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Liver

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Dr. NIMRAH NASIR
Senior Demonstrator Anatomy
Fatima Memorial Medical & Dental College
Shadman, Lahore
 A patient presented with chronic
hepatitis c in medical OPD with
heametemesis,distended abdomen
with radiating veins in abdomen.
His ultrasound examination
revealed a mass in right lobe of
liver.
 What is the condition he might be
suffering from?
 Most likely diagnosis is
Hepatoma of liver.
AT THE END OF SESSION STUDENT WILL BE ABLE TO:
 Explain the location OF LIVER
 Explain the anatomical FEATURES OF LIVER
 Describe the functional subdivisions OF LIVER
 Describe the supports and relations OF LIVER
 Describe the Blood Supply, Nerve Supply and Lymphatic Drainage OF LIVER.
 Clinical Correlations
 Liver is the largest gland in human body after skin
 It weighs 1500 grams
 It comprises of 2.5% of the total body weight
 In a mature fetus it may even serve as an Hematopoietic organ
 Except fat it absorbs all the nutrients from GIT by portal system
 Liver stores glycogen and secretes bile for emulsification of fats
 Liver lies mainly in right
upper quadrant of abdomen
under cover of 7-11 ribs on
right side occupying
predominantly right
Hypochonndium and
Epigastrium
 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 abdomnal
wall and diaphragm by
falciform ligament.

