Download MBBS Anatomy PPT 67 Liver Notes

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of liver

LIVER ? HEPAR

Largest Gland, exocrine secretion (bile),

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metabolic functions

Weight ?

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1.6 kg , fragile tissue, 1.3kg females,

Reddish Brown C.

Newborn - 5% of body weight, Adult - 2.5% of body wt

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Shape- wedge, four sided pyramid

laid on one side.

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LIVER ? HEPAR

Position: right diaphragmatic dome --- left medioclavicular line

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Rt. Hypochond. ? epigastric- Lt.hypochond.


Five surfaces- Ant., Post., Sup., Inf. & Right.

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Coverings of the liver

1. T. SEROSA (X area nuda)

= visceral peritoneum

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2. FASCIA GLISSONI

DIAPHRAGMATIC SURFACE

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Two lobes - right and left l.

Ligaments:

Lig. teres hepatis

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- obliterated umbilical vein

ligament falciforme hepatis

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(attachment to the peritoneum of

anterior abdominal wall)

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Coronary hepatic lig.

Triangular hepatic lig.

LIG.TERES HEPATIS

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,,BARE AREA" ( ,,Area nuda") ? not

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covered by peritoneum, fused with

diaphragm, bordered by ligaments

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Ligaments:

- Lig. teres hepatis - obliterated

umbilical vein

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-Falciform hepatic ligament

DIAPHRAGM

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(attachment to the peritoneum

- of anterior abdominal wall)

- Coronary hepatic lig.

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- Triangular hepatic lig.

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VISCERAL SURFACE

LOBES :

1. Lobus dexter ? right lobe

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2. l. sinister ? left l.

3. l. caudatus ? caudate l.

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4. l. quadratus ? quadrate l.

PORTA

HEPATIS

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Borders among lobes ? fissures

,,H"

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Imprints of surrounding organs:

Right lobe-

duodenum, right kidney and suprarenal gland,

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right colic flexure

Left lobe -

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stomach, oesophagus


VISCERAL SURFACE

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Caudate Lobe : post. Surf.

Rt. ? Groove fr IVC

Lt.- Fissure fr Lig. Ven.

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Inf.- Porta hepatis

PORTA

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HEPATIS

Quadrate Lobe : Inf. Surf.

Ant. ? Inf. Border

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Post.- Porta hepatis

Rt.-fossa fr G.B.

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Lt.- Fissure fr Lig. Teres

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PORTA HEPATIS - hepatic triad

Inf. Surface

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Deep ,Transverse fissure, 5 cm long.

Between Caudate l. & Quadrate l.

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1. PORTAL VEIN

2. PROPER HEPATIC ARTERY (branch of

common HA)

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3. Hepatic plexus of nerves

4. RIGHT and LEFT HEPATIC DUCT

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- lymphatics, - vegetative nerve


Parasagittal section

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through liver

Showing subphrenic

recess and

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hepatorenal recess

(Rutherford-Morison pouch)

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Liver

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Surfaces of Liver

1. Diaphragmatic surface
2. Visceral surface : structures lie like `H'

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Visceral

Surface

`H'

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Liver

Visceral surface `H'

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1. Cross-bar of H = Porta hepatis

?

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Hepatic artery, Portal vein, Bile

ducts, Nerves and Lymphatic vss.

2. Lt. inferior of H = Ligamentum teres

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hepatis or round ligament of liver

(Remnant of umbilical v.)

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3. Lt. superior of H = Ligamentum

venosum (Remnant of ductus venosus)

4. Rt. inferior of H = Gall bladder

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5. Rt. superior of H = Inferior vena cava

Visceral

Surface

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`H'

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Liver

Peritoneal relations

1. Peritoneal ligaments

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?

Lesser omentum

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?

Falciform ligament

?

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Coronary ligaments

?

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Triangular ligaments

2. Vascular ligaments

?

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Round ligament of the liver

?

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Ligamentum venosum


Parts of stomach and lesser omentum

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Liver

Bare areas of the liver

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peritoneum

1. b/t Ant. & Post. Coronary ligaments

2. Fossa for gall bladder

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3. Porta hepatis

4. Fissure for round ligament

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5. Fissure for ligamentum venosum

6. Fossa for IVC

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Liver

Lobes of liver
1. Anatomical lobation

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?

