ANATOMY OF LIVER

1. LIVER
Dr. Kumar Satish Ravi
MBBS,MD(JIPMER),MNAMS,FAIMER(M-FIILIPE), FIMSA, D.Litt.
Editor In Chief, National Journal of Clinical Anatomy
Professor(Additional) of Anatomy
All India Institute of Medical Sciences Rishikesh
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2. 2
“A good knowledge of the Anatomy is a
PREREQUISITE for Surgey of the Liver”
- Henri Bismuth

3. Learning objectives
• Introduction
• Functions
• Surface anatomy
• External features
• Internal features
• Peritoneal relations
• Blood supply
• Innervation
• Applied aspects
• Questions
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4. Introduction
• Largest gland
• Foregut derivative
• Location- Extends from right upper
quadrant to left upper quadrant
of abdomen
• Shape- wedge, four sided
pyramid laid on one side
• Weight – 1.6 kg in males &
1.3kg (females)
• Colour- Red - Brown
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5. • Weight-
- At birth: 150 g.
- In males: 1.4 to 1.8 kg.
- In females: 1.2 to 1.4 kg.
• Proportional weight-
- Newborn: 5% of body weight
- Adult: 2.5% of body wt
• Attached to diaphragm by:
- Falciform & coronary ligaments
- Left & right triangular ligaments
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Contd…

6. 1. False ligaments
• Lesser omentum
• Falciform ligament
• Coronary ligaments
• Triangular ligaments
2. True ligaments
• Round ligament of the liver
• Ligamentum venosum
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Ligaments of Liver

7. 7

8. • Bile production & secretion
• Detoxification
• Storage of glycogen
• Protein synthesis
• Production of heparin & bile pigments
• Erythropoiesis (in fetus)- occupies 2/5th of abdomen
Note: Liver is much larger in newborn & young children due
to its hemopoietic function in fetal life, & occupies 2/5th of
the abdomen
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Functions

9. Surface anatomy
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10. Surfaces
1.Diaphragmatic surface:
 Smooth & dome-shaped surface
 Superior surface
 Anterior surface
 Right lateral surface
 Inferior to diaphragm
 Posterior surface
 Separated from diaphragm by subphrenic recess & from posterior
organs {kidney & suprarenal glands} by hepatorenal recess
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11. Ligaments:
- Ligamentum teres hepatis -
obliterated umbilical vein
- Falciform hepatic ligament
(attachment to peritoneum
of anterior abdominal wall)
- Coronary hepatic ligament
- Triangular hepatic ligament
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12. Visceral surface
Covered by visceral peritoneum except porta hepatis & gall
bladder bed
Inferior surface
• Visceral surface is related to:
 Right side of stomach i.e. gastric & pyloric areas
 Superior part of duodenum
i.e. duodenal area
 Lesser omentum
 Gall bladder
 Right colic flexor & right
transverse area- colic area
 Right kidney & suprarenal
gland; Renal area
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13. Visceral surface ‘H’
a. Cross-bar of H = Porta hepatis
- Hepatic artery, Portal vein, Bile ducts,
Nerves and Lymphatic vessels
b. Left inferior of H = Ligamentum teres
hepatis or round ligament of liver
(Remnant of umbilical vein)
c. Left superior of H = Ligamentum
venosum (Remnant of ductus
venosus)
d. Rt. inferior of H = Gall bladder
e. Rt. superior of H = Inferior vena cava
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14. 14

15. Posterior view
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16. Liver lobes
 Right and left lobe
 Functionally independent
i.e. each with own blood
& nerve supply
Blood supply by:
 Hepatic artery
 Portal vein
Blood out through:
 Veins &
 Biliary drainage
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17. 17

18. Liver lobes
Right lobe Demarcated by :
a) Gall bladder fossa
b) Inferior vena cava fossa
c) Imaginary line from fundus of
gall bladder & inferior vena
cava
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19. Left lobe
Divided into:
Medial & lateral segments
a) Medial superior
– caudate lobe
b) Medial inferior
- quadrate lobe
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20. VISCERAL SURFACE
LOBES :
1. Lobus dexter – right lobe
2. l. sinister – left l.
3. l. caudatus – caudate l.
4. l. quadratus – quadrate l.
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21. Imprints of surrounding organs
• Right lobe-
• duodenum, right kidney and
suprarenal gland,
• right colic flexure
• Left lobe - Stomach,
oesophagus
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22. • Caudate Lobe: posterior Surface
• Right - Groove for IVC
• Left - Fissure for Lig. Ven.
• Inferior - Porta hepatis
• Quadrate Lobe: Inferior surface
• Anterior -Inferior Border
• Posterior - Porta hepatis
• Right - fossa for Gall bladder
• Left - fissure for Lig. teres
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23. 24

