Liver Flashcards
Site
Right hypochondrium, epigastrium and may extend slightly in left hypochondrium
Size
Largest gland in the body, weighing 1-2.5 kg
Shape
Wedge shaped with its base on right side
Borders
It has 5 surfaces:
- Anterior
- Posterior
- Superior
- Inferior
- right
Borders separating them are rounded and ill-defined except inferior border which is sharp
Surface anatomy: upper border
Concavo-convex line passing through:
1. 5th intercostal space in left midclavicular line (close to heart apex and stomach fundus)
2. Xiphisternal junction (7th Sternocostal junction level)
3. 5th rib in right midclavicular line (represents liver highest point)
4. 7th rib in right mid Axillary line
Surface anatomy: right border
Curved line to right between 2 points:
1. 7th rib in right midaxillary line
2. 1cm below costal margin in right midaxillary line
Inferior border
Passes through 5 points:
1. 1 cm below costal margin in right midaxillary line
2. 9th costal cartilage in midclavicular line (Murphy’s point) which represents surface anatomy of gall bladder fundus
3. Transpyloric plane in midline (hand’s breadth below xiphisternal junction or midway between xiphisternal junction and umbilicus
4. Left 8th costal cartilage tip
5. 5th intercostal space in left midclavicular line
Blood supply
- Mainly portal vein (70%) and hepatic artery (30%)
- Inside liver blood coming from both are mixed in sinusoids
- Blood is collected from each hepatic lobule in a central vein which are collected forming 3 hepatic veins (right, left, and middle) which join IVC
Lymph vessels
- Superficial vessels
- Deep vessels: join forming ascending and descending trunks
Superficial vessels
Run in subserous areolar tissue
Ascending trunks
Accompany hepatic veins and pass in diaphragm IVC opening
Descending trunks
Emerge from porta hepatis
Lymph nodes
- Lateral diaphragmatic nodes
- Paracardial nodes
- Hepatic nodes
- Coeliac nodes
Lateral diaphragmatic nodes
Around IVC end
Paracardial nodes
Around esophagus lower part
Hepatic nodes
In porta hepatis and lesser omentum free border around hepatic artery
Coeliac nodes
Around coeliac artery drain hepatic nodes
Factors supporting liver in position
- Hepatic veins: connecting it with IVC
- Peritoneal folds and ligaments: attaching liver to diaphragm and anterior abdominal wall
- Intra-abdominal pressure and anterior abdominal wall tone
Applied anatomy: position
- In living adult, normal liver is soft and cannot be felt but its position can be determined by percussion
- If liver is felt, it indicates pathology
Applied anatomy: bleeding
To stop liver tear bleeding, lesser omentum free border of is compressed by clamp for a period up to 20 minutes to occlude hepatic artery and portal vein
Applied anatomy: vascular segments
Liver physiological vascular segments are essential to perform partial hepatectomy and partial liver transplantation
