The document provides information about the liver, gallbladder, and spleen. It discusses the formation, location, lobes, blood supply, and clinical notes of the liver. It describes the gallbladder's formation, location, vasculature, and clinical issues like biliary colic and cholecystitis. For the spleen, it notes the location under the left ribs and impressions from other organs on its surface.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Liver, Gall Bladder,
and Spleen
By
Ammar Mohammed Saleih
Registrar G.Surgery, MSC
Anatomy, ER.Diploma

2. objectives
By the end of this session any one can be able to:
• Identify the different relations of the liver
Gallbladder and spleen.
• Identify the lobs, blood supply and divisions
of the liver.
• Identify the Gallbladder and important
relations and clinical notes .

3. Liver
General Info
• Largest gland in the body
• Has many metabolic activities
– stores glycogen
– secretes bile
• connected to GI tract by the bile duct
• located mainly in the RUQ
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4. • http://d-mis-web.ana.bris.ac.uk/calnet/vetAB3/page2.htm

5. Formation
• Hepatic diverticulum arises as an endodermal
bud on the ventral surface of the distal foregut
– grows between layers of the septum transversum
– Two new buds forming the L/R lobes of liver
» these contain the blood filled sinusoids of the
liver
• Diverticular stalk between the liver buds and
primitive gut give rise to the gall bladder and
cystic duct. The remaining stalk turns into
the bile duct
5

6. • Umbilical vein in fetus is surrounded by
ventral mesentery connecting the body wall
and the fetus. This is called the falciform
ligament in the adult.
• The Ligamentum venosum is the remnant of
the ductal shunt for blood in the fetus called
the ductus venosus.
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7. Location
• RUQ beneath the diaphragm.
• R hypochondrium and epigastric region.
• Gall bladder is under the visceral surface of
the right lobe, lateral to the liver’s Quadrate
lobe.
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8. L
S
L L
S
Small Intestine
Greater
Omentum
D
Falciform ligament
Transverse Colon

9. right
left
Falciform lig.
Ligamentum teres
hepatis
Diaphragmatic surface

10. L L
S
Small Intestine
D
Transverse Colon
Falciform ligament and
Round Ligament

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12. 5
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13. Externally
i. The superior, lateral and anterior surface contact
the inferior surface of the diaphragm: liver’s
diaphragmatic surface.
ii. The inferior base of the liver is in contact with the
digestive organs and is called the visceral
surface.
iii. 4 lobes
– R/L are separated by the falciform ligament.
– Caudate lobe is bounded laterally by the fossa for the IVC
and medially by the fissure for the ligamentum venosum.
– Quadrate lobe is inferior to the caudate lobe and lies
between the gall bladder and the fissure for the
ligamentum teres .
13

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15. iv. Bare area
– lacks visceral peritoneum
– superioposterior surface adjacent to the diaphragm
– Coronary ligament: extension fo the peritoneum
between the liver and the diaphragm
– L/R Triangular ligaments: lateral extensions of
the coronary ligament
v. Subphrenic recess: cul-de-sac of
peritoneum located between the anterior
surface of the liver and the diaphragm
vi. Hepatorenal recess: cul-de-sac of
peritoneum located between the visceral
surface of the liver and the posteriorly
related right kidney
– fluids can collect in this pocket because it is the
lowest trough in the peritoneal cavity when a
person is supine
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16. vii. Visceral surface
– right lobe contacts the R kidney, hepatic flexure of
the colon and second part of the duodenum and
gall bladder
– left lobe contacts the esophagus and the stomach
viii.Porta hepatis is the area between the the
caudate and quatrate lobes
– location for passage of the portal triad : portal
vein, hepatic artery and bile duct
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17. S
Bare area
diaphragm
?
Lt. & Rt. Triangular ligs.