24. Parasagittal section through liver
Showing subphrenic recess and
hepatorenal recess
(Rutherford-Morison pouch)
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25. Left lobe cont…
 Lateral segment is separated from the
medial segments by:
 On visceral surface:
 fissure of ligamentum teres (round
ligament)
 fissure of ligamentum
venosum
 On diaphragmatic surface:
 attachment of falciform
ligament
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26. Visceral surface
A. Round ligament(ligamentum teres) –
obliterated umbilical vein
B. Ligamentum venosum – fibrous remnant
of fetal ductus vein
C. Porta hepatis (hepatic potal: portal
fissure) - transverse fissure on the
visceral surface of liver.
– It gives passage to the:
a) Portal vein
b) Hepatic artery
c) Hepatic nerve plexus
d) Hepatic ducts
e) Lymphatic vessels
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27. 28

28. PORTA HEPATIS - hepatic triad
Inf. Surface
Deep ,Transverse fissure, 5 cm long.
Between Caudate l. & Quadrate l.
1. PORTAL VEIN
2. PROPER HEPATIC ARTERY (branch of common HA)
3. Hepatic plexus of nerves
4. RIGHT and LEFT HEPATIC DUCT
- lymphatics, - vegetative nerve
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29. 30

30.  Liver is composed of hexagonal
shaped units- lobules
 Radiate from central vein to the
periphery
 Between the rows of hepatocytes
are sinusoids which supply blood
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Internal features

31. 32

32. Portal Triad
Branches of portal vein, hepatic artery and the biliary
ducts bound together in the perivascular fibrous capsule
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33. Peritoneal relations
Lesser omentum
• Encloses portal triad (bile duct, hepatic artery and portal vein)
• Passes from liver to lesser curvature of stomach + 1st inch of first part of duodenum.
duodenum
• Thick free edge -- hepatoduodenal ligament
• Sheet like remainder – hepatogastric ligament
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34. Contd…
• Posterior Surface-
 Bare area- Diaphragm & Rt.
Suprarenal gland
 Groove for IVC.
 Caudate lobe- crura of
diaphragm, Inf. Phrenic art. &
Coeliac trunk
 Fissure for lig. Venosum
 Post. Surf of lt. lobe is maked
by oesophageal impression.
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35. Bare areas of the liver
peritoneum
• b/t Ant. & Post. Coronary ligaments
• Fossa for gall bladder
• Porta hepatis
• Fissure for Lesser omentum
• Fissure for ligamentum venosum
• Fossa for IVC
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36. 37

37. Intraparenchymal branches of right division of portal vein
(portal) -> retroperitoneal veins (systemic)
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38. Couinaud segments
Segments I, II, III and IV make up the functional left lobe
Segments V,VI, VII and VIII make up the functional right lobe
Segment I corresponds to the gross anatomical caudate
lobe and segment IV to the quadrate lobe
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39. 40

40. 41

41. Couinaud segments
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42. Functional lobes
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43. Functional lobes
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44. 45

45. 46

46. Blood supply
a) Rt. & Lt. hepatic arteries carry oxygenated blood (25%).
b) Portal vein (valveless) carries venous blood (75%) rich in nutrients.
c) Hepatic veins drain venous blood to IVC.
d) Right & left branches -> segmental vessels -> Interlobular – Hepatic
sinusoids. Mixes
• Venous Drainage- Hepatic sinusoids- interlobular + sublobular veins +
Hepatic veins IVC
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47. Hepatic Veins (Right, Middle, Left)
Interlobular veins
Central Vein
Portal Venules Hepatic Arterioles
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Contd….

48. 49

49. 50
Venous Drainage

50. Nerve supply
 Hepatic plexus contains sympathetic &
parasympathetic or vagal fibers
 Nerve also reach liver various peritoneal ligaments
 Capsule is supplied by some fine branches of the
lower intercostal nerves, which also supply parietal
peritoneum
 Particularly in the area of the 'bare area' &
superior surface
 This is seen clinically when distension or disruption of
liver capsule causes quite well localized sharp pain
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51.  Hepatic plexus is the largest derivative of the coeliac plexus.
 It also receives branches from the anterior and posterior vagi.
 These branches not only supply vasomotor fibres to the hepatic vessels
and biliary tree, but also innervate the hepatocytes directly and are
involved in the control of some homeostatic mechanisms.
 Vagal fibres are motor to the musculature of gallbladder and bile ducts &
inhibitory to the sphincter of bile duct.
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52. Referred pain
 Pain arising from the parenchyma of liver is poorly localized
 In common with other structures of foregut origin, pain is referred to the
central epigastrium
 Stretch of or involvement of the liver capsule by inflammatory or neoplastic
processes rapidly produces well-localized pain of a 'somatic' nature
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53. Lymphatic drainage
Liver is a major lymph-producing organ
(1/4 -1/2 of lymph → Thoracic duct)
 Diaphragmatic surface of liver drains to
Phrenic nodes
 Visceral surface & deep lymphatics along
portal triads drains to Porta Hepatis →
Hepatic nodes → Coeliac nodes →
Cisterna chyli → Thoracic duct
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54. 55

