Surgical Anatomy of the Liver : Ηepatectomies - Dimitris P. KorkolisDimitris P. Korkolis
- The liver is the largest gland in the body and has a wide variety of functions
- Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
- It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen)
Function of the liver :
- Secretion of bile & bile salt
- Metabolism of carbohydrate, fat and protein
- Formation of heparin & anticoagulant substances
- Detoxication
- Storage of glycogen and vitamins
- Activation of vita .D
Surgical Anatomy of the Liver : Ηepatectomies - Dimitris P. KorkolisDimitris P. Korkolis
- The liver is the largest gland in the body and has a wide variety of functions
- Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
- It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen)
Function of the liver :
- Secretion of bile & bile salt
- Metabolism of carbohydrate, fat and protein
- Formation of heparin & anticoagulant substances
- Detoxication
- Storage of glycogen and vitamins
- Activation of vita .D
describes about peritoneal cavity and clinical importance of it. it describes in deatils about lesser sac, greater sac, pouch of Morrison, pouch of Douglas.
anatomy of duodenum, location or position of duodenum, parts of duodenum, relations of each parts of duodenum, ligaments of treitz, visceral and peritoneal relation of duodenum, blood supply of duodenum, innervation of duodenum, clinical aspects of duodenum, duodenal ulcer, diverticulum, deodinitis, duodenal obstruction
describes about peritoneal cavity and clinical importance of it. it describes in deatils about lesser sac, greater sac, pouch of Morrison, pouch of Douglas.
anatomy of duodenum, location or position of duodenum, parts of duodenum, relations of each parts of duodenum, ligaments of treitz, visceral and peritoneal relation of duodenum, blood supply of duodenum, innervation of duodenum, clinical aspects of duodenum, duodenal ulcer, diverticulum, deodinitis, duodenal obstruction
Liver is the largest internal organ of the body weighing about 1500g in adults. It occupies the right hypochondrium and extends into the epigastrium and left hypochondrium .
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
This presentation contains about how Liver regenerate and what are different method which can be used to augment the liver function before undergoing hepatectomy for treatment of tumor or liver transplant.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
3. HISTORICAL PERSPECTIVE
• The surface anatomy of the liver was described as early as
2000BC by the ancient Babylonians.
• Even Hippocrates understood and described the
seriousness of liver injury.
• In 1654, Francis Glisson was the first physician to describe
the essential anatomy of the blood vessels of the liver
accurately.
• Hogarth Pringle in 1908, described digital compression of
the hilar vessels to control hepatic bleeding from traumatic
injuries.
4. LIVER
• Liver is the largest gland in human body after skin
• It weighs 1.2-1.5 kg
• It comprises of 2.5% of the total body weight
• In a mature fetus it may even serve as an Hematopoietic
organ
5. LOCATION OF LIVER
• Liver lies mainly in right upper quadrant of abdomen under
cover of 7-11 ribs on right side occupying predominantly
right Hypochondrium and Epigastrium
6. SUPPORTS OF LIVER
• Primary Supports:
◦ IVC
◦ Hepatic Veins
◦ Coronary and triangular
ligaments
• Secondary Support:
◦ Right kidney
◦ Right colonic angle
◦ Duodenopancreatic complex
• Tertiary supports: attachment of
liver to the anterior abdominal wall and diaphragm by falciform
ligament.
7. ANATOMIC FEATURES
• Surfaces
◦ Diaphragmatic/antero superior
◦ Visceral/postero inferior
• Lobes :
• Major lobes
Right
Left
• Accessory lobes
Caudate
Quadrate
9. RECESSES OF LIVER
• Diaphragmatic surfaces of liver are the sub phrenic and
hepato-renal recesses.
• Sub phrenic recess separates the diaphragmatic surface of
the liver from the diaphragm, Right and Left areas are
divided by the falciform ligament.
