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LIVER

Alvin B. Vibar, M.D.


Abdominal Regions
Umbilicus – level of IVD of L3
– L4
Subcostal plane – 10th rib ; L3
Transtubercular – iliac
tubercle; L5
Nine regions
Central – Epigastric
Umbilical
Hypogastric / Pubic

Lateral - R/L Hypochondriac


R/L Lumbar
R/L Inguinal
LIVER:
Surface Anatomy:
lies mainly in the RUQ
of the abdomen;
occupies most of the R
hypochondrium, the
upper epigastrium &
extends into the L
hypochondrium
Lies deep to the 7
through 11 ribs on
the R side & crosses
the midline toward the
L nipple
Largest visceral organ
& gland in the body,
soft and pliable,
weighs 1500 gms
Functions:
Bile production and
secretion
Filtration of blood
Involvement in
metabolic activities –
carbohydrate, fat and
protein metabolism
Blood-clotting
mechanisms
Synthesizes Heparin
Detoxification
Surfaces:
Diaphragmatic –
dome shaped;
anterior, superior and
posterior parts;
covered with visceral
peritoneum except
posteriorly in the bare
area
Surfaces:
Visceral (posteroinf.) –
covered w/ visceral peritoneum
except at the bed of the gall
bladder & porta hepatis
Related to:
R side of stomach
1st part of duodenum
lesser omentum
Gall bladder
R colic flexure & R
transverse colon
R kidney & adrenal gland
Impressions and structures
on visceral surface of liver
Renal impression
Right lobe
Colic impression
Duodenal impression
Gastric impression Left lobe
Porta hepatis – central area undersurface of liver devoid
of peritoneum serves as entrance for the structures in
the portal triad
Portal triad
1. Hepatic artery
2. Bile duct
3. Portal vein
Inferior surface and its
impressions
Ligaments:
Falciform ligament
Coronary ligament
R / L triangular ligaments
Ligamentum teres /
round ligament – remnant
of umbilical vein; between
left lobe & quadrate lobe
Ligamentum venosum –
remnant of ductus
venosus; between left lobe
& caudate lobe
Falciform ligament –
2 layered fold of – free
margin contains the
Ligamentum teres
2 layers:
Right – Coronary
ligament – Right
triangular ligament
Left – Left triangular
ligament
Left triangular
ligament

Coronary ligament

Bare area

Right triangular
ligament
Anatomical
lobes:
Left lobe

Right lobe – caudate


& quadrate
Functional
lobes:
2 – approximately equal size
A line interconnecting the GB
and IVC separates the Left
lobe from the Right lobe
Has a separate arterial blood
supply, venous and biliary
drainage
Hepatic Segments
Segments:
Medial superior = I
Lateral superior = II
Lateral inferior = III
Medial inferior = IV
Anterior inferior = V
Posterior inferior = VI
Posterior superior=VII
Anterior superior=VIII
ABDOMINAL AORTA
Anterior Visceral
Celiac
Superior Mesenteric
Inferior Mesenteric
Lateral Visceral
Suprarenal
Renal
Gonadal
Lateral Abdominal
Inferior Phrenic
Lumbar
Terminal branches
Common iliac
Median Sacral
Celiac artery – T 12
Left Gastric
Splenic – Left Gastroepiploic
Short Gastric
Hepatic – Right Gastric
R/L Hepatic
Gastroduodenal –
Right Gastroepiploic
Sup. Pancreaticoduodenal
Superior Mesenteric Artery – L 1
Inferior Pancreaticoduodenal
Middle Colic
Right Colic
Ileo-colic
Jejunal-Ileal
Inferior Mesenteric Artery – L 3
Left Colic
Sigmoid
Superior Rectal
PRIMITIVE GUT divisible into:
FOREGUT – supplied by Celiac trunk
MIDGUT – Sup. Mesenteric artery
HINDGUT – Inf. Mesenteric artery
Foregut derivatives
Primordial pharynx and it’s derivatives ( oral
cavity, pharynx, tongue, tonsils, salivary glands,
upper respiratory )
Lower respiratory
Esophagus and Stomach
Duodenum ( proximal to the opening of bile
duct )
Liver, Biliary apparatus ( hepatic ducts, Gall
bladder and Bile duct ) and Pancreas
Supplied by Celiac artery
Midgut derivatives
Small intestine, including most of the
duodenum
Cecum, Vermiform appendix, Ascending
colon, and the right half to two thirds of the
Transverse colon
Supplied by Superior mesenteric artery
Hindgut derivatives
Left one third to one half of the transverse
colon
Descending colon and Sigmoid colon
Rectum and Superior part of the Anal
canal
Epithelium of the Urinary bladder and
most of the Urethra
Supplied by Inferior mesenteric artery
Blood supply to liver
Common Hepatic
artery divides into
Right and Left
hepatic arteries
supplying the Right
and Left functional
lobes of the Liver
Blood supply:
Portal vein – formed
by union of superior
mesenteric & splenic
veins ; 70%
Hepatic artery –
branch of celiac
artery; 30%
Blood Flow to liver
Portal vein
- 70% blood flow
- unoxygenated blood , absorbed
substance from the alimentary tract
- will drain to the hepatic veins
Hepatic artery
- 30% blood flow
- oxygenated blood
- branch of the celiac artery from
abdominal aorta
Hepatic lobule
Liver Acinus
Divisible into 3 zones:
Zone 1 – closest to
the portal tract and
receives the most O2
Zone 2
Zone 3 – farthest and
receives the least O2,
most susceptible to
ischemic injury
LIVER
PORTAL VENOUS SYSTEM
Tributaries:

