LIVER, SPLEEN PORTAL VEIN PORTAL HYPERTENSION Khaleel Alyahya khaleel@saudiforum.us Monday December 28, 2009

Structure It is located in the upper part of the abdomen just beneath the diaphragm. Its posteroinferior (visceral) surface lies in contact with the esophagus, the stomach, the duodenum, the right colic flexure, right kidney, suprarenal gland, and the gallbladder. It is completely surrounded by fibrous capsule and partially covered by peritoneum. Khaleel Alyahya, PhD

Relations ANTERIORLY Diaphragm, Right and left costal margins, Right and left pleura and lower margins of both lungs, Xiphoid process, Anterior abdominal wall at subcostal angle POSTERIORLY Right kidney, Hepatic flexure of colon, Duodenum, Gallbladder, IVC, Esophagus and Stomach fundus Khaleel Alyahya, PhD

Production and secretion of bile. Functions Production and secretion of bile. Metabolism of carbohydrates, lipids and proteins. Filtration of the venous blood from the intestinal tract. Synthesis of heparin. Detoxication. Production of bile pigments from hemoglobin. Storage of some vitamins. Khaleel Alyahya, PhD

Liver Lobes The liver is divided by falciform ligament into: A large right lobe A small left lobe The right lobe is further divided into: Quadrate lobe Caudate lobe by the gallbladder, the fissure for ligamentum teres, the IVC and the fissure for ligamentum venosum. Khaleel Alyahya, PhD

Portal Hepatis The Porta Hepatis (Hilum) of the liver lies between the right and left lobe on the posteroinferior surface. The lesser omentum is attached to its edge. Within, lie the right and left hepatic ducts, the right and left branches of the hepatic artery, the portal vein, sympathetic and parasympathetic nerve fibers and some lymph nodes. Khaleel Alyahya, PhD

Liver Lobule The liver is made up of liver lobules. The central vein of each lobule is a tributary of the hepatic veins. In the spaces between the lobules are the portal canals, which contain branches of the hepatic artery, portal vein and a tributary of a bile duct (portal triad). The arterial and venous blood passes between the liver cells by means of sinusoids and drains into the central vein. Khaleel Alyahya, PhD

Blood Supply ARTERIES the hepatic artery, branch of the celiac artery, divides into right and left terminal branches at porta hepatis VEINS the portal vein divides into right and left terminal branches that enter porta hepatis behind the arteries. the hepatic veins (3 or more) emerge from the posterior surface of the liver and drain into the IVC BLOOD CIRCULATION the hepatic artery brings 30% of the blood to the liver, and 70% comes from the portal vein Khaleel Alyahya, PhD

Lymph Drainage The liver produces approximately 30 to 50% of the total body lymph. The liver lymph vessels are drained in lymph nodes in the region of porta hepatis. The efferent lymph vessels are drained mainly to the celiac lymph nodes. A few lymph vessels from the bare area are drained through the diaphragm to the posterior mediastinal lymph nodes. Khaleel Alyahya, PhD

Lymph Drainage The sympathetic and parasympathetic innervation comes from the celiac plexus. The anterior vagal trunk gives rise to a large hepatic branch which passes directly to the liver. Khaleel Alyahya, PhD

Bile Ducts The liver secretes 40 mL bile par hour. Right and left hepatic ducts Common hepatic duct Bile duct Gallbladder Cystic duct The liver secretes 40 mL bile par hour. The bile canaliculi drain in the interlobular bile ducts, which form larger bile ducts. Khaleel Alyahya, PhD

Hepatic Ducts The larger bile ducts of the liver form, at porta hepatis, the left and right hepatic ducts. The left hepatic duct drains the left, caudate and quadrate lobes. The right hepatic ducts drains the right lobe. The right and left hepatic duct unite to form the common hepatic ducts. The common hepatic duct is 4 cm long and it descends in the free margin of the lesser omentum. It is joined from the right side by the cystic duct to form the bile ducts Khaleel Alyahya, PhD

Gallbladder

Structures & Relation This is a pear-shaped sac lying on the undersurface of the liver. It has a capacity of 30 to 50 mL and stores and concentrates bile. It has a rounded fundus, in contact with the anterior abdominal wall at the level of the tip of the 9th right costal cartilage. The body is in contact with the visceral surface of the liver. The neck is continuous with the cystic duct. ANTERIOR Anterior abdominal wall and inferior surface of liver POSTERIOR Transverse colon and 1st and 2nd parts of the duodenum Khaleel Alyahya, PhD

Blood Supply & Innervation Arterial blood supplied by the cystic artery (branch of the right hepatic artery). Venous blood is drained by the cystic vein into the portal vein. Small arteries and veins run between the gallbladder and the liver. Sympathetic and parasympathetic vagal fibers from the celiac plexus. Khaleel Alyahya, PhD

Lymph Drainage The lymph from the gallbladder drains into the cystic lymph nodes near the neck. From there, the lymph vessels pass to the hepatic lymph nodes along the course of the hepatic artery. These lymph nodes are drained to the celiac nodes. Khaleel Alyahya, PhD

spleen

Lymph Drainage The spleen is oval-shaped and has a notched anterior border. It is reddish color and it is the biggest lymphoid organ in the body. It lies beneath the left coupole of the diaphragm close to the 9th, 10th and 11th ribs. It's long axis lies along the shaft of the 10th rib and it's lower pole extends to the midaxillary line. Khaleel Alyahya, PhD

Relations ANTERIORLY the stomach. tail of pancreas. left coilic flexure. the left kidney lies along its medial border. POSTERIORLY the diaphragm. left pleura. left costodiaphragmatic recess. left lung. 9th, 10th and 11th ribs. Khaleel Alyahya, PhD

Blood Supply Arteries Splenic artery - the biggest branch of the celiac artery. It has a tortuous course and runs along the superior border of the pancreas. Before entering the spleen at the hilum, it divides into 6 branches. Veins The Splenic vein leaves the hilum and runs behind the body of the pancreas. Behind the neck of the pancreas it joins the superior mesenteric vein to form the portal vein. Khaleel Alyahya, PhD

Lymph Drainage & Innervation The lymph vessels emerge from the hilum and pass through a few lymph nodes (pancreaticosplenic nodes) along the course of the Splenic artery and then drain into the celiac nodes. The nerves accompany the splenic artery and are derived from the celiac plexus. Khaleel Alyahya, PhD

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