Hepatobiliary system anatomy

1. SURGICAL
ANATOMY
OF
HEPATOBILIARY
SYSTEM

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. Henri Bismuth: Performed first heterotopic
liver transplant in humans in 1980
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.

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
recanalize
• 12th week–
liver begin 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

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

12. Liver Acinus

13. Microstructur
e

14. Surface outline &Factors
contributing to its position

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

16. 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

17. •

18. Bare area of
liver

19. Porta
hepatis

20. Impressions
• Gastric
• renal
• colic
• Duodenal

21. Liver
bed

22. Rt Suprahepatic & Subhepatic
spaces

23. Left suprahepatic and Subhepatic
spaces

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

26. Segments of
Liver

28. Hepatoduodenal ligament
‘pringle’ manoeuvre

29. Blood supply and
venous
drainage

30. Nerve
supply

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

33. Hepatic artery
‘variants’

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

35. Portosystemic Anastomosis

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

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

38. 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

39. Gall bladder & biliary
tree

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

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

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

44. Calot’s Triangle

45. Anomaly of
GB

46. Types of Accessory
GB

47. Cystic duct
variations

48. Biliary tract
atresia

49. Choledochal
Cyst

50. Choledochal
cyst

51. Mirizzi
Syndrome

52. Arterial supply of Extra-hepatic biliary
tract

53. Cystic Artery
‘variants’

54. Lymphatic Drainage GB & Biliary
tree