Right lobe

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?

Left lobe

?

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Caudate lobe

?

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Quadrate lobe

2. Functional lobation

?

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Right lobe

?

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Left lobe

?

By a line passing the gal bladder and IVC

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Anatomical lobes


Anatomical lobes

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Functional lobes


Functional lobes

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Liver

Blood supply of liver
1. Rt. & Lt. hepatic arteries carry

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oxygenated blood (25%)

2. Portal vein carries venous blood

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(75%) rich in nutrients

3. Hepatic veins drain venous blood

to IVC

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Nerve

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Anterior vagal trunk

? Hepatic plexus

contains symp. +

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parasympath. Or vagal

fibers

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? Nerve also reach liver

via various peritoneal

ligaments.

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Celiac plexus


Liver

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Lymphatic drainage of liver
Liver is a major lymph-producing organ
(1/4 -1/2 of lymph Thoracic duct)
?

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Diaphragmatic surface of liver drains

to Phrenic nodes

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?

Visceral surface & deep lymphatics

along portal triads drains to Porta

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Hepatis Hepatic nodes Coeliac

nodes Cisterna chyli Thoracic

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duct

Lymphatic drainage of liver

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Lymphatic

drainage of GI

tract

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Arterial Supply-

Hepatic artery

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Portal vein

Rt& Lt. Branches -> segmental vessels ->

Interlobular ? Hepatic sinusoids. Mixes

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Venous Drainage- Hepatic sinusoids-

interlobular + sublobular v. + Hepatic v. -

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> I.V.C.

Nerve Supply- Hepatic plexus contains

symp. + parasympath. Or vagal fibers

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Nerve also reach liver via various

peritoneal ligaments.

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Gal bladder & Biliary tracts

Gal bladder & Biliary tracts

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Biliary system consists of
1. Gall bladder
2. Biliary tracts

Cystic duct, hepatic ducts,

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common hepatic duct and

common bile duct

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Gal bladder

? Length 7-10 cm.
? Capacity 30-50 ml

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? b/t Rt. lobe & Quadrate

lobe of liver

? Surface projection

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Fundus of gallbladder =

Murphy's point

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Gal bladder

Spiral valve

Neck

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Body

Gallbladder has 4 portions
1. Fundus

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2. Body

3. Neck Infundibulum :

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Hartmann's pouch

Hartmann's

pouch

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Internal surface : folds, spiral

folds and crypts of Luschka

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Fundus

Crypts

of

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Luschka


Gal bladder

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Gal bladder

Blood supply of gallbladder

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Cystic artery

1. Cystic artery from

Right Hepatic artery

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(in Calot's triangle

Cholecystectomy)

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2. Cystic vein : tributary of

Portal vein

Calot's triangle

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Biliary tract

1. Cystic duct : ~ 3-4 cm

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: spiral valve of Heister

2. Common hepatic duct

: ~ 3.5 cm

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: from Rt. & Lt. hepatic

ducts

3. Common bile duct

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: ~ 7-8 cm, Dia- 6mm

1+2 3

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Biliary tract

Common bile duct has 4 parts

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? Supraduodenal- Liver---portal

v. epi. For.? Hep. Art.

? Retroduodenal

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? Infraduodenal
? Intraduodenal

Common bile duct + Major pancreatic duct

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Hepatopancreatic ampulla (Ampulla of Vater)

Opening is Greater duodenal papilla in 2nd

part of duodenum (surrounded by Sphincter of Oddi)

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Icteric sclera

Compression of common

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bile duct resulted in

obstructive jaundice

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Biliary tract]

Anterior vagal trunk

Nerves of Gallbladder

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? Symp : Celiac plexus
? Parasymp : Ant. and

Post. vagal trunks

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Celiac plexus


Biliary tract

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Lymphatic drainage of Gallbladder
? Drain to Hepatic nodes of cystic nodes

Celiac nodes

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Applied Anatomy

? Cholelithiasis
? Cholecystitis
? Murphy's sign

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? Courvoisier's law- dilatation

of the G.B. occurs only in

extrinsic obst. Of CBD ,

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fibrosis

? Jaundice

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Radiograph of gallbladder

& biliary tracts