10. • Hepatorenal recess is a part of the peritoneal cavity
on the right side between the liver and right kidney and right
suprarenal gland
11. BARE AREA OF LIVER
• Presents on the diaphragmatic surface of liver
and is directly in
contact with the
undersurface of
diaphragm devoid
of peritoneum.
18. HEPATODUODENAL LIGAMENT
• Extends from Porta
Hepatis to superior
part of duodenum
and contains
common bile duct,
proper hepatica and
hepatic portal vein.
19. PORTA HEPATIS
• Porta hepatis serves as the point of entry into the liver for the hepatic arteries
and the portal vein, and the exit point for the hepatic ducts
• Mickey Mouse View: The ultrasound image of hepatic artery, bile duct and portal vein
is in a configuration, referred as
Mickey Mouse View
22. HEPATIC VEINS
Basis for modern lobar and segmental anatomy.
◦Used as dividers
Portal Veins feed centrally
◦ Used to name segments
MHV divide the liver into right and left lobe.
RHV divide the right lobe into anterior and posterior
segments.
LHV divide the left lobe into
medial and lateral segment.
23. Caudate Lobe
• Caudate lobe (segment I), lies between the left portal vein
and the IVC and extends to the hepatic venous confluence
Caudate lobe is unique
• It receives blood supply from both the right and left portal
pedicles
• Bile drain into both right and left hepatic duct
•
24.
25. MAJOR LOBES OF LIVER
Liver is composed
of two anatomical
lobes namely Right
and Left
27. FUNCTIONAL DIVISION OF LIVER
• Current understanding of the functional anatomy of the
liver is based on Couinaud’s division of the liver into eight
(subsequently nine) functional segments, based upon the
distribution of portal venous branches and the location of
the hepatic veins in the parenchyma (Couinaud 1957).
• Segment IX is a recent subdivision of segment I, and
describes that part of the segment that lies posterior to
segment VIII
28. • The liver is divided into four portal sectors by the four main
branches of the portal vein. These are right lateral, right
medial, left medial and left lateral (sometimes the term
posterior is used in place of lateral and anterior in place of
medial).
• The three main hepatic veins lie between these sectors as
intersectorial veins. These intersectoral planes are also
called portal fissures (scissures). The fissures containing
portal pedicles are called hepatic fissures.
• Each sector is sub-divided into segments (usually two)
based on their supply by tertiary divisions of the vascular
biliary sheaths.
30. Fissures of the Liver
Major
• Main portal fissure
• Left portal fissure
• Right portal fissure
Minor
• Umbilical fissure
• Venous fissure
• Fissure of Gans
31. • Main portal fissure
• Extends from the tip of the GB back to the midpoint of IVC and contains the middle
(main) hepatic vein.
• Separates liver into right and left hemi-livers.
Segments V and VIII lie to the right and segment IV to the left of the fissure.
32. Left portal fissure
• Divides left hemi-liver into medial (anterior) and lateral (posterior) Sectors
• Extends from the mid point of the anterior edge of the liver between
falciform ligament and left triangular ligament to the point, which marks the
confluence of the left and middle hepatic veins.
• Contains left hepatic vein
• Separates the left anterior and left posterior sectors: segment III lies
anteriorly and segment II posteriorly
33. Right portal fissure
Divides right hemi-liver into lateral (posterior) and medial (anterior) sectors.
• Plane of right fissure is the most variable amongst the main fissures
• The fissure divides right anterior sector to its left (segments V and VIII) from
right posterior sector to its right (segments VI andVII) Contains right hepatic
vein
• Right fissure marks the thickest point of liver parenchyma, which is
commonly transected during liver resection.
34. • Umbilical fissure
Umbilical fissure separates segment III from segment VI within left anterior
sector and contains a main branch of left hepatic vein
(umbilical fissure vein).
• It is marked by attachment of falciform ligament and sometimes covered by
a ridge of liver tissue extending between the segments: it is often avascular and
can be divided safely with diathermy during a surgical approach.
• It contains umbilical portion of left portal vein and the final divisions of left
hepatic duct and left hepatic artery branches.
