Download MBBS Anatomy PPT 67 Liver Notes

Surface projection

--- Content provided by FirstRanker.com ---

of liver

LIVER ? HEPAR

Largest Gland, exocrine secretion (bile),

--- Content provided by FirstRanker.com ---

metabolic functions

Weight ?

--- Content provided by FirstRanker.com ---

1.6 kg , fragile tissue, 1.3kg females,

Reddish Brown C.

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

--- Content provided by FirstRanker.com ---

Shape- wedge, four sided pyramid

laid on one side.

--- Content provided by FirstRanker.com ---

LIVER ? HEPAR

Position: right diaphragmatic dome --- left medioclavicular line

--- Content provided by FirstRanker.com ---

Rt. Hypochond. ? epigastric- Lt.hypochond.


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

--- Content provided by FirstRanker.com ---

Coverings of the liver

1. T. SEROSA (X area nuda)

= visceral peritoneum

--- Content provided by FirstRanker.com ---

2. FASCIA GLISSONI

DIAPHRAGMATIC SURFACE

--- Content provided by FirstRanker.com ---

Two lobes - right and left l.

Ligaments:

Lig. teres hepatis

--- Content provided by FirstRanker.com ---

- obliterated umbilical vein

ligament falciforme hepatis

--- Content provided by FirstRanker.com ---

(attachment to the peritoneum of

anterior abdominal wall)

--- Content provided by FirstRanker.com ---

Coronary hepatic lig.

Triangular hepatic lig.

LIG.TERES HEPATIS

--- Content provided by FirstRanker.com ---

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

--- Content provided by FirstRanker.com ---

covered by peritoneum, fused with

diaphragm, bordered by ligaments

--- Content provided by FirstRanker.com ---

Ligaments:

- Lig. teres hepatis - obliterated

umbilical vein

--- Content provided by FirstRanker.com ---

-Falciform hepatic ligament

DIAPHRAGM

--- Content provided by FirstRanker.com ---

(attachment to the peritoneum

- of anterior abdominal wall)

- Coronary hepatic lig.

--- Content provided by FirstRanker.com ---

- Triangular hepatic lig.

--- Content provided by FirstRanker.com ---

VISCERAL SURFACE

LOBES :

1. Lobus dexter ? right lobe

--- Content provided by FirstRanker.com ---

2. l. sinister ? left l.

3. l. caudatus ? caudate l.

--- Content provided by FirstRanker.com ---

4. l. quadratus ? quadrate l.

PORTA

HEPATIS

--- Content provided by FirstRanker.com ---

Borders among lobes ? fissures

,,H"

--- Content provided by FirstRanker.com ---

Imprints of surrounding organs:

Right lobe-

duodenum, right kidney and suprarenal gland,

--- Content provided by FirstRanker.com ---

right colic flexure

Left lobe -

--- Content provided by FirstRanker.com ---

stomach, oesophagus


VISCERAL SURFACE

--- Content provided by FirstRanker.com ---

Caudate Lobe : post. Surf.

Rt. ? Groove fr IVC

Lt.- Fissure fr Lig. Ven.

--- Content provided by FirstRanker.com ---

Inf.- Porta hepatis

PORTA

--- Content provided by FirstRanker.com ---

HEPATIS

Quadrate Lobe : Inf. Surf.

Ant. ? Inf. Border

--- Content provided by FirstRanker.com ---

Post.- Porta hepatis

Rt.-fossa fr G.B.

--- Content provided by FirstRanker.com ---

Lt.- Fissure fr Lig. Teres

--- Content provided by FirstRanker.com ---

PORTA HEPATIS - hepatic triad

Inf. Surface

--- Content provided by FirstRanker.com ---

Deep ,Transverse fissure, 5 cm long.

Between Caudate l. & Quadrate l.

--- Content provided by FirstRanker.com ---

1. PORTAL VEIN

2. PROPER HEPATIC ARTERY (branch of

common HA)

--- Content provided by FirstRanker.com ---

3. Hepatic plexus of nerves

4. RIGHT and LEFT HEPATIC DUCT

--- Content provided by FirstRanker.com ---

- lymphatics, - vegetative nerve


Parasagittal section

--- Content provided by FirstRanker.com ---

through liver

Showing subphrenic

recess and

--- Content provided by FirstRanker.com ---

hepatorenal recess

(Rutherford-Morison pouch)

--- Content provided by FirstRanker.com ---

Liver

--- Content provided by FirstRanker.com ---

Surfaces of Liver

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

--- Content provided by FirstRanker.com ---

Visceral

Surface

`H'

--- Content provided by FirstRanker.com ---

Liver

Visceral surface `H'

--- Content provided by FirstRanker.com ---

1. Cross-bar of H = Porta hepatis

?

