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LIVER
LIVER
DEFINITION:
• It is the largest gland in the body
SURFACE ANATOMY:
• It occupies the whole right hypochondrium, a part of epigastrium &
a part of left hypochondrium
ANTERIOR SURFACE OF LIVER
LIVER
SURFACES:
• ANTERIOR: related to diaphragm & anterior abdominal wall.
The diaphragm separates it from pleurae & lungs
• SUPERIOR: related to diaphragm separating it from pericardium
& heart (in the middle) & pleurae & lungs (on each side)
POSTERIOR SURFACE OF LIVER
LIVER
SURFACES:
• POSTERIOR: formed of (from right to left):
1. Bare area: triangular area related to diaphragm. Its base is
formed by groove for IVC; its sides are formed by upper &
lower layers of coronary ligaments that meet at the apex
to form the right triangular ligament
2. Groove for IVC
3. Caudate lobe: related to diaphragm, projects downwards
to form a process separating IVC from porta hepatis &
forming upper boundary of epiploic foramen
4. Fissure for ligamentum venosum (obliterated ductus
venosus)
5. Esophageal notch
INFERIOR SURFACE OF LIVER
INFERIOR SURFACE OF LIVER
LIVER
SURFACES:
• INFERIOR:
1. Related to the following viscera: right kidney, right suprarenal
gland, right colic flexure, 2nd part of duodenum, fundus & body of
stomach
2. Formed of (from right to left):
• Gall bladder fossa
• Quadrate lobe: related to pylorus, 1st part of duodenum &
transverse colon
• Fissure for ligamentum teres (obliterated left umbilical vein)
LIVER
• ACCORDING TO ITS RELATIONS, THE
LIVER IS DIVIDED INTO:
1. DIAPHRAGMATIC SURFACE: includes
superior, anterior & most of
posterior surface
2. VISCERAL SURFACE: includes inferior
& a part of posterior surface
LIVER
PORTA HEPATIS:
• It is the hilum of liver
• It lies in the inferior surface of liver
• Structures passing through it: right & left hepatic ducts, right & left
branches of hepatic artery & portal vein (DAV, from before
backwards)+ lymphatics, lymph nodes & autonomic fibers
LOBES OF LIVER
ANATOMICAL DIVISION:
• The liver is divided into a smaller left & a larger right lobe by:
1. Falciform ligament: anteriorly
2. Fissure for ligamentum venosum: posteriorly
3. Fisssure for ligametnum teres: inferiorly
LOBES OF LIVER
FUNCTIONAL DIVISION:
• The liver is divided into a nearly equal left & right lobes by a plane
passing through groove for IVC & gall bladder fossa.
• The caudate & quadrate lobes are included in the left lobe (because
they are supplied by left branches of hepatic artery & portal vein)
LIGAMENTS OF LIVER
PERITONEAL LIGAMENTS
• FALCIFORM LIGAMENT: a triangular fold formed of two
layers (right & left) with:
1. Anterior border: attached to diaphragm
2. Posterior border: attached to anterior & superior
surfaces of liver
3. Lower free border: extending from liver to
umbilicus & enclosing ligamentum teres &
paraumbilical veins
LIGAMENTS OF LIVER
PERITONEAL LIGMENTS
• LEFT TRIANGULAR LIGAMENT: to the left of falciform
ligament, the peritoneum is reflected from the
diaphragm to the upper surface of the liver to
form the anterior layer of left triangular ligament
(continuous with left layer of falciform ligament).
The peritoneum then covers anterior, inferior &
posterior surfaces & is reflected to the diaphragm
to form the posterior layer of left triangular
ligament
LIGAMENTS OF LIVER
PERITONEAL LIGMENTS
• RIGHT TRIANGULAR LIGAMENT: to the right of falciform
ligament, the peritoneum is reflected from the
diaphragm to the upper surface of the liver to
form the upper layer of coronary ligament
(continuous with right layer of falciform ligament).
