Consists of liver, biliary tree, gall bladder Liver is the largest gland in the body Multiple functions Disease of the liver and biliary tree influences drug actions Every anesthetic drugs are metabolized by the liver So liver is very much important for anesthetists

1. HEPATOBILIARY SYSTEM
Dr Mohammad Shahidul Islam
Professor of Pediatric Anesthesiology
Dhaka Shishu Hospital

2. INTRODUCTION
 Consists of liver, biliary tree, gall bladder
 Liver is the largest gland in the body
 Multiple functions
 Disease of the liver and biliary tree influences drug
actions
 Every anesthetic drugs are metabolized by the liver
 So liver is very much important for anesthetists

3. LIVER

4. LIVER
 Weight about 1500 gm
 Blood supply about 1500ml/min
 Occupies right hypochondrium and epigastrium
 It has two surfaces- diaphragmatic and visceral
 Diaphragmatic divided into anterior, superior and
posterior

5. LIVER

6. PORTA HEPATIS
 Hilum of the liver
 Vessels and ducts enter and leave the porta hepatis
 Right and left branches of hepatic artery
 Right and left hepatic duct
 Portal vein, lymphatic and nerves

7. LIVER
 Gall bladder lies on the visceral surface
 Bare area is devoid of peritonium and contact with
diaphragm and supra renal gland
 Visceral surface related to stomach,duodenum,
hepatic flexure and right kidney
 Liver is suspended by hepatic vein and inferior
vena cava

8. SURFACE ANATOMY
 Upper margin xipesternal joint
 Left fifth inter costal space 7-8 cm from mid line
 Right side to the fifth rib, 7-11 ribs mid axillary line
 Lower border lies at the level of the right costal
margin

9. LOBES
 Larger right lobe
 Smaller left lobe
 Line of attachment –falciform ligament anteriorly,
ligamentum teres, ligamentum venosum on the
visceral surface
 Caudate lobe
 Quadrate lobe
 Lobes are not arranged according to vascular and
biliary channels

10. FUNCTIONAL DIVISION
 Functional division of liver are right and left halves
 Oblique line from gallbladder bed and groove for
IVC
 Middle hepatic vein lies in this plane
 Useful landmark for radiological and
ultrasonographic investigations

11. SEGMENTS
 On the basis of blood supply and biliary drainage
there are four main hepatic segment
 Left lateral and medial, right lateral and medial.
 Caudate lobe is autonomous segment
 Blood receives from hepatic artery and portal vein
drains into the IVC
 Draining bile into heptatic duct

12. BLOOD SUPPLY OF LIVER
 From two sources – arterial from hepatic artery ,
venous from portal vein
 Hepatic artery arises from coeliac truk
 Hepatic artery may arise from supp. mesentric
artery or on aorta
 Right hepatic artery from supp.mesentric artery and
left hepatic artery from left gastric artery

13. LYMP DRAINAGE
 3-4 nodes lie in the porta hepatis
 Receives lymp of gall bladder
 Drain downwards to pyloric node and coeliac node
 Bare area lymphatics communicate with extra
peritoneal lymphatic drain to the nodes of posterior
mediastinum.

14. NERVE SUPPLY
 Both sympathetic and parasympathetic.
 Sympathetic through coeliac ganglia
 Vagal branch from hepatic branch of ant. Vagal
trunk
 Reach through porta hepatis.

15. STRUCTURE OF LIVER

16. STRUCTURE
 The hepatic lobule pinhead sized and hexagonal
shape.
 Central vein and plates of cords of hepatocytes
separated by vascular space or sinosoids.
 Corner of the lobule are the portal triad.
 Small branch of hepatic artery portal vein and bile
ductule.

17. PORTAL SYSTEM

18. PORTAL VENOUS SYSTEM
 Portal Vein is the upward continuation of superior
mesentric vein
 Join with the splenic vein
 Portal vein receives right and left gastric vein,
superior pancreatoduodenal vein and cystic vein 10
cm long no valves

19. FIVE SIDES OF PORTAL ANASTOMOSIS
 Lower end esophagus
 Upper end of anal canal
 Bare area of liver
 Periumblical region
 Retroperitoneal area
In portal hypertension 80% of portal blood may be
Shunted, 20% reaches to the liver.