- upper right quadrant - right hypochondrium, epigastrium, left hypochondrium - ribs 7-11, mid axillary line

Anatomy of the Liver Flashcards by Aarya Sumesh

What is the largest gland in the body?

Liver

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What is the second largest organ in the body?

Liver

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Liver: Location:

upper right quadrant
right hypochondrium, epigastrium, left
hypochondrium
ribs 7-11, mid axillary line

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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

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Location of Liver:

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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

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Hepatorenal recess

posterosuperior extension of subhepatic space

right visceral surface of liver and right kidney and suprarenal gland

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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

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Liver Location: Recesses:

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The liver has how many surfaces and describe them

two surface
diaphragmatic: smooth, domed
visceral: fissures, visceral impressions in the formalin
fixed liver

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Liver surface diagram

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visceral surface diagram

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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

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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

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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

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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

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Liver fissures

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What are the anatomical lobes of the liver?

Left and right lobe

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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 - 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