The peritoneum then covers anterior & inferior
surfaces then becomes reflected to the front of
right kidney to form the lower layer of coronary
ligament. The right extremity of both layers meet
to form the right triangular ligament
LIGAMENTS OF LIVER
PERITONEAL LIGMENTS
• LESSER OMENTUM:
1. It is attached to the margins of porta hepatis & fissure for
ligamentum venosum
2. It extends to lesser curvature of stomach & upper border of 1st
inch of 1st part of duodenum
LIGAMENTS OF LIVER
LIGMENTUM M TERES:
•Represents the obliterated left
umbilical vein that originally joins the
branch of portal vein
LIGAMENTUM VENOSUM:
•Represents the obliterated ductus
venosus that originally connects IVC
with left branch of portal vein
BARE AREAS OF LIVER
•TRIANGULAR DIAPHRAGMATIC AREA
•GROOVE FOR IVC
•GALL BALDDER FOSSA
•PORTA HEPATIS
•FISSURE FOR LIGAMENTUM VENOSUM
BLOOD SUPPLY OF LIVER
• HEPATIC ARTERY: brings oxygenated blood to the liver (30% blood
reaching the liver)
• PORTAL VEIN: brings blood absorbed from GIT to the liver (70% blood
reaching the liver)
• ALL BLOOD PASS TO HEPATIC SINUSOIDS
• Blood leave the liver through HEPATIC VEINS
LIVER
LYMPHATIC DRAINAGE:
• Mainly into hepatic lymph nodes in porta hepatis.
Efferent vessels pass to celiac lymph nodes
NERVE SUPPLY: Hepatic plexus of autonomic fibers derived
from celiac plexus
SUPPORT:
1. Hepatic veins (main support): suspend liver from IVC
& have no extrahepatic course
2. Peritoneal folds.
3. Surrounding organs
4. Tone of anterior abdominal wall
BILIARY SYSTEM
1. BILIARY DUCTS
2. GALL BLADDER
BILIARY SYSTEM
COMMON BILE DUCT
BILIARY DUCTS
RIGHT & LEFT HEPATIC DUCTS:
• Emerge from porta hepatis
• Drain bile from right & left lobes of liver
• Unite to form common hepatic duct
COMMON HEPATIC DUCT:
• One and half inches in length
• Formed by the union of the 2 hepatic ducts
• Unite with the cystic duct to form the common bile duct
BILIARY DUCTS
CYSTIC DUCT:
• One and half inches in length
• Connects the neck of gall bladder to common hepatic duct
• The mucous membrane of the duct as well as that of neck of gall
bladder is raised forming the spiral valve. The valve keeps the
lumen open
BILIARY DUCTS
COMMON BILE DUCT:
• Formation: Formed by union of cystic & common hepatic
duct
• Length: Three inches
• Course & relations: It descends:
1. In the free margin of lesser omentum (to the right side of
hepatic artery, anterior to portal vein)
2. Behind 1st part of duodenum (to the right side of
gastroduodenal artery, anterior to portal vein)
3. Behind the head of pancreas, anterior to IVC
• Termination: usually join the main pancreatic duct forming
the ampulla of Vater that opens into the lumen of 2nd part
of duodenum through the major duodenal papilla
GALL BLADDER
SHAPE: Pear-shaped sac
SITE: Lies in gall bladder fossa of liver
LENGTH: 3 – 4 inches
CAPACITY: 30 – 50 ml
GALL BLADDER
PARTS: Formed of 3 parts:
1. Fundus: projects below inferior margin of liver, lies opposite the
tip of right 9th costal cartilage, related anteriorly to anterior
abdominal wall & posteriorly to transverse colon
• Body: related anteriorly to liver & posteriorly to 1st part of
duodenum
• Neck: continuous with cystic duct has same relation as body
GALL BLADDER
PERITONEAL COVERING:
• Fundus: completely covered by peritoneum
• Body & neck: only covered posteriorly
FUNCTION: Stores & concentrates bile
SUPPLY OF BILIARY SYSTEM
• ARTERIES: Cystic branch of right hepatic artery
• VEINS: Cystic vein that drains into the right branch of portal vein
• LYMPH DRAINAGE: Cystic lymph nodes, then to hepatic & finally to
celiac lymph nodes
• NERVES: autonomic fibers from celiac lymph nodes

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LIVEERR.pptx

  • 1.