--- Content provided by FirstRanker.com ---

Hepatic artery, Portal vein, Bile

ducts, Nerves and Lymphatic vss.

2. Lt. inferior of H = Ligamentum teres

--- Content provided by FirstRanker.com ---

hepatis or round ligament of liver

(Remnant of umbilical v.)

--- Content provided by FirstRanker.com ---

3. Lt. superior of H = Ligamentum

venosum (Remnant of ductus venosus)

4. Rt. inferior of H = Gall bladder

--- Content provided by FirstRanker.com ---

5. Rt. superior of H = Inferior vena cava

Visceral

Surface

--- Content provided by FirstRanker.com ---

`H'

--- Content provided by FirstRanker.com ---

Liver

Peritoneal relations

1. Peritoneal ligaments

--- Content provided by FirstRanker.com ---

?

Lesser omentum

--- Content provided by FirstRanker.com ---

?

Falciform ligament

?

--- Content provided by FirstRanker.com ---

Coronary ligaments

?

--- Content provided by FirstRanker.com ---

Triangular ligaments

2. Vascular ligaments

?

--- Content provided by FirstRanker.com ---

Round ligament of the liver

?

--- Content provided by FirstRanker.com ---

Ligamentum venosum


Parts of stomach and lesser omentum

--- Content provided by FirstRanker.com ---

Liver

Bare areas of the liver

--- Content provided by FirstRanker.com ---

peritoneum

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

2. Fossa for gall bladder

--- Content provided by FirstRanker.com ---

3. Porta hepatis

4. Fissure for round ligament

--- Content provided by FirstRanker.com ---

5. Fissure for ligamentum venosum

6. Fossa for IVC

--- Content provided by FirstRanker.com ---

Liver

Lobes of liver
1. Anatomical lobation

--- Content provided by FirstRanker.com ---

?

Right lobe

--- Content provided by FirstRanker.com ---

?

Left lobe

?

--- Content provided by FirstRanker.com ---

Caudate lobe

?

--- Content provided by FirstRanker.com ---

Quadrate lobe

2. Functional lobation

?

--- Content provided by FirstRanker.com ---

Right lobe

?

--- Content provided by FirstRanker.com ---

Left lobe

?

By a line passing the gal bladder and IVC

--- Content provided by FirstRanker.com ---

Anatomical lobes


Anatomical lobes

--- Content provided by FirstRanker.com ---

Functional lobes


Functional lobes

--- Content provided by FirstRanker.com ---

Liver

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

--- Content provided by FirstRanker.com ---

oxygenated blood (25%)

2. Portal vein carries venous blood

--- Content provided by FirstRanker.com ---

(75%) rich in nutrients

3. Hepatic veins drain venous blood

to IVC

--- Content provided by FirstRanker.com ---

Nerve

--- Content provided by FirstRanker.com ---

Anterior vagal trunk

? Hepatic plexus

contains symp. +

--- Content provided by FirstRanker.com ---

parasympath. Or vagal

fibers

--- Content provided by FirstRanker.com ---

? Nerve also reach liver

via various peritoneal

ligaments.

--- Content provided by FirstRanker.com ---

Celiac plexus


Liver

--- Content provided by FirstRanker.com ---

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

--- Content provided by FirstRanker.com ---

Diaphragmatic surface of liver drains

to Phrenic nodes

--- Content provided by FirstRanker.com ---

?

Visceral surface & deep lymphatics

along portal triads drains to Porta

--- Content provided by FirstRanker.com ---

Hepatis Hepatic nodes Coeliac

nodes Cisterna chyli Thoracic

--- Content provided by FirstRanker.com ---

duct

Lymphatic drainage of liver

--- Content provided by FirstRanker.com ---

Lymphatic

drainage of GI

tract

--- Content provided by FirstRanker.com ---

Arterial Supply-

Hepatic artery

--- Content provided by FirstRanker.com ---

Portal vein

Rt& Lt. Branches -> segmental vessels ->

Interlobular ? Hepatic sinusoids. Mixes

--- Content provided by FirstRanker.com ---

Venous Drainage- Hepatic sinusoids-

interlobular + sublobular v. + Hepatic v. -

--- Content provided by FirstRanker.com ---

> I.V.C.

