Anatomy of Liver

Question 1

Liver surfaces (2)

Answer 1

1) Diaphragmatic
( Anterosuperior surface
Smooth and convex
Fits beneath curvature of diaphragm (direct contact) )

2) Visceral
(Posteroinferior surface
Covered with peritoneum (except for porta hepatitis + gall bladder fossa)
Irregular flat shape - moulded to surrounding organs)

Question 2

“Bare area” of liver =

Answer 2

Posterior area of diaphragmatic surface not covered with peritoneum

Question 3

What are liver ligaments?

Answer 3

Attach liver to surrounding structure

Formed from double layer of peritoneum

Question 4

Falciform Ligament

Answer 4

Attaches to anterior surface of liver + anterior abdominal wall

Form natural anatomical division between left + right lobes

Question 5

ligamentum teres?

Answer 5

Free edge of falciform ligament = (remnant of umbilical vein)

Question 6

Coronary ligament

Answer 6

Superior surface of liver to inferior diaphragm surface

Demarcrates (set’s boundaries of) ‘bare area’ of liver

Anterior + posterior fold unite (form triangular ligaments)

Question 7

R + L Triangular Ligaments

Answer 7

Left Triangular Ligament:
Formed by union of anterior + posterior layers of coronary ligament
Attaches left lobe to diaphragm

Right Triangular Ligament:
Anterior + posterior coronary ligament union
Adjacent to bare area
Attaches right lobe to diaphragm

Question 8

Lesser Omentum

Answer 8

Attaches liver to lesser curvature of stomach + first part of duodenum

Question 9

lesser momentum ligaments

Answer 9

Hepatoduodenal ligament - surrounds portal triad

Hepatogastric ligament

Question 10

Subphrenic spaces

Answer 10

Between diaphragm + anterior + superior aspects of liver

Divided into left + right by falciform ligament

Question 11

subhepatic spaces

Answer 11

Sub division of supracolic compartment (above transverse mesocolon)
Peritoneal space between inferior liver surface + transverse colon

Question 12

Morison’s Pouch

Answer 12

Potential space between visceral surface of liver + right kidney
Deepest part of peritoneal cavity when supine (lying flat)

Question 13

Glisson’s capsule?

Answer 13

Fibrous capsule covering the liver

Question 14

Where + what are the 2 accessory lobes?

Answer 14

On the right lobes visceral surface

Caudate + Quadrate Lobes

Question 15

Caudate Lobe?

Answer 15

Upper aspect of visceral surface

Between Inf. Vena Cave + fossa produced by ligamentum venosum (remnant of fetal ductus venosus)

Question 16

Quadrate Lobe?

Answer 16

Lower aspect of visceral surface

Between gall bladder + fossa produced by ligamentum teres (remnant of fetal umbilical vein)

Question 17

Porta Hepatis?

Answer 17

Deep transverse fissure seperating caudate + quadrate

Transmits all vessels, nerves + ducts entering/leaving liver (EXCEPT for hepatic veins)

Question 18

Structural Unit of Liver

Answer 18

Hepatocytes in lobules

Question 19

Lobules

Answer 19

Hexagonal shaped
Drained by a central vein
Periphery of hexagon = portal triad (3 structures: arteriole, venule, bile duct)
(+sinusoids + kpuffer cells)

Question 20

Portal Triad

Answer 20

Arteriole = branch of hepatic artery entering the liver

Venule = branch of hepatic portal vein entering liver

Bile duct = branch of bile duct leaving the liver

Also contains: lymphatic vessels + vagus nerve (parasympathetic) fibres

Question 21

Hepatic Plates

Answer 21

2 cells thick

Plates separated from each other by sinusoids (capillary spaces)

Question 22

Cell type lining sinusoids (2)

Answer 22

1) Specialised fenestrated (perforated) vascular endothelial cells
Form lining with gaps to facilitate transfer of metabolite from blood to hepatocytes

2) Mononuclear + phagocytic Kupffer cells
Near gaps in endothelial cells
Recycle non-functioning red blood cells (used to make bile)

Question 23

Arterial Supply

Answer 23

Dual blood supply

HEPATIC ARTERY PROPER
(25% of blood supply)
Supplies non-parenchymal structures with arterial blood
Derived from Coeliac Trunk

HEPATIC PORTAL VEIN
(75% of blood supply)
Supplies partially deoxygenated blood 
Nutrients absorbed from small intestine 
Dominant blood supply from parenchyma (allows liver to detoxify)

Question 24

Venous Drainage

Answer 24

Central Veins in Hepatic Lobules form collecting veins
Combine to form multiple hepatic veins
Hepatic veins open into Inferior Vena Cava

Question 25

Nerve supply (parasympathetic + sympathetic)

Answer 25

Parenchyma innovated by Hepatic Plexus

Sympathetic = Coeliac Plexus nerve fibres
Parasympathetic = Vagus Nerve nerve fibres 

Enter liver at porta hepatis + follow hepatic artery

Question 26

Lymphatic Drainage (anterior aspect)

Answer 26

Drain into Hepatic Lymph Nodes (along hepatic vessels + ducts in lower omentum)
Empty into colic lymph (cisterna chyli)

Question 27

Lymphatic Drainage (Posterior aspect)

Answer 27

Drain into phrenic + posterior mediastinal nodes

Join right lymphatic + thoracic ducts