For medical, nursing, and physiotherapy undergraduates, and postgraduates

1. LIVER
DR. SUNDIP CHARMODE
ASSOCIATE PROFESSOR
DEPARTMENT OF ANATOMY
AIIMS RAJKOT

2. GENERAL FEATURES
• Shape and situation:
• Weight:
• Males: 1.4 to 1.8 kg
• Females:1.2 to 1.4 kg

3. FACTORS KEEPING THE LIVER IN POSITION
1. Hepatic veins
2. Intra-abdominal pressure maintained by the tone of abdominal
muscles
3. Ligaments of the Liver

4. ANATOMICAL POSITION

5. PRESENTING PARTS
• Surfaces
• Borders
• Lobes
• Fissures

6. SURFACES
1. Diaphragmatic:
• Superior
• Right lateral
• Anterior
• Posterior
2. Visceral:
• Posterior
• Inferior

7. SUPERIOR SURFACE
• Under surface of
diaphragm
• Cupola: Base of the lung
and pleura
• Above the central tendon:
Inferior surface of heart

9. RIGHT LATERAL SURFACE
• Under-surface of the right part of
diaphragm
• 7 -11 ribs of the right side
• Between the ribs and diaphragm:
• In upper 1/3rd : Lower border of right
lung and right pleura
• In middle 1/3rd : Costo-
diaphragmatic recess of right pleura
• In lower 1/3rd : No lung , no pleura

12. ANTERIOR SURFACE
• Divided into anatomical right and left lobes by the attachment
of falciform ligament.
• Broad right part:
• Narrow left part
• Immediate triangular part

14. POSTERIOR SURFACE
• It intervenes
between Postero-
superior and Postero-
inferior borders.

15. POSTERIOR SURFACE - FEATURES
1. The Bare area
2. Groove for Inferior vena-cava
3. Caudate lobe
4. Fissure of Ligamentum venosum
5. Groove for Oesophagus

17. FISSURE FOR LIGAMENTUM VENOSUM

18. INFERIOR SURFACE
• It is directed downwards, backwards and to the left.
• It extends between Postero-inferior border and Inferior border.

19. INFERIOR SURFACE - FEATURES
1. Gastric impression
2. Tuber Omentale
3. Fissure for ligamentum teres
4. Quadrate lobe
5. Porta hepatis
6. Caudate and papillary process

22. INFERIOR SURFACE - FEATURES
7. Fossa for Gall bladder
8. Duodenal impression
9. Colic impression
10. Renal impression

25. FISSURE FOR LIGAMENTUM TERES

26. BORDERS
1. Postero-superior border
2. Postero-inferior border
3. Inferior border

28. CLASSIFICATION OF LOBES OF LIVER
• Anatomical
• Physiological

29. ANATOMICAL CLASSIFICATION

30. PHYSIOLOGICAL CLASSIFICATION

31. PHYSIOLOGICAL CLASSIFICATION
• The physiological right and left lobes are supplied respectively by the right
and left branches of portal vein and hepatic artery, and the bile of the
aforesaid lobes is conveyed by the corresponding hepatic ducts.
• Within the Physiological right lobe, these vessels and ducts subdivide into
Anterior and posterior sets of branches forming sectors or zones.
• Similarly, within the Physiological left lobe, they form Medial and lateral
sectors.

32. SEGMENTS OF LIVER
• Couinaud divided these sectors of the functional lobes into eight
independent functional units called Hepatic segments based on the
distribution of portal and hepatic veins.
• The delineation of the segments is based on the fact that each
segment has its own dual vascular inflow, biliary drainage and
lymphatic drainage.

33. EACH SEGMENT OF LIVER
• Wedge-shaped with the apex towards the porta hepatis.
• Apex – Entry of single segmental branch of the portal vein, hepatic
artery and bile duct (for inflow)
• Borders - Hepatic veins (for venous outflow)
• Hepatic vein drains two adjacent segments (and each segment has
multiple draining hepatic veins.

38. CLINICAL SIGNIFICANCE
• Surgical resection of liver may be performed with least number of
involvements of major vessels.

