hepatobiliary system 2024.pptx

1. HEPATOBILIARY SYSTEM

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. LYMPHATIC 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.

20. THANK YOU