  • 3. LIVER DEFINITION: • It is the largest gland in the body SURFACE ANATOMY: • It occupies the whole right hypochondrium, a part of epigastrium & a part of left hypochondrium
  • 5. LIVER SURFACES: • ANTERIOR: related to diaphragm & anterior abdominal wall. The diaphragm separates it from pleurae & lungs • SUPERIOR: related to diaphragm separating it from pericardium & heart (in the middle) & pleurae & lungs (on each side)
  • 7. LIVER SURFACES: • POSTERIOR: formed of (from right to left): 1. Bare area: triangular area related to diaphragm. Its base is formed by groove for IVC; its sides are formed by upper & lower layers of coronary ligaments that meet at the apex to form the right triangular ligament 2. Groove for IVC 3. Caudate lobe: related to diaphragm, projects downwards to form a process separating IVC from porta hepatis & forming upper boundary of epiploic foramen 4. Fissure for ligamentum venosum (obliterated ductus venosus) 5. Esophageal notch
  • 10. LIVER SURFACES: • INFERIOR: 1. Related to the following viscera: right kidney, right suprarenal gland, right colic flexure, 2nd part of duodenum, fundus & body of stomach 2. Formed of (from right to left): • Gall bladder fossa • Quadrate lobe: related to pylorus, 1st part of duodenum & transverse colon • Fissure for ligamentum teres (obliterated left umbilical vein)
  • 11. LIVER • ACCORDING TO ITS RELATIONS, THE LIVER IS DIVIDED INTO: 1. DIAPHRAGMATIC SURFACE: includes superior, anterior & most of posterior surface 2. VISCERAL SURFACE: includes inferior & a part of posterior surface
  • 12. LIVER PORTA HEPATIS: • It is the hilum of liver • It lies in the inferior surface of liver • Structures passing through it: right & left hepatic ducts, right & left branches of hepatic artery & portal vein (DAV, from before backwards)+ lymphatics, lymph nodes & autonomic fibers
  • 13. LOBES OF LIVER ANATOMICAL DIVISION: • The liver is divided into a smaller left & a larger right lobe by: 1. Falciform ligament: anteriorly 2. Fissure for ligamentum venosum: posteriorly 3. Fisssure for ligametnum teres: inferiorly
  • 14. LOBES OF LIVER FUNCTIONAL DIVISION: • The liver is divided into a nearly equal left & right lobes by a plane passing through groove for IVC & gall bladder fossa. • The caudate & quadrate lobes are included in the left lobe (because they are supplied by left branches of hepatic artery & portal vein)
  • 15. LIGAMENTS OF LIVER PERITONEAL LIGAMENTS • FALCIFORM LIGAMENT: a triangular fold formed of two layers (right & left) with: 1. Anterior border: attached to diaphragm 2. Posterior border: attached to anterior & superior surfaces of liver 3. Lower free border: extending from liver to umbilicus & enclosing ligamentum teres & paraumbilical veins
  • 16. LIGAMENTS OF LIVER PERITONEAL LIGMENTS • LEFT TRIANGULAR LIGAMENT: to the left of falciform ligament, the peritoneum is reflected from the diaphragm to the upper surface of the liver to form the anterior layer of left triangular ligament (continuous with left layer of falciform ligament). The peritoneum then covers anterior, inferior & posterior surfaces & is reflected to the diaphragm to form the posterior layer of left triangular ligament
  • 17. LIGAMENTS OF LIVER PERITONEAL LIGMENTS • RIGHT TRIANGULAR LIGAMENT: to the right of falciform ligament, the peritoneum is reflected from the diaphragm to the upper surface of the liver to form the upper layer of coronary ligament (continuous with right layer of falciform ligament). The peritoneum then covers anterior & inferior surfaces then becomes reflected to the front of right kidney to form the lower layer of coronary ligament. The right extremity of both layers meet to form the right triangular ligament
