1 / 78

THE LIVER

THE LIVER. Introduction/General Information A. Largest of viscera 1. ~ 2.5% body weight 2. Completely covered by Glisson’s Capsule 3. Incomplete covering by peritoneum. General Information, continued … 4. Measurements are ~ a. 21 – 23 cm transverse

anoush
Download Presentation

THE LIVER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE LIVER

  2. Introduction/General Information • A. Largest of viscera • 1. ~ 2.5% body weight • 2. Completely covered by Glisson’s Capsule • 3. Incomplete covering by peritoneum

  3. General Information, continued … 4. Measurements are ~ a. 21 – 23 cm transverse b. 15 – 18 cm superior to inferior c. 10 – 13 cm anterior to posterior

  4. General Information, continued … Location: 1. right hypochondrium 2. epigastrium C. Mostly covered by ribs D. Contains numerous vascular structures

  5. II. Detailed Anatomy • A. Four lobes • 1. Divisions based on blood supply, bile drainage • 2. Anatomical lobes divided by falciform ligament

  6. Inferior View of the Liver A P

  7. Detailed Anatomy, con’t… 3. Functional Lobes a. right and left lobes separated by imaginary line b. from fossa for GB  IVC

  8. Right and Left Functional Lobes of the Liver Left Lobe Right Lobe

  9. Detailed Anatomy, continued … • Functional Divisions • Right lobe with caudate process • Left lobe: • a. Caudate lobe • b. Quadrate lobe Caudate Process

  10. Detailed Anatomy, continued … • C. Fissures: • 1. Right sagittal (main) • 2. Left sagittal (accessory) • 3. Portal • 4. Right oblique intersegmental • 5. Lateral intersegmental

  11. Fissures of the Liver • Main lobar fissure • Boundary between R and L lobes • L.S. on U/S: seen as hyperechoic line from PV to neck of GB • Used to ID GB when it is packed with stones

  12. Fissures of the Liver • Portal fissure • T.S. on U/S • Created by portal veins (triads) • R. main PV is // to anterior body wall

  13. Segments of the Liver • Hepatic segments • I = caudate lobe • II & III = superior and inferior lateral segments, L. lobe • IV = medial segment, L. lobe • V & VI = caudal to transverse plane • VII & VIII = cephalad to transverse plane I

  14. Functional divisions, continued … 4. Fossae (Superficial) a. IVC – posterior b. Portal Vein – inferior c. Gallbladder – inferior

  15. Fossae, Inferior Surface of the Liver • Fossa for IVC • Fossa for Portal Vein • Fossa for Gall Bladder

  16. Functional Divisions, continued … 5. Impressions (visceral surface): produced by abdominal viscera a. Gastric (fundus of stomach) b. Renal (right kidney) c. Adrenal (right adrenal gland) d. Duodenal (bulb of duodenum) e. Esophageal (esophagus) f. Right and left colic (flexures of the colon)

  17. Visceral Impressions, continued … P • Esophageal • Renal • Gastric • Adrenal • Duodenal • Right colic • Left colic L R A

  18. Detailed Anatomy, continued … D. Ligaments 1. Falciform (most superficial anteriorly) a. Divides left lobe in two sections 1. anatomical left lobe 2. caudate & quadrate lobes b. Two layers of peritoneum c. Extends to umbilicus

  19. Ligaments, continued … 2. Ligamentum teres hepatis (fetal source??) 3. Ligamentum venosum (fetal source??) 4. Right/Left Coronary Ligaments

  20. Hepatic Ligaments • Falciform ligament • L. coronary ligament • L. triangular ligament • Ligamentum teres hepatis • Ligamentum venosum

  21. Ligaments, continued … • 5. Hepatophrenic & Hepatorenal ligaments: • a. Subdivisions of right coronary ligament • b. hepatophrenic (superior) & hepatorenal (inferior) • c. Surround BARE AREA

  22. Hepatic Ligaments, con’t… • Hepatophrenic ligament • Hepatorenal ligament Bare Area

  23. Detailed Anatomy, continued … E. Lesser Omentum 1. Sleeve-like structure 2. Connects lesser curvature of stomach & bulb of duodenum to inferior surface of liver 3. AKA: Gastrohepatic or Hepatoduodenal ligament

  24. Lesser Omentum, continued … 3. Attachment surrounds Porta Hepatis 4. Continues on each side of ligamentum venosum 5. Extends to caudate & left lobes on posterior surface of liver

  25. Lesser Omentum • Lesser Omentum: (R) Anterior view, (L) Inferior view

  26. Detailed Anatomy, con’t… • E. Subphrenic Spaces • clinically important • common sites for abscesses • Between liver and diaphragm

  27. Subphrenic Spaces, con’t… • 4. Right superior posterior subphrenic space • a. Boundaries: • - superior: right coronary ligament • - anterior: liver • - posterior: parietal peritoneum covering diaphragm • b. Extends inferiorly to….

