1. WELCOME!!!

2. Macro Anatomy of the Liver
Georgia Barker and Louise Young

3. Contents Location and Lobe Description Important Relations
Peritoneal Ligaments of the Liver
Blood Supply
Calot’s Triangle
Lymph Drainage
Nerve Supply
Bile Ducts

4. Regions of the Abdomen

5. What regions does the liver lie in?
The liver lies in the right hypochondrium and epigastric region, extending into the left hypochondrium.
Greater part of the liver is situated under the cover of the right costal margin; separated from the pleura, lungs, pericardium and heart by the right hemi diaphragm.

6. Lobes Divided into right and left lobes by the falciform ligament.
Right lobe is larger and from it arise:
Caudate lobe- bounded on the left by a groove for the ligamentum venosum and on the right by the IVC.
Quadrate lobe- bounded on the left by a groove for the ligamentum teres and on the right by the gallbladder.

7. Think about it as a letter H

8. Important Relations of the Liver
Anteriorly: diaphragm, costal margins, pleura, lower margins of both lungs, xiphoid process and anterior abdo wall.
Posteriorly: diaphragm, right kidney, hepatic flexure of the colon, duodenum, gallbladder, IVC and oesophagus and fundus of the stomach.

10. •The convex upper surface of the liver is moulded to the under surface of the domes of the diaphragm.
•The posteroinferior (visceral) surface is irregular in shape due lying in contact with; the abdominal part of the oesophagus, the stomach, duodenum, right colic flexure, right kidney and suprarenal gland, and the gallbladder. It is therefore very irregular in shape.

11. Porta Hepatis
Found on the posteroinferior surface, lies between the caudate and quadrate lobes.
Contains the portal triad:
Hepatic portal vein
Hepatic artery proper
Common hepatic duct
(Can remember this as VAD from posterior to anterior)
Also has sympathetic and parasympathetic nerve fibres. As well as a few hepatic lymph nodes which drain into the celiac lymph nodes.
•The hepatic portal vein and hepatic artery enter the liver at the porta hepatis whereas the common hepatic duct is leaves.
•The hepatic duct is most anterior and the hepatic portal vein is most posterior- the order can be remembered as VAD from posterior to anterior.

12. Calot’s Triangle
This is an anatomical space bounded by the common hepatic duct, the cystic duct and the inferior border of the liver.

13. Peritoneal Ligaments Falciform ligament
Coronary ligament- has upper and lower layers
Right triangular ligament
Left triangular ligament
Ligaments making up the lesser omentum:
Hepatogastric ligament
Hepatoduodenal ligament
•Falciform Ligament
Two layered fold of peritoneum, ascends from umbilicus to liver
Contains ligamentum teres in free margin
LT is the remains of the umbilical vein.
FL continues anteriorly, splits into R and L with the R side forming the upper layer of the coronary ligament and the L side forming the upper layer of the left triangular ligament.
The right extremity of the CL is known as the right triangular ligament.
In forming the CL, an area of the liver is left devoid of peritoneum; this is the bare area of the liver.
•Ligamentum Venosum
•Fibrous band that is the remains of the ductus venous.
•In the foetus, oxygenated blood is brought into the liver via the umbilical vein (LT). A greater proportion of blood bypasses the liver in the ductus venosus (LV) to join the IVC.
•At birth, the umbilical vein and DV close and become fibrous cords.
•Ligamentum Teres
•Passes into a fissure on the visceral surface of the liver, joins into the portal hepatis as the portal vein.

14. Blood Supply Afferent:
•25% from hepatic arteries- left and right hepatic arteries are from the hepatic artery proper, a branch of the common hepatic artery from the celiac trunk.
•75% from hepatic portal vein- supplies deoxygenated blood to the liver containing nutrients absorbed from the intestine.
Efferent:
•Hepatic veins which join the IVC

15. Portal System Deoxygenated blood, rich in absorbed nutrients
Hepatic Portal Vein
Splenic Vein
Inferior Mesenteric Vein
Superior Mesenteric Vein
From Small Intestine
From Large Intestine

16. Lymph
The liver produces up to ½ of the bodies lymph.
Efferent vessels pass through the porta hepatis and drain into the celiac nodes
A few vessels from the bare area pass through the diaphragm to the posterior mediastinal lymph nodes.

17. Innervation
Sympathetic and parasympathetic nerves from the celiac plexus.
Also the anterior vagal trunk gives rise to a large hepatic branch, which passes directly to the liver.

18. •Secreted by liver cells at a rate of 40 mL/hr
Bile Ducts
•Opens into the Ampulla of Vater
•Which opens in the duodenum via the major duodenal papilla
•Which is controlled by a small circular muscle known as the sphincter of Oddi
•Secreted by liver cells at a rate of 40 mL/hr