18. Visceral Surface
left
right
quad
caud
Porta hepatis
Hepatic vein
IVC Bare area
Gall bladder
Falciform lig.
peritoneum

19. Internally
• Functional lobes
– different than the anatomical lobes
– determined according to the independent blood
supply to each
– L functional lobe includes the left lobe, caudate
and quadrate lobes
•
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20. Green line: Surgical or functional
division of liver into Right and Left portal lobes
Purple line: Anatomical division
of liver into Right and Left anatomical lobes
Q
c

22. Vasculature: ( mostly located in the
hepatogastric ligament )
• Arteries
– celiac trunk at the level of L1
» common hepatic
» proper hepatic
» right and left hepatics
» porta hepatis of the liver
• Veins
– Portal vein carries the venous return of the
abdominal organs to the liver
– Liver’s venous return in via 3 hepatic veins
emptying into the IVC
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23. Innervation
• Parasympathetic
– left vagal trunk: the hepatic branch and hepatic
plexus
• Sympathetic
– greater thoracic splanchnic nerve (t7-9): celiac
plexus and hepatic plexus
• Referred pain would present at level of T7-9
dermatomes
Lymphatics:
• Liver to the hepatic nodes to the celiac
nodes around the celiac trunk
• To the intestinal trunk to the lumbar trunk to
the cisterna chili and into the thoracic duct
• 23

24. Clinical Notes
i. Portal hypertension: increased venous pressure
in the portal vein due to resistance of blood flow
through the liver
causes are classified:
» pre-hepatic: partial occlusion in the portal vein
» intra-hepatic: intrinsic liver disease
» post-hepatic: occlusive pathology in the venous
drainage of the liver
3 key portal-caval anastomotic links
» esophagus: can cause life threatening
hemmorrhage
» anal canal: vein distension can cause hemorrhoids
» anterior abdominal wall in the umbilical region:
produce a snake-like radial pattern called caput
medusae
24

25. ii. Inflammation of the liver: due to infection
that can lead to erosion through the dense
liver capsule into the abdominal cavity
producing pleuritis or empyema
iii. Metastatic cancer of the liver: resulting from
deposition of spreading cancerous cells that
originated in the GI tract
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26. Gall Bladder
General Info
• Non-vital organ
• Concentrates and stores the liver’s bile
Formation :An expansion of the diverticular stalk
Location: in the gall bladder fossa of the liver
lateral to the quadrate lobe
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27. Externally: composed of a fundus, body, neck,
and cystic duct that joins the common hepatic
duct
Internally: spiral mucosal folds in the duct are
thought to act like a valve in response to
hormonal stimuli
27

28. D
GB
Cystic duct
(with spiral valve)
Common hepatic
duct
Bile duct
Main pancreatic duct
Ampulla of Vater
Rt. & Lt.
Hepatic ducts
Major
papilla
Hepatopancreatic Duct
System

29. Vasculature and innervation
Arteries
– celiac trunk to the common hepatic to the proper
hepatic to the cystic artery
Veins:
– cystic vein to the right branch of the portal vein
Parasympathetic
– left vagal trunk to the hepatic branch to the cystic
plexus
Sympathetic
– Greater thoracic splanchnic (T7-9) to the celiac
plexus and cystic plexus
29

30. Ant. & post.
Pancreatico-
duodenal aa.
gastroduodenal a.
Cystic a.
Rt. Hepatic a.
Cystic duct
Bile duct
Sup. Mesenteric
A. & V.
Splenic a.
Portal triad
Uncinate process (of pancreas)
S
GB
P

31. Clinical Notes
Biliary colic: with blockage of the duct will
get referred pain in the RUQ
Cholecystitis: inflammation
Gall stones: make from bilirubin metabolites,
cholesterol or calcium salts
– can obstruct the gall bladder
– can obstruct the common duct or the
hepatopancreatic duct
– when passed can stretch the sphincters making
them less useful to regulate the flow of bile and
pancreatic enzymes
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33. • http://www.med-ed.virginia.edu/courses/rad/edus/index.html

34. ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

35. Splenic a. & v.
S
P
K

36. Hilum
(splenic a. & v.)
what ligament?
Visceral surface
Gastric impression
Colic impression
Superior notched
border
Diaphragmatic surface
3,5,7,9,11 -- 3" x 5",
7oz., under 9-11 ribs
Renal
impression
Spleen

37. THANK YOU