1. BY Prof. ANSARI Wednesday, April 26, 2017.
LIVER AND GALL BLADDER BY
Prof. ANSARI
Wednesday, April 26, 2017.

2. OBJECTIVES OF THE LECTURE
1.LOCATION OF LIVER, PLANES& 9 REGIONS OF ABDOMEN.
2.SURFACE ANATOMY OF ABDOMINAL WALL.
3.GROSS FEATURES OF LIVER, SURFACES, LOBES, LIGAMENTS & BLOOD SUPPLY.
4.DEVELOPMENT OF LIVER& GALL BLADDER.
5.EXTRAHEPATIC BILIARY APPARATUS, GALLBLADDER.
6.APPLIED ANATOMY OF LIVER AND GALL BLADDER.

3. LOCATION:- It is located in abdomen below the diaphragm

6. Liver is the largest gland of the body.
It normally weighs about 1.5 kg.
It is located under the right hypochondrium, epigastrium, & left hypochondrium.
It is both endocrine and exocrine gland.
It has got maximum regenerating power, if 2/3 of liver is resected out it will grow and retain its full size.

7. SURFACES OF LIVER Visceral surface has gall bladder and porta hepatis.
Diaphragmatic surface is related to right & left domes of diaphragm.
Visceral surface is related to various viscera, esophageal impression, gastric impression, renal impression and colic impression.

9. LOBES OF LIVER Right lobe Left lobe Quadrate lobe Caudate lobe
Riedel”s lobe

10. Riedel’s lobe is a normal anatomical variant.
It is a projection of the liver from the inferior surface of the right lobe.
The lobe may be quite large, some times extending in to the right iliac fossa, and so, mistaken for pathological enlargement of the liver.

11. LIGAMENTS OF LIVER Falciform ligament.
Round ligament/ligamentum teres.
Ligamentum venosum.
Gastro-hepatic ligament/lesser omentum.
Coronary ligament.
Right and left triangular ligaments.

13. LIGAMENTS OF LIVER
Falciform ligament is a sickle shaped ligament of peritoneal fold that binds the sternocostal surface of liver with the anterior abdominal wall.
Ligamentum teres is an obliterated left umbilical vein present in the free border of falciform ligament.
Ligamentum venosum is an obliterated ductus venosus that connects the umbilical vein directly with the inferior vena cava bypassing the liver circulation.
Gastrohepatic ligament is also a peritoneal fold that binds the liver with the stomach.

17. BLOOD SUPPLY OF LIVER
Hepatic artery brings the oxygenated blood to the liver which is 20 % of the blood supply. Hepatic artery is a branch from coeliac trunk.
Portal vein brings 80% of the blood to the liver, portal vein is formed by the union of superior mesentric vein and splenic vein.
Portal vein, hepatic artery and bile duct run in the free margin of lesser omentum and enter the liver through the porta hepatis, on the visceral surface.

19. Developmentally liver and gall bladder develops from
Endoderm &
Septum transversum
A hepatic diverticulum arises from the junction of foregut and midgut,
It grows in to septum transversum
The cystic diverticulum is a part of hepatic diverticulum which forms gall bladder.

21. Liver bud/septum transversum

22. EXTRAHEPATIC BILIARY APPARATUS
The biliary system is made up of the ducts arising in the liver, right hepatic duct arising from right lobe of liver.
The left hepatic duct arises from the left lobe of liver.
Both the hepatic ducts unites to form common hepatic duct.
The gall bladder duct is the cystic duct which joins the common hepatic duct to form common bile duct.
The common bile duct opens in the posterior wall of second part of duodenum along with the main pancreatic duct at major duodenal papilla.

24. THE GALL BLADDER It is a storage house of bile.
It has a fundus, body, neck and a cystic duct.
The gall bladder receives bile from the liver by way of the common hepatic duct into the cystic duct.
The gall bladder stores the bile and concentrates and excretes its bile back through the cystic duct to join the common hepatic duct.
Gall bladder is a common site for the formation of cholelithiasis/ formation of gall stones.

25. GALL STONES

26. CLINICAL CONSIDERATION
Cirrhosis of liver is the result of atrophy of the liver parenchyma and a hypertrophy of the connective tissue, this leads to jaundice and portal hypertension.
Jaundice is an accumulation of bile pigments in the blood stream. This is frequently a result of obstruction of the duct system.
Liver is a frequently a site of secondary metastasis of cancer from all most any part of body.

27. jaundice
Gall stones
Secondary liver

28. Wish you a healthy liver