Nerve Supply- Hepatic plexus contains

symp. + parasympath. Or vagal fibers

--- Content provided by FirstRanker.com ---

Nerve also reach liver via various

peritoneal ligaments.

--- Content provided by FirstRanker.com ---

Gal bladder & Biliary tracts

Gal bladder & Biliary tracts

--- Content provided by FirstRanker.com ---

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

Cystic duct, hepatic ducts,

--- Content provided by FirstRanker.com ---

common hepatic duct and

common bile duct

--- Content provided by FirstRanker.com ---

Gal bladder

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

--- Content provided by FirstRanker.com ---

? b/t Rt. lobe & Quadrate

lobe of liver

? Surface projection

--- Content provided by FirstRanker.com ---

Fundus of gallbladder =

Murphy's point

--- Content provided by FirstRanker.com ---

Gal bladder

Spiral valve

Neck

--- Content provided by FirstRanker.com ---

Body

Gallbladder has 4 portions
1. Fundus

--- Content provided by FirstRanker.com ---

2. Body

3. Neck Infundibulum :

--- Content provided by FirstRanker.com ---

Hartmann's pouch

Hartmann's

pouch

--- Content provided by FirstRanker.com ---

Internal surface : folds, spiral

folds and crypts of Luschka

--- Content provided by FirstRanker.com ---

Fundus

Crypts

of

--- Content provided by FirstRanker.com ---

Luschka


Gal bladder

--- Content provided by FirstRanker.com ---

Gal bladder

Blood supply of gallbladder

--- Content provided by FirstRanker.com ---

Cystic artery

1. Cystic artery from

Right Hepatic artery

--- Content provided by FirstRanker.com ---

(in Calot's triangle

Cholecystectomy)

--- Content provided by FirstRanker.com ---

2. Cystic vein : tributary of

Portal vein

Calot's triangle

--- Content provided by FirstRanker.com ---

Biliary tract

1. Cystic duct : ~ 3-4 cm

--- Content provided by FirstRanker.com ---

: spiral valve of Heister

2. Common hepatic duct

: ~ 3.5 cm

--- Content provided by FirstRanker.com ---

: from Rt. & Lt. hepatic

ducts

3. Common bile duct

--- Content provided by FirstRanker.com ---

: ~ 7-8 cm, Dia- 6mm

1+2 3

--- Content provided by FirstRanker.com ---

Biliary tract

Common bile duct has 4 parts

--- Content provided by FirstRanker.com ---

? Supraduodenal- Liver---portal

v. epi. For.? Hep. Art.

? Retroduodenal

--- Content provided by FirstRanker.com ---

? Infraduodenal
? Intraduodenal

Common bile duct + Major pancreatic duct

--- Content provided by FirstRanker.com ---

Hepatopancreatic ampulla (Ampulla of Vater)

Opening is Greater duodenal papilla in 2nd

part of duodenum (surrounded by Sphincter of Oddi)

--- Content provided by FirstRanker.com ---

Icteric sclera

Compression of common

--- Content provided by FirstRanker.com ---

bile duct resulted in

obstructive jaundice

--- Content provided by FirstRanker.com ---

Biliary tract]

Anterior vagal trunk

Nerves of Gallbladder

--- Content provided by FirstRanker.com ---

? Symp : Celiac plexus
? Parasymp : Ant. and

Post. vagal trunks

--- Content provided by FirstRanker.com ---

Celiac plexus


Biliary tract

--- Content provided by FirstRanker.com ---

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

Celiac nodes

--- Content provided by FirstRanker.com ---

Applied Anatomy

? Cholelithiasis
? Cholecystitis
? Murphy's sign

--- Content provided by FirstRanker.com ---

? Courvoisier's law- dilatation

of the G.B. occurs only in

extrinsic obst. Of CBD ,

--- Content provided by FirstRanker.com ---

fibrosis

? Jaundice

--- Content provided by FirstRanker.com ---

Radiograph of gallbladder

& biliary tracts