35. Venous fissure
Venous fissure is a continuation of umbilical fissure on under
surface of liver
• Contains ligamentum venosum
• It lies between caudate lobe and segment IV.
• The deeper continuation of this plane is the dorsal fissure.
36. Fissure of Gans
Fissure of Gans lies on undersurface of right lobe of liver
behind GB fossa.
• Contains portal pedicle to right posterior sector
38. Sectors and segments of the liver:
• The sectors of the liver are made up of between one and three segments:
• right lateral sector = segments VI and VII; right medial sector= segments V
and VIII; left medial sector = segments III and IV (and part of I); left lateral
sector = segment II.
• Segments are numbered in an ante-clockwise spiral centered on the portal
vein with the liver viewed from beneath, starting with segment I up to
segment VI, and then back clockwise for the most cranial two segments VII
and VIII.
39. CANTLIE’S LINE
• Grossly divides liver into left and right lobe using a plane
from gall bladder fossa to IVC
• The MHV lies in the
Cantlie’s Line
41. Couinaud’s Classification of Liver
Segments
Branching of the portal vein and the
hepatic veins defines these segmentsQ
42.
43. Segmental anatomy of the liver
• True morphological and physiological division by a line
extend from fossa of GB to fossa of I.V.C each has its own
arterial blood supply, venous drainage and biliary drainage
• No anastomosis between divisions
• 3 major hepatic veins Rt, Lt & central
• 8 segments based on hepatic and portal venous segments
44.
45.
46.
47. Source: HPB 2000; 2(3):333-39
Terminology Committee of the International Hepato-Pancreato-
Biliary Association
48.
49.
50.
51. Credit for the first anatomic liver resection is usually given to Lortat-Jacob, who
performed a right hepatectomy in 1952 in France
Operative mortality rates in excess of 20% were common and usually related to
massive hemorrhage.
Many surgeons were reluctant to perform hepatic surgery because of these
results, and understandably, many physicians were reluctant to refer patients for
hepatectomy.
With the courage of patients and their families as well as the persistence of
surgeons, safe hepatic surgery has now been realized.
52. Advances in anesthesia, intensive care, antibiotics, and
interventional radiologic techniques have also contributed
tremendously to safety of major hepatic surgery.
Total hepatectomy with liver transplantation and live donor
partial hepatectomy for transplantation are now performed
routinely in specialized transplantation centers.
Partial hepatectomy for large number of indications is now
performed throughout the world in specialized centers, with
mortality rates of 5% or less.
Partial hepatectomy on normal livers is now consistently
performed, with mortality rates of 1% to 2%.
53. The role of robotics in liver surgery is rapidly evolving.
Thermal ablative techniques to treat hepatic tumors, including
radiofrequency and microwave ablation, have exploded in popularity.
Finally, techniques to improve the safety of liver resection further, such as
portal vein embolization to induce preoperative hypertrophy of the
future liverremnant (FLR), have been developed and are now being used.
The celiac axis, just below the diaphragmatic
hiatus, trifurcates into the splenic, left gastric, and common
hepatic arteries. The common hepatic artery heads to the right and
turns superiorly toward the hilum. At the point of this turn, the gastroduodenal
artery is given off, and the proper hepatic artery is formed.
The common hepatic artery gives off right and left hepatic arteries in
the hilum. Note the middle hepatic artery off the proximal left hepatic
artery, which goes on to supply segment IV. The cystic artery usually
comes off the right hepatic artery within the triangle of Calot
Venous drainage is directly into IVC
Each segment receives its own portal pedicle (triad of
portal vein, hepatic artery, and bile duct). The eight segments are illustrated,
and the four sectors, divided by the three main hepatic veins
running in scissurae, are shown. The umbilical fissure (not a scissura)
is shown to contain the left portal pedicle
Cantlie's line is a vertical plane that divides the liver into left and right lobes creating the principal plane used for hepatectomy. It extends from the inferior vena cava posteriorly to the middle of the gallbladder fossa anteriorly