anatomy of Liver and biliary system

anatomy of liver and biliary system

1. Liver and biliary system
Dr. Mohamed Elfiky
Professor of anatomy and embryology

2. The Liver
Sit: The liver is the largest
visceral organ in the body and is
primarily in the right
hypochondrium and epigastric
region, extending into the left
hypochondrium (or in the right
upper quadrant, extending into
the left upper quadrant)
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3. Surface anatomy of the liver
abcd
BC
D
E
Upper border of the liver :
a: Apex of the heart .
b: Xiphisternaljunction.
c: Right 5th rib at mid-clavicular line .
d: Right 8th rib at mid-axillary line.
Lower border of the liver :
a: Apex of the heart
B: Tip of 8thLt. costal cartilage
C: transpyloric plane and the midline
D: Tip of the 9thRt. costal cartilage.
E: half an inch below the costal cartilage in the mid-
axillary line.
Right margin :
right 8th rib at mid-axillary line downwards till a point half
an inch below the right costal margin in the midaxillary
line .
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4. A-Anatomical:
-Left lobe.
-Right lobe.
-Caudate lobe.
-Quadrate lobe.
Lobes of the liver
Left lobe
Right lobe
Falciform
ligament
Left lobe
Right lobe
Quadrate lobe
Qudatelobe
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5. Lateral segment
Medial segment
Anterior segmentPosterior segment
Left hepatic vein
Meddle hepatic vein
Right hepatic vein
Left fissure
Median fissure
Right fissure
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Surgical lobes of the liver

6. Left fissureMedian fissureRight fissure
Lat. superior seg.
Lat. inferior seg.
Med. Superior
seg.
Med.
Inferior
seg.
Ant. Superior
seg.
Ant. Inferior
seg.
Post. Superior
seg.
Post. Inferior seg. Mohamed el fiky
Surgical lobes

7. Mohamed el fiky
Surgical lobes

8. It has 5 surfaces :
§Right lateral (base).
§Anterior surface.
§Superior surface.
§Posterior surface.
§Inferior surface.
-Its borders are ill-defined except the inferior border (which separates the anterior
surface and base from the visceral surface ), which is sharp and well defined .
Surfaces and Borders of the liver
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9. Ligaments of the liver
Peritoneal folds related to liver:
1-Falciformligament.
2-Coronary ligament (Rt. And Lt. surround bare area ).
3-Triangular ligaments.
4-Lesser omentum
Non Peritoneal folds related to liver:
1-Ligamentum teres: It is the obliterated left umblicalvein .
2-Ligamentum venosum: It is the obliterated ductus venosus
1-Porta hepatis.
2-Fissure of ligamentum venosum.
3-Fissure of ligamentum teres.
Fissures of the Liver
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10. Upper Layer Coronary Ligament
Lower Layer Coronary Ligament
Rt. Triangular
Ligament
Lt. Triangular
Ligament
Ligamentum Teres
Ligamentum Venosum
Faciform Ligament
Peritoneal Folds and Ligaments of the Liver
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11. Mohamed el fiky
Peritoneal Folds and Ligaments of the Liver

12. Ligamentum Teres
Ligamentum Venosum
Non-Peritoneal Ligaments of the Liver
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13. 1
2
3
4
5
Bare Areas of the Liver
Areas not covered with
peritoneum:
1-Bare area of the liver.
2-Fossa for gall bladder
3-Groove for IVC.
4-Porta hepatis.
5-fissure for ligamentum venosumMohamed el fiky

14. Liver
Rt. LungLt. Lung
Right Lung and Pleura
Costodiaphragmatic Recess
Heart
Xiphoid
Process
Relations of the Anterior, Superior and Right Surfaces of The Liver
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15. Stomach
1stPart of
Duodenum
Transverse Colon
Lt. Colic Flexure
Rt. Colic Flexure
2ndPart of Duodenum
Right Kidney
Omental
Tuberosity
Right SuprarenalBare Area
of the Liver
Groove
for Inferior Vena Cava
Caudate Lobe
Oesophagus
Relations of the Inferior and Posterior Surfaces
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16. Relations of the posterior and inferior surfaces
Gastric area
Esophageal
area
Renal area
Suprarenal area
Duodenal
area
Colic area
Bare area
Caudate lobe
Quadrate lobe lobe Mohamed el fiky