  • 18. LIGAMENTS OF LIVER PERITONEAL LIGMENTS • LESSER OMENTUM: 1. It is attached to the margins of porta hepatis & fissure for ligamentum venosum 2. It extends to lesser curvature of stomach & upper border of 1st inch of 1st part of duodenum
  • 19. LIGAMENTS OF LIVER LIGMENTUM M TERES: •Represents the obliterated left umbilical vein that originally joins the branch of portal vein LIGAMENTUM VENOSUM: •Represents the obliterated ductus venosus that originally connects IVC with left branch of portal vein
  • 20. BARE AREAS OF LIVER •TRIANGULAR DIAPHRAGMATIC AREA •GROOVE FOR IVC •GALL BALDDER FOSSA •PORTA HEPATIS •FISSURE FOR LIGAMENTUM VENOSUM
  • 21. BLOOD SUPPLY OF LIVER • HEPATIC ARTERY: brings oxygenated blood to the liver (30% blood reaching the liver) • PORTAL VEIN: brings blood absorbed from GIT to the liver (70% blood reaching the liver) • ALL BLOOD PASS TO HEPATIC SINUSOIDS • Blood leave the liver through HEPATIC VEINS
  • 22. LIVER LYMPHATIC DRAINAGE: • Mainly into hepatic lymph nodes in porta hepatis. Efferent vessels pass to celiac lymph nodes NERVE SUPPLY: Hepatic plexus of autonomic fibers derived from celiac plexus SUPPORT: 1. Hepatic veins (main support): suspend liver from IVC & have no extrahepatic course 2. Peritoneal folds. 3. Surrounding organs 4. Tone of anterior abdominal wall
  • 23. BILIARY SYSTEM 1. BILIARY DUCTS 2. GALL BLADDER
  • 26. BILIARY DUCTS RIGHT & LEFT HEPATIC DUCTS: • Emerge from porta hepatis • Drain bile from right & left lobes of liver • Unite to form common hepatic duct COMMON HEPATIC DUCT: • One and half inches in length • Formed by the union of the 2 hepatic ducts • Unite with the cystic duct to form the common bile duct
  • 27. BILIARY DUCTS CYSTIC DUCT: • One and half inches in length • Connects the neck of gall bladder to common hepatic duct • The mucous membrane of the duct as well as that of neck of gall bladder is raised forming the spiral valve. The valve keeps the lumen open
  • 28. BILIARY DUCTS COMMON BILE DUCT: • Formation: Formed by union of cystic & common hepatic duct • Length: Three inches • Course & relations: It descends: 1. In the free margin of lesser omentum (to the right side of hepatic artery, anterior to portal vein) 2. Behind 1st part of duodenum (to the right side of gastroduodenal artery, anterior to portal vein) 3. Behind the head of pancreas, anterior to IVC • Termination: usually join the main pancreatic duct forming the ampulla of Vater that opens into the lumen of 2nd part of duodenum through the major duodenal papilla
  • 29. GALL BLADDER SHAPE: Pear-shaped sac SITE: Lies in gall bladder fossa of liver LENGTH: 3 – 4 inches CAPACITY: 30 – 50 ml
  • 30. GALL BLADDER PARTS: Formed of 3 parts: 1. Fundus: projects below inferior margin of liver, lies opposite the tip of right 9th costal cartilage, related anteriorly to anterior abdominal wall & posteriorly to transverse colon • Body: related anteriorly to liver & posteriorly to 1st part of duodenum • Neck: continuous with cystic duct has same relation as body
  • 31. GALL BLADDER PERITONEAL COVERING: • Fundus: completely covered by peritoneum • Body & neck: only covered posteriorly FUNCTION: Stores & concentrates bile
  • 32. SUPPLY OF BILIARY SYSTEM • ARTERIES: Cystic branch of right hepatic artery • VEINS: Cystic vein that drains into the right branch of portal vein • LYMPH DRAINAGE: Cystic lymph nodes, then to hepatic & finally to celiac lymph nodes • NERVES: autonomic fibers from celiac lymph nodes