Liver surfaces and attachments (Dave's notes)

Question 1

What are the divisions of the diaphragmatic surface surface of the liver?

Answer 1

Anterior, posterior, superior and right surfaces. Covered mostly in peritoneum but peels off in places to join the diaphragm

Question 2

What are the relations of the anterior surface of the liver?

Answer 2

Diaphragm, lung, pleura, and ribs - 6-9R and 6-7L, curves back at the superior surface

Question 3

What are the relations of the superior surface of the liver?

Answer 3

Heart and pericardium centrally with lung and pleura laterally. The lower border sloapes up along the right rib border and then across the epigastrium (or does this mean the lower border of the liver rather than the superior surface?

Question 4

Describe the position of the falciform ligament relative to the liver.

Answer 4

The falciform ligament lies from the centre to the ligamentum teres notch, left to the fundus of the gall bladder. It splits and sweeps to the rightas the upper layer of the coronary ligament and to the left as the left tirangular ligament

Question 5

What are the relations of the right surface of the liver?

Answer 5

Ribs 7-11, lower 1/3rd to the ribs and diaphragm, middle 1/3rd also to pleura, upper 1/3rd also to lung

Question 6

Describe the visceral surface of the liver

Answer 6

The visceral surface of the liver slopes downwards, forwards and to the right. Its main feature is an H-pattern of structures. Contains the portahepatis, lesser omentum extending into the ligamentum venosum and impressions of lower organs

Question 7

What forms the H pattern of structures on the visceral surface of the liver?

Answer 7

The crosspiece of the H is the portahepatis, and is enclosed by the two layers of the lesser omentum. From the left and end these are attached to the ligamentum venosum. The lesser omentum passes down from here to enclose the stomach and the first 2cm of the duodenum. From the right end the gall bladder lies in the shallow ofassa on the downsloping surface, neck highest, fundus lowest

Question 8

Describe the porta

Answer 8

The porta hepatis is a transverse slit perforated by the right and left hepatic ducts and the right and left branches of the hepatic artery and portal vein (VAD, ducts in front). The cystic duct lies in loose cntact with the right end of teh porta.

Question 9

What constitutes the right limb of the H?

Answer 9

the right limb is incomplete and consists of the IVC and GB

Question 10

What constitutes the left limb of the H?

Answer 10

The ligamentum venosum and teh ligamentum teres

The ligamentum venosum and the ligamentum teres

Question 11

Describe the posterior surface of the liver

Answer 11

The posterior surface of the liver blends with the visceral surface of the liver. It contains the bare area, the bounding ligamnts, the right suprarenal impression, the IVC groove, the caudate lobe and process, the ligamentum venosum fissure

Question 12

Describe the bare area of the liver

Answer 12

The bare area is triangular and lies to the right of teh IVC (its base). The sides are formed by upper and lower layers of teh coronary lifament. The apex is at the right triangular ligament. Frm here peritoneum sweeps doesn over the right kidney.

Question 13

What encloses the caudate lobe?

Answer 13

The lower layer of the coronary ligament in the upper recess of the lesser sac

Question 14

What are the relations of the caudate lobe?

Answer 14

In in contact with the diaphragm??? in front of the thoracic aorta, left of the IVC an dright of the oesophagus and ligamentum venosum

Question 15

List the lobes of the liver

Answer 15

Left, caudate, quadrate, and right

Question 16

What does the falciform divide?

Answer 16

The anatomical left and right lobes

Question 17

What is the location and relations of the caudate lobe?

Answer 17

The caudate lobe lies between the IVC and ligamentum venosum and is connected to the right lobe via the caudate process

Question 18

What is the location and relations of the quadrate lobe?

Answer 18

The quadrate lobe lies between the gall bladder fossa and the fissure for the ligamentum teres.

Question 19

Which lobe to the caudate and quadrate belong to functionally?

Answer 19

The left lobe

Question 20

Describe one simple way of dividing the liver into segments

Answer 20

Left lateral (1), left medial (2), right anterior (2), and right posterir (2)

Question 21

Location of segment 1 (8 segment division)

Answer 21

Caudate

Question 22

Location of segment 2 (8 segment division)

Answer 22

left lateral

Question 23

Location of segment III (8 segment division)

Answer 23

Lateral part of left medial

Question 24

Location of segment IV (8 segment division)

Answer 24

Medial part of left medial

Question 25

Location of segment V (8 segment division)

Answer 25

Lower part of right anterior

Question 26

Location of segment VI (8 segment division)

Answer 26

Lower part of right posterior

Question 27

Location of segment VII (8 segment division)

Answer 27

Upper part of right posterior

Question 28

Location of segment VIII (8 segment division)

Answer 28

Upper part of right anterior

Question 29

Describe the artery and portal vein divisions

Answer 29

The hepatic artery division is Y-shaped, the portal vein division is T-shaped

Question 30

The right hepatic artery divides into what?

Answer 30

Anterior and posterior branches

Question 31

The left hepatic artery divides into what? What abberation may occur?

Answer 31

Medial and lateral branches. The commonest aberration is a left hepatic artery arising from the left gastric (20%)

Question 32

What arterial mixing occurs between the left and right halves of the liver?

Answer 32

There is no communication between the arterial supply of the left and right halves of the liver

Question 33

What venous mixing occurs between the left and right halves of the liver?

Answer 33

There is left, right and central venous drainage, with mixing. The central veins drain left and right, and ?? are the main structural support

Question 34

Describe the lymphatic drainage of the liver

Answer 34

The lymphatic drainage of the liver is to nodes at the porta hepatis that drain down the hepatic artery to retropyloric and coeliac nodes.

Question 35

What is the nerve supply of the liver and by what route?

Answer 35

Via sympathetic and vagus pathways, vagal from anterior/left branches across ???

Question 36

Describe the development of the liver

Answer 36

The development of the liver is by way of cells proliferating from the blind-ended Y-shaped diverticulum (bile duct) into the ventral mesogastrium