  28. Subphrenic Spaces, continued … 5. Right posterior inferior subphrenic space a. Boundaries - above: inferior surface of liver - below: transverse colon & mesocolon b. Extends over right adrenal & kidney

  29. Subphrenic Spaces, continued … c. AKA: Hepatorenal Pouch/Recess, Morrison’s Pouch d. Patient lying supine: 1. Lowest part of peritoneal cavity is behind liver 2. Fluid, pus, etc. collects here 3. Can cause abscess formation

  30. Subphrenic spaces, continued … • 6. Right superior anterior subphrenic space • a. Boundaries: • - right side of falciform ligament • - upper layer of right coronary ligament • - underside of diaphragm • - superior surface of liver • b. Found when patient lying prone

  31. Subphrenic spaces, continued … 7. Most sources of peritoneal contamination are on the right 8. Right posterior & right inferior spaces are most significant sites 9. Infection may spread via diaphragmatic lymphatics

  32. Detailed Anatomy, continued … • F. Porta Hepatis: contains the following structures • 1. Hepatic arteries • a. Usually two, sometimes one • b. Originate from common/proper hepatic artery • c. Course is variable

  33. Porta Hepatis, continued … • 2. Portal vein (supplies 1100 ml/blood per minute) • a. Largest structure in porta • b. Formed by confluence of mesenteric veins & splenic vein

  34. Porta Hepatis Hepatic Artery Portal Vein Common Bile Duct

  35. Porta Hepatis, continued … • 3. Hepatic & cystic ducts • 4. Nerves: • a. Vagus X (parasympathetic) • b. Fibers from celiac ganglion

  36. Porta Hepatis, continued … 4. Lymph nodes: a. most hepatic lymph vessels end in nodes around porta hepatis • b. From here, drain into celiac nodes

  37. Porta Hepatis, continued … • c. Some vessels pass through falciform ligament • 1. through diaphragm • 2. into mediastinal nodes • d. enlarged nodes may compress portal vein or hepatic duct

  38. Detailed Anatomy, continued … G. Vascular Structures in Liver 1. Largest vessels are portal vein and IVC a. Portal Vein: 1. appears on T.S. as tubular, echolucent structure 2. courses horizontally from porta hepatis

  39. Detailed Anatomy, continued … 3. walls echogenic due to structures in portal triad b. Left Portal Vein: 1. has more variable course 2. May be difficult to trace on transverse scans

  40. Hepatic Vessels • IVC • Right Portal Vein • Left Portal Vein • Main Portal Vein

  41. Vascular Structures, continued … c. Right Portal Vein: 1. anatomical landmark 2. extends into right lobe 3. branches after porta hepatis 4. L.S. shows “dumbbell” or circular structure with echogenic “collar”

  42. Computer-enhanced image of RPV, L.S.

  43. Computer-enhanced 3-D image of RPV, L.S.

  44. Vascular Structures, continued … d. IVC: 1. To right of aorta 2. Appears to pass through liver 3. Diameter enlarges after renal veins join (~L-1)

  45. Computer-enhanced 3-D image of Hepatic Vessels

  46. Vascular structures, continued … 2. Hepatic Veins: a. Tubular structures b. Enlarge cephalad c. In superior half of liver d. Angles of hepatic vein branches oriented toward IVC e. Walls not echogenic

  47. Hepatic Veins R. Hepatic Vein Middle Hepatic Vein L. Hepatic Vein

  48. Detailed Anatomy, continued … • Bile Ducts • 1. No “normal” anatomy • 2. If dilated: • a. Echogenic collar • b. Lobulated shape • c. Highly branched over short distances • d. Converge toward porta hepatis

  49. Anatomy of the Biliary System (yeah, right…) P L R A

More Related