Anatomy of liver

Liver is the largest internal organ of the body weighing about 1500g in adults. It occupies the right hypochondrium and extends into the epigastrium and left hypochondrium .

1. ANATOMY OF LIVER Presented by Saranya chandran 4 th year Bsc Nursing Nehru College of Nursing

2. INTRODUCTION The liver is the largest gland of the body , occupying much of the right upper part of the abdominal cavity. It consists of both exocrine and endocrine parts. The liver performs a wide range of metabolic activities necessary for homeostasis, nutrition and immune response.

3. THE LIVER The liver is the largest internal organ of the body weighing about 1500g ( 1.5kg) in adults. It occupies the right hypochondrium and extends into the epigastrium and left hypochondrium.

4. LOCATION : It fully occupies the right hypochondrium , upper part of the epigastrium, and part of left hypochondrium upto left lateral line. SHAPE : Wedge shaped organ COLOUR : Reddish brown in colour.

5. External features The liver presents 2 well defined surfaces and one border. SURFACES : * Diaphragmatic surface * Visceral surface BORDER : * Inferior border

6. * Diaphragmatic surface It is a dome shaped surface, includes smooth peritoneal areas which face superiorly, anteriorly and to the right and a rough bare area which faces posteriorly.

7. It is further subdivided into : - superior surfaces - Anterior surfaces - Right lateral surfaces - Posterior surfaces FEATURES : - Bare area of liver - Groove for IVC - Fissure for ligamentum venosum - Attachment of ligaments.

8. * VISERAL SURFACE It is flat or concave. It is separated in front from the diaphragmatic surface by sharp inferior border and behind from the diaphragm by posterior layer of coronary ligament. FEATURES : - fossa for gall bladder - fissure for ligamentum teres hepatis - Porta hepatis

9. * Inferior border It separates the diaphragmatic surface from visceral surface. It is thin and sharp. It presents 2 notches : - Notch for ligamentum teres or interlobar notch - cystic notch

10. Lobes of liver ANATOMICAl LOBES PHYSIOLOGICAL LOBES

11. 1.ANATOMICAL LOBES On diaphragmatic surface, the liver is divided into two lobes : Right lobe Left lobe They are separated from each other by a ligament called falciform ligament On the visceral surface, the liver is divided into 4 lobes : - Right lobe : to right of fossa of gall bladder - left lobe : left of fissure for ligamentum teres and ligamentum venosum - Quadrate lobe : seen on inferior surface of right lobe Caudate lobe : situated on posterior surface of right lobe.

12. 2.Physiological lobes The liver is divided into Right and Left physiological lobes by an imaginary sagittal plane. On postero-superior surface, this plane passes through fossa of gall bladder, to the groove of IVC On Antero-superior surface, this plane passes from IVC to cystic notch present a little to right of falciform ligament.

13. Ligaments of liver Two types : 1. False ligaments 2. True ligaments 1.FALSE LIGAMENTS : Includes, a. Falciform ligament : It is a sickle shaped fold of peritoneum connecting the liver to the undersurface of the diaphragm and anterior abdominal wall

14. b. Coronary ligament : A triangular fold of peritoneum connecting the bare area of liver to the diaphragm. Right triangular ligament : A small triangular fold of peritoneum which connects the right lateral surface of liver to the diaphragm. Left triangular ligament : A very small triangular fold of peritoneum which connects the upper surface of left lobe to the diaphragm. Lesser omentum : double fold of peritoneum connects lesser curvature of stomach to the liver.

15. 2. TRUE LIGAMENTS Remnants of fetal structures, includes : a. Ligamentum teres hepatis : remnant of obliterated left umbilical vein and extends from the umbilicus to the left branch of portal vein. b. Ligamentum venosum : Remnant of obliterated ductus venosus which in fetal life connects the left branch of the portal vein with the Inferior Vena cava.

16. Diaphragmatic surface Superior surface : Related to the diaphragm Anterior surface : Related to the xiphoid process and anterior abdominal wall in the median plane and diaphragm on each side. Right lateral surface : Related to the diaphragm Relations

17. 4 . Posterior surface : This surface presents, a. Bare area of liver : Related to the diaphragm and upper pole of right kidney . b. Caudate lobe : Related to superior recess of lesser Sac c. Fissure for ligamentum venosum : deep cleft to the left of Caudate lobe. Lodges the obliterated ductus venosus. d. Posterior surface of left lobe : related to abdominal part of the esophagus.

18. VISCERAL SURFACE This oval surface is divided into right and left lobes by the fissure for ligamentum venosum and the fissure for ligamentum teres. * left lobe is related to stomach. * Right lobe presents 3 features : - Quadrate lobe : Related to pyloric end of stomach and first part of duodenum. -

19. - fossa for gall bladder : lies to the right of Quadrate lobe, occupied by gall bladder with its cystic duct close to the right end of Porta hepatis. - Porta hepatis : It is a transverse fissure, separates the Quadrate lobe from Caudate lobe.

20. FUNCTIONS Secretion of bile Storage of glycogen Synthesizes serum proteins and lipids Metabolism of fat Storage of iron in the form of ferritin

21. Carbohydrate metabolism Deamination of amino acids and production of ammonia Storage of vitamins Production of plasma proteins . Clotting factor production.

22. Blood supply Liver receives blood from 2 sources : * The arterial blood is supplied by the hepatic artery * The venous blood is supplied by portal vein.

23. Venous drainage Most of the venous blood from liver is drained by three large hepatic veins :- - Left hepatic vein - Middle hepatic vein - Right hepatic vein

24. Nerve supply The liver is supplied by both sympathetic and para sympathetic fibers. The sympathetic fibres are derived from the coeliac plexus. The para sympathetic fibres are derived from hepatic branch of anterior vagal trunk

25. Histology The liver is covered by a connective tissue capsule called Glisson’s capsule. The liver cells are arranged in plates or cords, radiating from the central vein. Between the plates of cells are blood-filled spaces called sinusoids. Arranged around the periphery of each lobule are branches of : hepatic artery, portal vein, bile duct.

26. The oxygenated blood from hepatic artery, products of digestion and destruction of RBCs from portal vein sinusoids Central vein joins to form hepatic veins Inferior Vena cava. Bile is secreted by the hepatocytes , into a minute channel adjacent to these cells are called biliary canaliculi. These canaliculi joins to form larger ducts, finally emerge as Right and left hepatic ducts.

27. Applied anatomy Inflammation of liver – Hepatitis. Fracture of lower ribs or penetrating injury of upper part of abdomen can injure the liver. Hematogenous spread of cancer from other parts of the body Is very common . Enlargement of liver - Hepatomegaly. Cirrhosis of liver.

28. Conclusion The liver is the largest organ of the abdominal viscera, occupying a substantial portion of the upper abdominal cavity. It performs a wide range of metabolic activities necessary for homeostasis, nutrition and immune defense.

29. Assignment Draw the structure of a liver. Label it’s parts and list out the segments.

30. REFERENCES PR Ashalatha, Textbook of Anatomy, 2 nd edition, jaypee brothers medical publishers. Vishram Singh, Textbook of Anatomy abdomen and lower limb, 2 nd edition, Elsevier publications. Ross and Wilson, Anatomy and Physiology in health and illness, 11 th edition, Elsevier publications Dr. AK Jain, textbook of physiology, avichal publishing company .