55. Hepatitis
• Inflammation of liver due to viral infections
• Causes- viral infection, autoimmune
hepatitis , drugs, toxins, & alcohol
• Types –
hepatitis A
hepatitis B
hepatitis C
hepatitis D
hepatitis E
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56. Liver Cirrhosis
SYMPTOMS:
• Early symptoms- asymptomatic
- Non specific (weight loss, weakness & fatigue
• Later – jaundice
- Ascites
- Hepatic encephalopathy
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Cirrhosis is scarring (fibrosis) of the liver caused
by long-term liver damage. The scar tissue
prevents the liver working properly

57. Normal liver Liver cirrhosis
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58. Acute Liver Failure
Rapid deterioration of
liver function, without
known pre existing
disease
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59. Portal Hypertension
• Portal vein provides about 75%
of the liver's blood flow & about
60% of its O2 supply
• Normal portal pressure is 5-10
mmHg (7-14 cm H2O), which
exceeds inferior vena caval
pressure by 4-5 mm Hg (portal
venous gradient)
• Higher values are defined as
portal hypertension
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60. 61

61. CALOT’S TRIANGLE
The borders are as follows:
• Medial – common hepatic duct.
• Inferior – cystic duct.
• Superior – inferior surface of the
liver.
Contents
• Right hepatic artery
• Cystic artery
• Lymph node of Lund – the first
lymph node of the gallbladder.
• Lymphatics
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62. Pringle’s maneuver
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63. Hepatocellular Carcinoma
• Cancer that starts in liver
Diagnosis:
- Blood test (alpha fetoprotein)
- Imaging test- CT-scan,MRI, X-ray
- Liver biopsy
Treatment:
Radiation, Chemotherapy, Immunotherapy
,Liver transplant
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64. MCQ
Q-The bare area of the liver is located on the _______________ surface of the liver?
a) Inferior
b) Anterior
c) Posterior
d) superior
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65. Q- Liver is completely covered by a dense fibroelastic connective tissue
layer called ?
a) Parenchyma
b) Glisson's capsule
c) Visceral capsule
d) Liver sheath
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66. Q- Which ligament is the remnant of ductus venosus?
a) Ligamentum teres
b) Ligamentum venosus
c) Falciform ligament
d) Coronary ligament
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67. Q- The Couinaud’s segmental nomenclature is based on the position of
the :
a) Hepatic veins and portal vein
b) Hepatic veins and biliary ducts
c) Portal vein and biliary ducts
d) Portal vein and hepatic artery
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68. Q- A 29 yr old male presented with abdominal
pain and fever for 15-20 days, with loss of
appetite for 5 days. On abdominal examination
there was tenderness and guarding in the right
upper quadrant with hepatomegaly extending 5
cm below right costal margin. Ultrasound
examination showed abscess in right lobe of
the liver. The patient tested positive for
amoebic antibody by ELISA test.
• What is the probable diagnosis?
Ans. Amoebic liver abscess
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69. Q- A 49-year-old man presents with acute abdominal pain and jaundice
resulting from a tumor at the head of the pancreas. The tumor will most
likely obstruct which of the following structures?
A. Bile duct
B. Common hepatic duct
C. Left hepatic duct
D. Cystic duct
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70. Q- Which of the following doesn’t contribute in forming hepatic
plexus ?
a. Celiac plexus
b. Left phrenic nerve
c. Rt and Lt. vagus nerve
d. Right phrenic nerve
• Ans- b
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71. References
• Williams PL. Gray’s Anatomy. The Anatomical Basis of Clinical
Practice. 41st Ed. Edinburgh: Churchill Livingstone; p.1098-1107.
• Snell, Richard S. (2018) Clinical neuroanatomy /Philadelphia : Wolters
Kluwer Health/Lippincott Williams & Wilkins
• Moore KL, Agur AM, Dalley AF, Moore KL. Essential clinical anatomy.
Wolters Kluwer Health,; 2015.
• Lautt WW. Hepatic circulation: physiology and pathophysiology.
InColloquium Series on Integrated Systems Physiology: from Molecule
to Function 2009 Jan 1 (Vol. 1, No. 1, pp. 1-174). Morgan & Claypool
Publishers.
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72. THANK YOU
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