Superior mesenteric

Splenic

Inferior mesenteric

Left gastric

Paraumbilical
Tributaries of the Portal Veins
Venous drainage,
lymphatic & nerve
supply
Hepatic veins formed
by the union of central
veins drain into IVC
Hepatic lymph
nodes drain into
celiac lymph nodes
– cisterna chyli
Hepatic nerve
plexus from celiac
plexus
Portal-Caval Anastomoses
Normal route – portal vein
– liver – hepatic vein – IVC
If blocked:
Esophageal branch of L
gastric = esophageal of
Azygos
Superior rectal = middle &
inferior rectal
Paraumbilical = superficial
veins of ant. Abd’l wall
Colic veins = retroperitoneal
veins
Portal Hypertension
Esophageal plexus of
veins
Azygous vein Para-umbilical veins
Hemorrhoidal plexus
of veins

Left
gastric
vein
Clinical
Correlation:
Liver biopsy usually done
at R 10th ICS in MAL
Rupture of liver
Hepatomegaly
Liver cirrhosis – causes
portal HPN w/c can
produce esophageal
varices, caput medusae
and hemorrhoids
PANCREAS
Pancreas ( exocrine and
endocrine)
Parts
Head – expanded part; is embraced by
the C shaped curve of the Duodenum
Neck – short and overlies the Superior
mesenteric vessels
Body – to the left of SMA and SMV
Tail – closely related to the hilum of
spleen and left colic flexure
Parts of the Pancreas
Head
Neck
Body
Tail
Uncinate process
– projection from
the inferior part of
head; extends
medially to the left
post. to SMA
Relations:
Lies Posterior to the
Stomach between
the Duodenum on
the right and Spleen
on the Left
Ducts of the Pancreas
Main pancreatic
duct (Wirsung)
begins in the tail of
the pancreas and
runs through the
parenchyma to the
head where it turns
inferiorly and
merges with the Bile
duct
Blood supply:
Superior pancreaticoduodenal artery
from Gastrodudenal ( Hepatic – Celiac)

Inferior pancreaticoduodenal from SMA

Pancreatic arteries from Splenic


Blood supply of Pancreas
Blood supply to the body and
tail
Venous drainage:
Pancreatic veins
which are tributaries
of the Splenic and
Superior
mesenteric; most of
them empty into the
Splenic vein
Rupture of the Pancreas
Pancreatic injury can result from sudden,
severe, forceful compression of the
abdomen
Rupture frequently tears its duct system
allowing pancreatic juice to enter the
parenchyma of the gland and to invade
adjacent tissues – digestion of pancreatic
and other tissues by pancreatic juice is
painful
Pancreatic cancer
Cancer involving the pancreatic head
accounts for most cases of extrahepatic
obstruction of the biliary system
Compresses and obstructs the Bile duct
causing Obstructive jaundice resulting in
the retention of bile pigments,
enlargement of GB and jaundice