17. Porta Hepatis
It is the hilum of the liver .
Site : It is a transverse slit on the posterior part of inferior surface . It is
about 2 inches long .
Boundaries :
Anteriorly : Quadrate lobe.
Posteriorly : Caudate lobe and caudate process.
Structures passing through it :
a-major structures :
1-Portal vein and its two terminal branches right and left (posterior).
2-Hepatic artery and its two terminal branches right and left ( in the
middle).
3-2 Hepatic ducts and common hepatic duct (anterior).
b. Minor structures :
1-Hepatic plexus of autonomic nerve fibresaround hepatic artery.
2-Lymphatic vessels. 3-A bad of fat.
* Its margins : give attachment to lesser omentum.
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18. 1-Hepatic veins
2-Inferior vena cava
3-The left triangular ligament and the ligamentum teres
4-The falciformligament
5-The underlying viscera
6-The intra-abdominal pressure
7-The tone of the anterior abdominal wall
Stability of the Liver
Lymphatic Drainage
A-Lymph vessels:Superficial & Deep.
B-Lymph nodes:
1-Lateral diaphragmatic nodes.
2-Paracardialnodes.
3-Hepatic nodes.
4-Coeliac nodes.
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19. Blood Supply of the Liver
1-Portal vein (75%) : the
main blood supply of
liver from portal vein
2-Hepatic artery (25 %)
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20. Extra-hepatic Biliary System

21. Left Hepatic DuctRight Hepatic Duct
Common Hepatic Duct
Gall Bladder
Cystic Duct
Common Bile Duct
Main Pancreatic Duct
Ampulla of Vater
Major Duodenal Papilla
BILIARY SYSTEM
Consists of :
1-Gall bladder and cystic duct.
2-Right and left hepatic ducts, common hepatic
duct and common bile duct .
The Gall Bladder
Site : Gall bladder fossa on the inf. surface
of the liver , attached to it by loose areolar
C.T. and small veins (passing from the gall
bladder to liver ) .
Size : 3-4 inches long , 1 1/2 inches wide
(at its broadest part).
Shape : Pear-shaped.
Capacity : 30-40 c.c.Mohamed el fiky

22. Parts and Relations ;
1-Fundus : Projects beyond the inferior border of liver and
is completely covered with peritoneum.
Anterior relations : Anterior abdominal wall .
Posterior relations : Transverse colon .
-Surface Anatomy : The angle between the right costal margin
and right lineasemilunaris.
2-Body : Covered by peritoneum inferiorly and on the sides
.
-Superiorly : it is adherent to the gall bladder fossa of right
lobe of the liver .
-Inferiorly : it is related to 2nd part of duodenum above and
the beginingof transverse colon below .
The Gall Bladder
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23. 3-Neck :
-Lies close to the porta hepatisand is continuous with the cystic duct.
-May present a dilatation (Hartmann's pouch) on its side.
-Related below to the end of the 1st part of duodenum.
Cystic duct : (1 1/2 inches long , S-shaped) .
-It enters the lesser omentum, where it joins the common hepatic duct at an acute angle to
form the common bile duct .
Blood Supply of Gall Bladder :
1-Cystic artery : from right branch of hepatic artery .
2-Cystic vein : drains into right branch of portal vein.
Nerve Supply :
1-Sympathetic and parasymatheticfibres(from coeliac ganglion and anterior gastric nerve ).
2-Sensory fibresfrom the right phrenic nerve . Mohamed el fiky

24. I-Hepatic ducts :
-A right and a left hepatic ducts emerge from the right and left lobes of the liver
-They lie infrontof the branches of the hepatic artery and portal vein .
-The 2 ducts unite in the right part of the porta hepatisto form the common hepatic duct .
II-Common hepatic duct :
-A short duct one inch formed by the union of the right and left hepatic ducts. -It descends infrontof portal
vein and on the right side of the hepatic artery .
-It ends by joining the cystic duct at acute angle to form the common bile duct.
III-Common bile duct :
Begining: It is formed lust below the porta hepatisby the union of the common hepatic duct and cystic duct .
Length : 3 inches.
Parts : of common bile duct :
1-supraduodenalpart
2-Retro-duodenal part.
3-Infra-duodenal part.
The Duct System
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25. Course and Relations :
1-Supra-duodenal part ;
Descends in the free border of the lesser omentuminfrontof
the portal vein and on the right side of the hepatic artery .
2-Retro-duodenal part :
Descends behind the 2nd inch of the 1st part of duodenum
infrontof the portal vein and on the right side of gastro-
duodenal artery .
3-Infra-duodenal (Retro-pancreatic) part :
Passes in a groove on the posterior surface of head of pancreas
( or it may be completely embedded ) lying infrontof inferior
vena cava and on the left side of the superior pancreatico-
duodenal artery .
Termination :
-Ends in the wall of the 2nd part of duodenum by uniting with
the main pancreatic duct to form the hepato-pancreatic
ampulla (ampulla of Vater) which is surrounded by the
sphincter of Oddi.
-Ampulla of Vateropens on the summit of the major duodenal
papilla in the postero-medial wall of the 2nd part of the
duodenum just bellow its middle .
Common bile duct
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Sphincter of
hepatopancreati
c ampulla

26. Left Hepatic DuctRight Hepatic Duct
Common Hepatic Duct
Gall Bladder
Cystic Duct
Common Bile Duct
Main Pancreatic Duct
Ampulla of Vater
Major Duodenal PapillaMohamed el fiky
Common bile duct
Hartman’s Pouch
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