Liver and it's variation

1. MORPHOLOGY OF LIVER AND ITS CLINICAL
SIGNIFICANCE
Dr. M.VASANTHAKOHILA MBBS,
SECOND YEAR POST GRADUATE,
DEPARTMENT OF ANATOMY,
GOVT KILPAUK MEDICAL COLLEGE,
CHENNAI - 10.

2. MORPHOLOGY OF LIVER AND ITS CLINICAL
SIGNIFICANCE
Dr. M.Vasanthakohila (Post graduate 2nd year),
Dr.V.Lokanayaki (Prof & head), Dr. E.Srividhya(Assistant professor)
INTRODUCTION:
• Liver is the largest
wedge shaped
abdominal organ.
• Located in right
hypochondrium,
epigastrium and left
hypochondrium in
upper abdominal cavity.
LIVER

3. contd
• The liver has two
lobes and eight
segments.
• It has caudate and
quadrate lobes as
the parts of right
anatomical lobe.

4. • The hilum of the liver or porta hepatis is
situated on its visceral surface and it
transmits the blood vessels and nerves of
the liver.
• It is divided into right and left lobes by the
line of attachment of falciform ligament
anteriorly, fissure for ligamentum venosum
and fissure for ligamentum teres posteriorly.

5. • The fossa for gall bladder is situated on the
inferior surface of the right lobe of the liver with
the gall bladder situated in it.
• The fundus of the gall bladder usually projects
beyond the inferior border of the liver.
• Morphology of liver is very important for both
the radiologists and surgeons,to avoid
misdiagnosis for radiologist and best outcome of
liver surgery .

6. AIM :
To study the morphology of liver and
its variations.
INCLUSION AND EXCLUSION CRITERIA:
 All intact cadaveric livers with no
obvious deformity were studied.
 Liver with features of Cirrhosis or any
damage were excluded.

7. MATERIALS AND METHODS :
 The study is conducted on 30 embalmed
cadaveric specimens of both sex in the
Department of Anatomy, Government Kilpauk
medical college, Chennai.
 The specimens were photographed and the
morphological features of liver were classified
according to NETTER’S CLASSIFICATION.

8. PARAMETERS OF THE STUDY
1. Shape
2. Accessory fissures
3. Presence or absence of accessory lobe
4. Presence or absence of Fissure for ligamentumteres
5. Pons hepatis - connecting left lobe with
quadrate lobe
6. Riedel’s lobe - it is a tongue like inferior
projection of right lobe of the liver.
7. Presence or absence of Gallbladder and its fundus
project beyond the inferior border of the liver or
not.

9. RESULTS :
 Among the
30
livers studied,
 18 livers
(60%) were
normal in
their external
appearance,
number of
lobes and
fissures.
Normal wedge shaped Liver

10. However, 12 livers (40%) showed anomalies in lobes,
fissures, shape and the size of gall bladder.
1.Variation in shape were found in 5specimens -16.6%
 3 – enlargement of right
lobe of liver is present
Among 5 specimens 2 were
Conical in shape.
Conical shaped Liver
Enlargement of right
lobe of liver

11. 2. In 3.3% (1 Liver specimen) the fissure for
ligamentum teres is absent.

12. 3. In 6.6 % (2 Liver specimens) was the gall bladder was
short and did not project beyond the inferior border
of the liver.
Short gall
bladder
&
gall
bladder
fossa not
cross the
inferior
border of
liver

13. 4. In 13.3% the liver(4 specimens) has long
left lobe.
Elongated
left lobe of
liver

14. S.NO MORPHOLOGICAL FEATURES NUMBER OF
SPECIMENS I %
1 Normal 18 (60%)
2 Variation in shape 5 (16.6%)
3 Absence of fissure for ligamentum
teres
1 (3.3%)
4 Gallbladder and its fundus did not project
beyond the inferior border of the liver
2 (6.6%)
5 Accessory fissures on caudate lobe -
6 Pons hepatis connecting left lobe with
quadrate lobe
-
7 accessory lobe present -
DISCUSSION

15. S.NO NETTER’S CLASSIFICATION NUMBER OF
SPECIMEN IN %
1 Netter Type 1 (Very small left lobe, deep costal
impressions)
-
2 Netter Type 2 (Complete atrophy of left lobe) -
3 Netter Type 3 (Transverse saddle like liver, relatively
large left lobe)
4 (13.3%)
4 Netter Type 4 (Tongue like process of right lobe) -
5 Netter Type 5 (Very deep renal impression and
corset constriction)
-
6 Netter Type 6 (Diaphragmatic grooves) -
Total 30 (100%)

16. • The knowledge of Liver anomalies is useful to the
radiologist when interpreting liver radiologic findings.
• The common congenital anomalies in liver are agenesis
of the lobes, absence of segments, deformed lobes,
smaller lobes, atrophy of the lobes and hypoplastic
lobes.
• It is mainly due to defective development or excessive
development and sometimes these deformities are
associated with abnormality of diaphragm.

17. S.N
O
Morphological
features
Joshi SD
et al., [8]
Muktyaz
H and
Nema
Patil S et
al.,
Nayak
BS
Heena J
Chaudha
ri
Present
Study
1 Absence of
fissure for
ligamentum teres
- 9.7% 4% 1.81% 11.2% 3.3%
2 Elongated left
lobe present
- - - 1.81% 12.5% 13.3.%
3 Short
Gallbladder
20% - 4% - 7.5% 6.6%
4 Accessory
Fissures
30% 12.1% 10% 1.81% 12.5% -
5 Mini accessory
lobe present
- - 2% - 3.7% --

18. • Abnormal ‘L’ shaped large left lobe, with the shift of
quadrate lobe and fissure for ligamentum teres to right
was also noticed in Nayak BS et al.,he
also observed similar findings in 1.81%. In present
study it is observed 13.3%.
• Enlargement of left lobe associated with agenesis or
hypoplasia of right lobe .
• Rare variation in liver in which the fissure for
ligamentum teres is absent and transformed into a
tunnel was observed in Ebby et al study . .

19. • Due to the presence of this tunnel, the demarcation
between the quadrate lobe and left lobe of the liver was
not very clear.
• Absence of fissure for the ligamentum teres is present
in my study but presence of complete tunnel instead of
fissure has been reported by Ebby et al.
• In present study absence of fissure for ligamentum
teres is seen in 1 out of 30 liver that is 3.3% similar to
findings of Patil S et al.

20.  The gall bladder is situated in the inferior surface of
the right anatomical lobe and projects beyond the
inferior border to come in contact with the anterior
abdominal wall.
 In my study, gall bladder is short in 6.6% and failed
to cross the inferior border of the liver.
 My findings similar to the study of Pamidi et al.,
2008; and Nayak, 2009

21. CONCLUSION:
• This study highlights the frequent
occurrence of morphological variations of
the liver.
• Knowledge about the morphological
variations are very important in cases of
laparoscopic removal or thermal ablation
and surgical procedures of the liver .
• It is important for surgeons and
gastroenterologists and Radiologist.

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