39. PERITONEAL RELATIONS OF LIVER

40. LIGAMENTS OF LIVER
Five peritoneal folds / false ligaments
1. Falciform ligament
2. Coronary ligament
3. Right triangular ligament
4. Left triangular ligament
5. Lesser Omentum
Two developmental / True ligaments
1. Ligamentum teres hepatis
2. Ligamentum venosum

42. BLOOD SUPPLY
1. Portal vein – 66 – 75%
2. Hepatic artery – 25 – 33 %

43. LYMPHATIC DRAINAGE
1. Superficial set of lymph nodes
2. Deep set of lymph nodes -

44. LYMPHATIC DRAINAGE
SUPERFICIAL SET OF LYMPH NODES
1. Anterior and Intermediate groups of Supra-diaphragmatic lymph nodes -
Most of the posterior surface, adjoining parts of superior and right lateral
surface
2. Hepatic group – Inferior surface and adjoining part of anterior surface
converge towards porta hepatis
3. Coeliac group – convex surface of right lobe
4. Para-cardiac group – posterior surface of left lobe

45. LYMPHATIC DRAINAGE
DEEP SET OF LYMPH NODES
1. Partly lie along the Hepatic veins – drain into Supradiaphragmatic group
of lymph nodes
2. Partly lie along the Portal veins – drain into Hepatic group of lymph nodes

46. EXTRA HEPATIC BILIARY
APPARATUS
DR. SUNDIP CHARMODE
ASSISTANT PROFESSOR

47. BILIARY APPARATUS
Intra-hepatic part
1. Bile canaliculi
2. Canals of Hering (Cholangiole)
3. Bile ductules
4. Right and left hepatic ducts
Extra hepatic part
• Common hepatic duct
• Gall bladder
• Cystic duct
• Common Bile duct

49. EXTRA HEPATIC
BILIARY APPARATUS
1. Common hepatic duct
2. Gall bladder
3. Cystic duct
4. Common Bile duct

50. COMMON HEPATIC DUCT
• Formed close to the right end of porta hepatis by the union of right
and left hepatic ducts.
• It passes downwards within the right free margin of lesser
omentum.
• Length – 3 cm
• Caliber – 4 mm

51. RIGHT AND LEFT HEPATIC
DUCTS
• Right and left hepatic ducts drain
bile respectively from
physiological right and left lobes
of liver.
• At porta hepatis the arrangement
of structures are:

53. COMMON HEPATIC DUCT - RELATIONS
• Posteriorly: Portal vein, right
branch of hepatic artery
• Left side: principal hepatic artery
• Below and to the right: Cystic
duct

54. GALL BLADDER

58. FUNDUS
• Lower expanded free end of gall bladder
• Directed downward, forwards and to the
right
RELATIONS
In front: Anterior abdominal wall just below
the tip of right 9th costal cartilage at the
intersection of right rectus abdominis and
right costal margin
Behind: Transverse colon

59. BODY
Extedns fron the

60. BODY - RELATIONS
• Above: Liver separated by loose areolar
tissue containing deep branch of cystic
artery and corresponding vein
• Below: Transverse colon and first part of
duodenum
• Right side: Right colic flexure and superior
duodenal flexure
• Left side: Pyloric part of stomach

63. NECK
• From the neck, a diverticulum called
Hartmann’s pouch projects downwards
and backwards towards the
duodenum.
• The portion of the neck giving
attachment to the pouch is called
Isthmus of gall bladder.

64. NECK - RELATIONS
• Above: Non-peritoneal and related to
liver separated by connective tissue
containing cystic artery
• Below: Covered with peritoneum and
related to first part of duodenum

65. FUNCTIONS OF GALL BLADDER
1. Stores and concentrates the bile
2. Reduces the alkalinity of the bile
3. Equalizes the ductal biliary pressure
4. Gall bladder is not in-despensable

66. ARTERIAL SUPPLY
• Cystic artery - Branch of right
branch of hepatic artery
• Divides into:
1. Superficial – peritoneal covered
superficial / lower surface
2. Deep – deep / upper surface

67. VENOUS DRAINAGE
• Cystic vein does not accompany the cystic artery. It pierces the liver
through the fossa of gall bladder and drains into intra hepatic part of
portal vein.

