hepatobiliary system

1. Seminar on
SURGICAL ANATOMY OF
HEPATOBILIARY SYSTEM
Presenter: BISWAJIT DEKA

2. INTRODUCTION
• HEPATOBILIARY SYSTEM:
LIVER
GALL BLADDER
INTRA & EXTRA HEPATIC BILIARY TREE

3. Herophilus of Chalcedon (334-280 B.C.) First
anatomical description of liver
Johann Vesling (1647) First to report
bifurcation of human portal vein
Thomas Starzl: Performed first
successful human orthotopic liver
transplant in 1968
HISTORICAL BACKGROUND

4. Hugo Rex 1888 :Described right and left
lobes as being equal in size. Showed the
plane of division is through bed of GB &
notch of IVC ; not through falciform
ligament
J. Cantlie 1897 Confirmed Rex's findings. Rex's
lobular plane of division later named Cantlie's
line.
Henri Bismuth: Performed first heterotopic
liver transplant in humans in 1980

5. FEW FACTS : LIVER
Second largest organ of body after skin
Average weight : 1.5kg ( 2 % of total body weight)
Largest gland
Position – b/w 5th ICS & costal margin
Blood flow : 1500 ml/min (25% of CO)
Blood supply : 1/3rd hepatic artery , 2/3rd portal vein

6. Embryology
3rd &4th week
ventral outgrowth from
distal end
of foregut
Cranial Bud - Liver
Caudal Bud -GB,extrahepatic
Biliary Tree
Early 5th wk--liver bud stalk
9th wk– rapid growth

7. Embryology cont.
• 7th week – biliary
lumen recanalise
• 12th week– liver
begine to secrete
bile

8. Congenital anomalies
• Transposition of liver
• Riedel’s lobe
• Accessory and ectopic lobe of liver
• Mesenchymal hamartoma
• Intrahepatic biliary atresia
• Congenital cyst
• Congenital hepatic fibrosis
• Vascular malformation

9. Sites of anomaly

12. Riedel’s lobe

13. Histology
• classic hepatic
Lobules- roughly
hexagonal structure
•At each corner of a
lobule is portal triad
•Between the
hepatocytes are the
liver sinusoids

14. Liver Acinus

15. Microstructure

16. Surface outline &Factors contributing
to its position

17. GROSS ANATOMY
division of lobes:Principal plane (Cantlie line)

18. Ligaments of liver
1.Falciform Ligament
2.Right & Left Coronary Ligament
3. Right & Left Triangular Ligaments
4. Gastrohepatic Ligament
5. Hepatoduodenal Ligament
6. Ligamentum Venosum

19. •

20. Bare area of liver

21. Porta hepatis

22. Impressions
•Gastric
• renal
• colic
• Duodenal

23. Liver bed

24. Rt Suprahepatic & Subhepatic spaces

25. Left suprahepatic and Subhepatic spaces

27. Segments: By Couinaud in 1957
based on Hepatic veins

28. Segments of Liver

29. Rise and Demise of Segment IX
• For several years Couinaud and his colleagues, as
well as several other investigators, referred to an
area of the dorsal sector of the liver close to the
IVC as "segment IX." But the existence of this
segment was short-lived when, in 2002, Couinaud
and his associates104 published the following
conclusion:
• Because no separate veins, arteries, or ducts can be
defined for the right paracaval portion of the
posterior liver and because pedicles cross the
proposed division between the right and left
caudate, the concept of segment IX is abandoned.

31. Hepatoduodenal ligament
‘pringle’ manoeuvre

32. Blood supply and venous
drainage

33. Nerve supply

34. HEPATIC ARTERY
• 1/3rd of hepatic
blood flow
• arise from the
celiac trunk
• only 55-65% of
population has
normal arterial
anatomy

36. Hepatic artery ‘variants’

38. Portal vein
•2/3rd of hepatic blood
flow
• 1-3 cm in diameter
• 5-8 cm length
• 5-10mm Hg
•Portal htn >12mm Hg

39. Portosystemic Anastomosis

40. Hepatic vein
• 3 hepatic vein
- Right
- Middle
- Left

41. Plates system
1 . Cystic plate
2 . Hilar plate
3 . Umbilical plate
HILAR
PLATE
CYSTIC
PLATE
UMBILICAL
PLATE

42. Functions
• Metabolic : anabolic & catabolic
• Endocrine
• Exocrine
• Drug detoxificaion : cyt 3A4
• Clotting factors
• Storage

43. GB & BILIARY TREE
• Kune (1964) Described surgical anatomy
of common bile duct
• Mouret (1987 )Generally credited with
first human laparoscopic cholecystectomy
• Petelim (1991) Performed laparoscopic
choledocholithotomy

44. Gall bladder & biliary tree

45. GALL BLADDER
• 7-10 cm long, 3 cm
broad at its
widest part
• VOLUME : 30 – 60 ml
• CONTENT
• FUNCTON

46. Cystic duct
• Length : 3-4 cm
• Mucuos membrane
forms 5-12 crescentic
folds – spiral valve of
Heister
• not a true valve

47. CBD
• Length: 5-15 cm
• Diameter: 6mm

49. Calot’s Triangle

50. Anomaly of GB

51. Types of double GB:
arising from split primordium

52. Types of Accessory GB

53. Cystic duct variations

54. Biliary tract atresia

55. Choledochal Cyst

56. Choledochal cyst

57. Mirizzi Syndrome

58. Arterial supply of Extra-hepatic biliary tract

59. Cystic Artery ‘variants’

61. Lymphatic Drainage GB & Biliary tree

62. Innervation
• coeliac plexux,
• left & right vagus Hepatic plexus cystic
plexus
• Right phrenic nerves
• Parasympathetic : inhibit sphincters
• Sympathetic :T7-T9 : vasomotor & motor to
sphincters

63. Microstructure GB

64. Microstructure Bile Ducts

65. THANK YOU