Marilyn Rose

Largest organ of abdomen Rt hypochondriac/ and epigastric regions Borders: Superior/lateral and anterior= Rt diaph Medial= sto/duodenum, transverse colon. Inferior= hepatic flex Posterior= Rt Kid Glisson’s Capsule Covered in peritoneum Except: GB fossa, area of IVC and bare area.

Ligamentum teres- divides lt hepatic lobe into medial and lateral segments Ligamentum venosum- separates the caudate lobe from Lt lobe Transverse (portal) fissure- horizontal R/L PVS Main lobar fissure (GB)- divides R/L lobes Porta Hepatis- inferomedial border of the liver- the site of the MPV/HA and common bile duct.

Fissures of the liver

Lt lobe- most anterior- lt of midline- separated from Rt by interlobar fissure/ Middle hepatic vein. Caudate lobe Smallest lobe, on the inferior/posterior surface, between the IVC and ligamentum venosum Quadrate lobe- Anterior-inferior surface of LT lobe between GB and ligamentum teres (remnant fetal umbilical vein, which runs along edge of falciform- The falciform supports/ attaches liver to diaphragm. 1: Right lobe of liver 2: Left lobe of liver 3: Quadrate lobe of liver 4: Round ligament of liver 5: Falciform ligament 6: Caudate lobe of liver 7: Inferior vena cava 8: Common bile duct 9: Hepatic artery 10: Portal vein

Subcapsular Hematoma

Divided into 8 segments by the vascular supply (4=a/b) Three hepatic veins: MHV- divides liver into Rt/Lt lobes RHV- divides Rt lobe into medial and lateral LHV- Lt lobe into medial and lateral Rt/ Lt Portal veins: Divides each section transversely Each segment is functionally independent with its own artery, portal vein and bile duct

Nutrient rich blood from GI tract via the portal veins. (75-80%) Formed in the retroperitoneum by the superior mesenteric and splenic veins. (posterior to the neck of the pancreas) Porta hepatis- the portal vein branches into the Rt and Lt main portal veins- following the course of the HA’s RPV branches into anterior and posterior branches LPV courses left and then turns medially

Portal Hypertension-leads to Ascites and splenomegaly

Arterial blood (20-25%) from common hepatic artery Common hepatic artery arises from the celiac, entering the liver ANTERIOR to the portal vein. The common hepatic artery arises from the celiac and branches into the Rt gastric and gastroduodenal arteries and continues ast eh proper heaptic towards the porta hepatis. Prior to entering the liver it divides into the LT/RT hepatic arteries; which bring blood to each lobe.

Right Hepatic Vein Largest- drains segments 5, 6 and 7 Left Hepatic Vein Smallest – drains segments 2,3 Middle Hepatic Vein Interlobar fissure- drains segments 4,5 and 8 The three veins converge and enter the IVC just below the diaphragm

Gallbladder and bile ducts Drain the liver and store bile until transported to the duodenum for digestion of fats.. GB lives in the GB fossa- anterioinferior Rt lobe of the liver closest to the main lobar fissure. Reservoir -fundus, body and neck- cystic duct  Rt/Lt= CBD Rt/Lt hepatic ducts unite at the porta hepatis to form the common hepatic duct (CHD), the CHD joins the cystic duct and forms the CBD. CBD continues posterior to the pancreatic head and enters the duodenum along with the main pancreatic duct (Duct of Wirsung) at the Ampulla of Vater ( the muscle at the opening is called the sphincter of Oddi.

ERCP MRCP Ultrasound

ERCP- Cholangiocarcinoma

Retroperitoneal, long, narrow- un- encapsulated Posterior to the stomach/ between duodenum and splenic hilum Head- located at the second portion of the duodenum about L2-L3, anterior to IVC and renal veins Landmarks: CBD Rt posterior and GDA on the anterior aspect Uncinate process- between SMV and IVC Neck- portal splenic confluence main landmark- posterior to the neck Body- largest, anterior to AO and SMA with the splenic vein running along the posterior surface Tail- extends to the LT anterior pararenal space and LT kidney Endocrine (insulin) and Exocrine (digestive enzymes) Enzymes= amylase, lipase and peptidases and sodium bicarbonate

MRI -ABDOMEN

Largest lymph organ Red pulp= blood White pulp= lymphoid tissue and white blood cells Intraperitoneal organ- covered in peritoneum Posterior to stomach in the LUQ Behind the 9-11 th ribs Borders- medial- Lt kidney, splenic flexure, pancreatic tail Posterior- diaphragm, pleura, Lt lung, ribs Attached to > curvature of sto and Lt kid by the Gastrosplenic and lienorenal ligaments SAGITTAL TRANSVERSE

Splenic Rupture