavity), bacterial peritonitis, and liver cancer

• Causes loss of appetite, easy bruising, jaundice,

itching, and fatigue

• If Cirrhosis progresses, it may be treated with a

anastomose between the portal system and
venous system
Clinical Applications – Gall Stones

• A stone formed in the gallbladder, cystic duct or bile duct

made mostly of cholesterol crystals

• Also referred to as, “Cholelithiasis”

• More common in females, and likelihood increases with

age

• Many gallstones are asymptomatic; for them to cause

issues, they must do physical damage to the gallbladder
or obstruct the biliary tract

• May cause pain in the posterior thoracic wall or shoulder

region

• Symptoms include: fever, jaundice, vomiting, and pain

• Treatment includes the removal of the gallbladder

(“cholecystectomy”) or medication to dissolve the stone
Clinical Applications - Cholecystectomy

• Removal of the gallbladder

• Typically done laparoscopically ! Does not require the abdominal

muscles to be cut

• Indicated when there is inflammation, biliary colic, gallbladder

cancer, or gallstones that are causing pancreatitis

• Common bile duct will still be intact after surgery; bile produced by
the liver will be dumped straight into the small Intestine