3. LIGAMENTS AND PERITONEAL
REFLECTIONS
• fixed in the right upper quadrant
• left triangular ligament
• The right triangular ligament
• falciform ligament (remnant of the umbilical
vein)
• lesser omentum
4. BLOOD SUPPLY
• coeliac trunk
• along with the splenic artery
• gastroduodenal artery
• right and left hepatic arteries
• right hepatic artery arising from the superior mesenteric
artery
• left gastric branch
5. HILUM OF THE LIVER
• bile duct to be within the free edge
• the hepatic artery to be above and medial
• portal vein to lie posteriorly
• common hepatic artery branches at a variable level within the
ligament to form two, or often three main arterial branches to the
liver
• The right hepatic artery often crosses the bile duct either anteriorly
or posteriorly before giving rise to the cystic artery
• portal vein left gastric vein joins just above the pancreas
6. VENOUS DRAINAGE
• The vena cava lies within a groove in the
posterior wall
• The inferior hepatic veins are short vessels
• three large veins
• The right hepatic vein can be exposed fully
outside the liver
7. INTERNAL ANATOMY
• Couinaud, a French anatomist
• eight segments
• branch of the hepatic artery, portal vein and bile
duct, and drained by a branch of the hepatic vein
• line between the gall bladder fossa and the
middle hepatic vein (Cantlie’s line)
8. HEPATIC LOBULES
• plates of liver cells separated by the hepatic sinusoids,
large, thin-walled venous channels that carry
• blood to the central vein, a tributary of the hepatic vein,
from the
• portal tracts, which contain branches of the hepatic artery
and
• portal vein. During passage through the sinusoids, the
many functions
• of the liver take place, including bile formation, which is
• channelled in an opposite direction to the blood flow to
drain via
• the bile duct tributaries within the portal tracts.
9. TESTS OF LIVER FUNCTION
• Bilirubin 5–17 μmol l–1
• Alkaline phosphatase (ALP) 35–130 IU l–1
• Aspartate transaminase (AST) 5–40 IU l–1
• Alanine transaminase (ALT) 5–40 IU l–1
• Gamma-glutamyl transpeptidase (GGT) 10–48 IU l–1
• Albumin 35–50 g l–1
• Prothrombin time (PT) 12–16 s
10. ULTRASOUND
• bile duct dilatation
• gallstones
• liver tumours
• flow in the hepatic artery, portal vein and
hepatic veins
• guiding the percutaneous biopsy
11. COMPUTERISED TOMOGRAPHY
• triple-phase, multislice, spiral computerised
tomography (CT)
• less than 1 cm
• Oral contrast enhancement
• The early arterial phase small liver cancers
12. • venous phase maps the branches of the portal
vein within the liver and the drainage via the
hepatic veins
• Inflammatory liver lesions exhibit rim
enhancement
• haemangioma late venous enhancement
• density cystic lesion
13. MAGNETIC RESONANCE IMAGING
• iodine-containing intravenous contrast
• magnetic resonance cholangiopancreatography
(MRCP) provides excellent quality, non-invasive
imaging of the biliary tract
• Magnetic resonance angiography (MRA) high-quality
images of the hepatic artery and portal Vein
• patency of the portal vein and its branches
15. • coagulation profile
• Prophylactic antibiotics
• pancreatitis, cholangitis and bleeding or
perforation of the duodenum related to
sphincterotomy.
16. PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY
• previous pancreatoduodenectomy
• Pólya gastrectomy
• hilar bile duct tumours
• guide external drainage of the bile ducts to
relieve jaundice
• direct stent insertion
17. ANGIOGRAPHY
• therapeutic intervention
• Prior to liver resection
• anatomy of the hepatic artery
• confirm patency or tumour involvemen of the portal vein
• occlusion of arteriovenous malformations
• embolisation of bleeding sites in the liver and liver tumours
(transarterial embolisation, TAE)
18. NUCLEAR MEDICINE SCANNING
• Iodoida technetium-99m (99mTc)-labelled
radionuclide that is administered intravenously
• processed by hepatocytes and excreted in the bile
• gamma camera
• sulphur colloid liver scan Kupffer cell activity
• adenomas and haemangiomas lack Kupffer cells
