Anatomy of the Liver Flashcards
What is the largest gland in the body?
Liver
What is the second largest organ in the body?
Liver
Liver: Location:
- upper right quadrant
- right hypochondrium, epigastrium, left
hypochondrium - ribs 7-11, mid axillary line
Location of Liver:
superior:
lateral:
medial:
posterior:
inferior:
superior: diaphragm
lateral: diaphragm and thoracic wall
medial: stomach
posterior: IVC, abdominal aorta, right kidney
inferior: duodenum
Location of Liver:
Subphrenic recess
superior extension of the greater sac
inferior surface of diaphragm and diaphragmatic surface of liver, divided into left and right by falciform ligament
Hepatorenal recess
posterosuperior extension of subhepatic space
right visceral surface of liver and right kidney and suprarenal gland
Subhepatic recess
supracolic compartment of the greater sac
right visceral surface of liver and right kidney and suprarenal gland
communicates anteriorly with the subphrenic recess
Liver Location: Recesses:
The liver has how many surfaces and describe them
- two surface
- diaphragmatic: smooth, domed
- visceral: fissures, visceral impressions in the formalin
fixed liver
Liver surface diagram
visceral surface diagram
Fissures of the Liver (3):
- Right sagittal: groove for IVC and gallbladder fossa
- Left (umbilical) sagittal: ligamentum teres hepatis,
ligamentum venosum - Porta hepatis (transverse): structures enter/exit the
liver
Ligamentum teres hepatis:
- remnant of
- purpose embryologically
- which fissure of the liver?
- remnant of the left umbilical vein
- drains oxygenated blood from small venules of placenta
into growing fetus and drains into ductus venosus - Left (umbilical) sagittal fissure
Ligamentum venosum:
- remnant of
- purpose embryologically
- which fissure of the liver?
- remnant of ductus venosus, which shunts a portion of
umbilical blood directly to the IVC, allowing
oxygenated blood from the placenta to bypass the
liver - left (umbilical) sagittal fissure
Porta Hepatis is the —— and —— of the liver containing:
Porta Hepatis is enclosed by
Porta Hepatis is the hilum and root of the liver: portal triad, lymphatics, nerve plexus
Enclosed by lesser omentum
Liver fissures
What are the anatomical lobes of the liver?
Left and right lobe
What are accessory lobes?
functionally part of the left lobe of the liver, anatomically part of the right lobes of the liver
Quadrate lobe of liver:
- type
- location
- between
- accessory lobe
- inferior and anterior
- between ligamentum teres hepatis and gallbladder
Caudate lobe of the liver:
- type
- location
- between
- accessory lobe
- superior and posterior
- between IVC and ligamentum venosum
Label lobes and fissures
Label and describe what the bare area of the liver is
Additionally, label the recesses of the liver
Bare area: part of the diaphragmatic surface not
covered by visceral peritoneum, groove for
IVC
Where is the apex of the liver?
Left extremity
Portal triad
Label the ligaments and peritoneal folds of the liver
Falciform ligament:
- anterior abdominal wall to diaphragmatic hepatic
surface - free edge contains ligament teres hepatis
Coronary ligaments (liver):
- inferior diaphragmatic surface to diaphragmatic
hepatic surface - anterior, posterior lamina
Triangular ligaments (liver):
- inferior diaphragmatic surface to diaphragmatic
hepatic surface - right, left
Liver: Arteries:
- coeliac trunk (T12) arises from the abdominal aorta
- coeliac trunk divides into 3 main branches: left gastric
artery, splenic artery and common hepatic artery - common hepatic artery gives off gastroduodenal
artery and right gastric artery leaving hepatic artery
proper - Hepatic artery proper (20-25%)
- divides into right and left hepatic artery
- right hepatic artery also gives of the cystic artery
(supplies gallbladder)
Venous nutrient rich blood supplied to liver by:
- portal vein (75-80%)
- Two veins that form the portal vein are:
- splenic vein: inferior mesenteric vein drains into
the splenic vein - superior mesenteric vein
- splenic vein: inferior mesenteric vein drains into
- left gastric vein is also a tributary of the portal vein
Venous drainage of the liver
3 hepatic veins:
- right hepatic
- intermediate/middle hepatic veinn
- left hepatic vein
All drain into the IVC!
Blood supply to liver
Portal vein
venous drainage of liver
Lymphatic Drainage of the liver:
- superficial = capsular drainage
- deep = deep connective tissue
- anterior aspects drain to hepatic nodes into coeliac
nodes and then into cisterna chyli, which is the origin
of the thoracic duct - posterior aspects drain into phrenic nodes, into
posterior mediastinal nodes, into the right lymphatic
duct or the thoracic duct
Lymphatic Drainage of the Liver
Innervation of the Liver:
Hepatic Plexus:
- sensory innervation: to capsule hence pain due to
stretch - intercostal nerves T6-T9
- sympathetic: greater splanchnic nerve (T5-9), lesser
splanchnic nerve (T10-T11)
- parasympathetic: vagus nerve (CNX)
Innervation of the Liver:
Referred hepatic pain: dermatomes
T6-T9: epigastrium, right hypochondrium
C3-C5: shoulder and neck
Referred pain
Porto-systemic anastomoses:
- is
- 3 main sites
- collateral route for venous return to the right atrium
- gastro-oesophageal junction
- peri-umbilical region
- anal canal
Porto-systemic anastomoses:
- is
- clinical relevance
- blood can drain via portal vein through the liver back
to the heart or via a more systemic route directly back
to the right atrium - if a pathology in the liver is causing portal hypertension, creates a backpressure in venous drainage of portal system
- at porto-systemic anastomoses, dilations will occur
causing varicosities, hence blood will return via the
systemic route due to the increased pressure
Porto-systemic anastomoses: Gastro-oesophageal junction:
- can drain via the left gastric vein ( a small tributary of
the portal system) or the azygous system - portal hypertension can lead to oesophageal varices
due to dilatations in the veins and can bleed profusely
Porto-systemic anastomoses: Peri-umbilical region:
- can drain via the para-umbilical vein (portal system)
or via the superficial veins of the abdo wall - can cause caput medusae (head of medusa), belly
button looks like head of medusa and veins are
squiggly looking like snakes, if portal hypertension
causes dilatation
Porto-systemic anastomoses: Anal canal:
- can drain via the superior rectal ( which drains into
the inferior mesenteric vein and into portal system) or
the middle or inferior rectal veins (systemic) - internal haemorroids if portal hypertension causes
dilatations
Functional Hepatic Divisions:
- 4 hepatic divisions
- further divided into 8 surgically resectable hepatic
segments - divisions and segments: independent branches of the
portal triad