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Liver.pdf

  • 1. Dr. NIMRAH NASIR Senior Demonstrator Anatomy Fatima Memorial Medical & Dental College Shadman, Lahore
  • 2.  A patient presented with chronic hepatitis c in medical OPD with heametemesis,distended abdomen with radiating veins in abdomen. His ultrasound examination revealed a mass in right lobe of liver.  What is the condition he might be suffering from?  Most likely diagnosis is Hepatoma of liver.
  • 3. AT THE END OF SESSION STUDENT WILL BE ABLE TO:  Explain the location OF LIVER  Explain the anatomical FEATURES OF LIVER  Describe the functional subdivisions OF LIVER  Describe the supports and relations OF LIVER  Describe the Blood Supply, Nerve Supply and Lymphatic Drainage OF LIVER.  Clinical Correlations
  • 4.  Liver is the largest gland in human body after skin  It weighs 1500 grams  It comprises of 2.5% of the total body weight  In a mature fetus it may even serve as an Hematopoietic organ  Except fat it absorbs all the nutrients from GIT by portal system  Liver stores glycogen and secretes bile for emulsification of fats
  • 5.  Liver lies mainly in right upper quadrant of abdomen under cover of 7-11 ribs on right side occupying predominantly right Hypochonndium and Epigastrium
  • 6.  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 abdomnal wall and diaphragm by falciform ligament.
  • 7.  Surfaces ◦ Diaphragmatic/antero superior ◦ Visceral/postero inferior  Lobes : ◦ Major lobes  Right  Left ◦ Accessory lobes  Caudate  Quadrate  Border ◦ Inferior Border
  • 9.  Diaphragmatic surface of liver is dome shaped  Smooth in outline where it lies under the concavity of inferior surface of diaphragm  It separates from pluerae, pericardium and lungs.
  • 10.  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, derived from the ventral mesentery ◦ Hepatorenal recess is a part of the peritoneal cavity on the right side between the liver and the right kidney and right suprarenal gland.
  • 11.  Presents on the diaphragmatic surface of liver and is directly in contact with the undersurface of diaphragm devoid of peritoneum.
  • 12.  Falciform ligament  Anterior coronary ligament  Posterior coronary ligament  Round ligament  Ligamentum venosum  Lessser omentum has 2 parts: • Hepatogastric ligament • Hepatoduodenal ligament
  • 14.  Is surrounded by the peritoneum and is attached to the diaphragm by the coronary and the falciform ligament  Diverging cut edges of the superior part of the coronary ligament
  • 16.  Two layers folds of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum.
  • 17.  Extends from Porta Hepatis to lesser curvature of Stomach
  • 18.  Extends from Porta Hepatis to superior part of duodenum and contains common bile duct, proper hepatica and hepatic portal vein.
  • 19. Is covered with visceral peritoneum except in the fossa for the gallbladder and at the porta hepatis, and structures related to it include:  the right anterior part of the stomach;  the superior part of the duodenum;  the lesser omentum;  the gallbladder;  the right colic flexure;  the right transverse colon;  the right kidney;  the right suprarenal gland.
  • 21.  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
  • 24.  Liver is composed of two anatomical lobes namely Right and Left
  • 25.  Right lobe is the largest in volume and contributes to all surfaces of the liver.  On the diaphragmatic surface It is divided from the left lobe by falciform ligament superiorly and ligamentum venosum inferiorly.  On the visceral surface left sagittal fissure separates the two.
  • 26. The triangular smaller lobe that lies lateral to the left saggital fissures and occupies the epigastrium and extends till the left hypochondrium is called the left lobe of liver.
  • 27. The quadrate and caudate lobes are described as arising from the right lobe of liver, but functionally are distinct:  Quadrate lobe is visible on the upper part of the visceral surface of the liver and is bounded on the left by the fissure for ligamentum teres and on the right by the fossa for the gallbladder. Functionally it is related to the left lobe of the lever.  Caudate lobe is visible on the lower part of the visceral surface of the liver and is bounded on the left by the fissure for the ligamentum venosum and on the right by the groove for the IVC. Functionally, it is separate from the right and the left lobes of the liver
  • 30.  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  Couinaud divided the liver into functional right an left lobe by a main portal scissurae containing the middle hepatic vein.
  • 32.  Liver like lungs has dual blood supply. The hepatic portal vein brings 75-80% blood to liver.  Portal vein contains 40% oxygen than blood returning to the heart from systemic circuit.  The hepatic portal vein contains virtually all nutrients absorbed from the alimentary tract to the liver with the exception of lipids which is absorbed through the hepatic artery.
  • 36.  Basis for modern lobar and segmental anatomy.  Hepatic Veins drains peripherally ◦ Interlobar, Intersegmental ◦ Used as dividers  Portal Veins feed centrally ◦ Intralobar, intrasegmental ◦ 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.
  • 42.  Peritonitis may result in the formation of localized abscesses (collections of purulent exudate, or pus)  A subphrenic abscess is often drained by an incision inferior to, or through, the bed of the 12th rib (Ellis, 2010)
  • 43.  It was discovered that the right and left hepatic arteries and ducts, as well as branches of the right and left hepatic portal veins, do not communicate.  It became possible to perform hepatic lobectomies, removal of the right or left (part of the) liver, without excessive bleeding.
  • 44.  The liver is easily injured because it is large, fixed in position, and friable (easily crumbled).  Liver lacerations often cause considerable hemorrhage and right upper quadrant pain.  Remove devitalized tissue by dissection or to perform a segmentectomy?
  • 45.  May be replaced in part or entirely by an aberrant (accessory or replaced)  Common replacement source of an aberrant right hepatic artery is the SMA  Common replacement source of an aberrant left hepatic artery is the left gastric artery
  • 46.  Diseases that produce hepatic engorgement such as congestive heart failure, bacterial and viral diseases such as hepatitis cause hepatomegaly (liver enlargement)  When Liver is massively enlarged, its inferior edge may be readily palpated below the right costal margin.
  • 47.  Cellular damage and consequent scarring, accompanied by regenerative nodules.  The treatment of cirrhosis may include the surgical creation of a portosystemic or portocaval shunt, anastomosing the portal and systemic venous systems.
  • 48.  Fibrosis from cirrhosis obstruct the hepatic portal vein in the liver, pressure rises in the vein and its tributaries, producing portal hypertension.  The veins may become so dilated that their walls rupture, resulting in hemorrhage.