68. LYMPHATIC DRAINAGE
• Hepatic group of lymph nodes

69. NERVE SUPPLY
• Sympathetic supply – coeliac and hepatic plexus
• A few twigs of right phrenic nerve carrying post ganglionic fibers
reach the gall bladder through phrenic and hepatic plexuses.
• Referred pain to tip of shoulder during inflammation of gall bladder

70. ANOMALIES OF GALL BLADDER
1. Agenesis
2. Double gall bladder
3. Septate gall bladder
4. Intra hepatic gall bladder
5. Mobile or floating gall bladder
6. Phrygian cap – folded fundus of
gall bladder without any
pathological significance

72. CYSTIC DUCT
• Dimensions: Length - 3 to 4 cm ,
Caliber – 2mm
• Begins from the neck of gall
bladder
• Passes downwards, backwards
and to the left
• Joins the right side of common
hepatic duct at an acute angle

73. SPIRAL VALVES OF HEISTER
• Interior of the cystic duct
presents about 5 to 12 crescentic
valves known as ‘Spiral valves of
Heister’, which make the lumen
patent.

74. CYSTIC DUCT - RELATIONS
• Behind - Portal Vein
• Medially – Common hepatic duct
• Above and laterally – Cystic artery

75. CALLOT’S TRIANGLE
• Infero-laterally: Cystic duct
• Supero-laterally: Inferior surface of
segment V of the liver
• Medially: Common hepatic duct
• Contains cystic artery with its variable
disposition, 1-2 small cystic veins,
cystic lymph node draining lymph
from the gall bladder, accessory
hepatic ducts

76. CALLOT’S TRIANGLE – SURGICAL SIGNIFICANCE
• Enclosed by the double layer of peritoneum which act as a
mesentery of the cystic duct
• Such critical area with variations of arterial and ductal anatomy is of
considerable importance during surgical removal of gall bladder in
order to avoid ligating the common hepatic or bile duct.

77. COMMON BILE DUCT
• Dimensions: Length: 7.5 cm, 6 mm in
caliber
• Formed close to the porta hepatis by
the union of common hepatic and cystic
ducts
• Passes downwards, backwards and
slightly to the left within the free margin
of lesser omentum, and in front of the
epiploic foramen

78. COMMON BILE DUCT
• Behind the first part of duodenum
• Groove behind the head of
pancreas
• Unites with Main Pancreatic duct
• Both ducts pierce the duodenal wall
separately
• Form a dilatation known as the
‘Ampulla of Vater’
• Ampulla opens on the summit of
Major duodenal papilla - 8 cm to
10 cm distal to the pylorus

79. COMMON BILE DUCT - DIVISIONS

80. SUPRA-DUODENAL PART - RELATIONS
• Behind - Portal vein
• Left side - Trunk of hepatic
artery

81. RETRO-DUODENAL PART - RELATIONS
• In front – First part of Duodenum
• Behind – Portal vein
• Left side - Gastro-duodenal artery

82. INFRA-DUODENAL PART - RELATIONS
• In front – Head of pancreas,
accessory pancreatic duct, anterior
row of vasa recta of duodenum
• Behind – Posterior row of vasa recta,
Inferior vena cava
• Left side – Superior mesenteric and
portal veins

83. INTRA-DUODENAL PART - RELATIONS
• Intra-duodenal Part / Intra-mural
• Length - 2cm and ampulla 5mm
• Its course is represented by a
longitudinal fold in the interior of
second part of duodenum.

84. SPHINCTOR OF ODDI
• Consists of three sets of sphincters:
1. Sphincter Choledochus (Sphincter of
Boyden) around the pre-ampullary
part of the bile duct (strongest)
2. Sphincter Pancreaticus around the
pre-ampullary part of pancreatic duct
3. Sphincter of Oddi (proper) around the
termination of ampulla

86. ARTERIAL SUPPLY
• Upper part: Cystic artery
• Middle part: Small twigs from Right
Hepatic artery
• Lower part: Postero-superior
Pancreaticoduodenal artery

87. CLINICAL CORRELATION
1. Jaundice
2. Cholecystitis
3. Cholelithiasis
4. Choledocholithiasis
5. Cholecystography

88. THANK YOU
DR. SUNDIP CHARMODE
ASSISTANT PROFESSOR