BLOOD SUPPLY OF LIVER can be used to take lecture

presentation for blood supply of liver can be use to take lecture

1. SEGMENTATION & BLOOD SUPPLY OF LIVER Ranjeet Kumar 2013

2. HEPATIC SEGMENT OF LIVER On the basis of intrahepatic distribution of the hepatic artery and portal vein and biliary duct. The liver can be divide into right and left functional lobe. The physiological lobe are seperated by a plane passing on the anterio -superior surface along a line joining the cystic notch to the groove for the inferior vena cava. On the inferior surface the plane pass through the fossa for the gall bladder and on posterior surface it pass through the middle of the caudate lobe.

3. Part Division Segment Left Posterior part 1. Caudal lobe Left lateral division 2. Left Posterolateral lobe 3. Left anterolaterallobe Left medial 4. Left medial lobe Right Anterior part 5. Right anteromedial lobe 6. Right anterolateral lobe Posterior part 7. Right posterolaeral lobe 8. Right posteromedial lobe

4. BLOOD SUPPLY OF LIVER Liver receive 1200 to 1400ml of blood per minute, it is 25% of total cardiac output. 100gm of liver piece contain 25 to 30 ml of blood. It is 10-15% of total blood volume. In liver 20% blood flow in artery of liver. 10% flow in capillary of liver. 70% blood flow in vein of liver. So liver also function as blood reservior .

5. Liver receive blood by two source- Arterial source and venous source Arterial source by hepatic artery Hepatic are arise from coeliac artery in 85% cases. Hepatic artery also arise from aorta, superior mesenteric artery, left gastric artery and gastroduodinal artery. Hepatic artery provide 20% blood to liver. It is oxygenated. Before entering the liver hepatic artery divides in to left and right hepatic artery. With in liver they further divide to form segmental artery which further divide to form interlobular artery. Interlobular artery open in to hepatic sinusoid.

6. Hepatic artery Right lobular artery Segmental artery Inter lobular artery Left lobular artery Segmental artery Inter lobular artery Hepatic sinusoids

7. Venous source Portal vein It is form by superior mesenteric vein and splenic vein. It supplies 80% blood to the liver. This blood is deoxygenated. Portal blood are rich in nutrients and GIT hormone. It receive blood from stomach, intestine, pancreas and spleen.

8. Before entering, portal vein divided in to left and right portal vein. After entering in liver, portal vein divide in to segmental branch. Then further divide to form inter lobular branch. And finally open in to hepatic sinusoids.

9. Portal vein Right branch Segmental branch Inter lobular branch Left branch Segmental branch Inter lobular branch Hepatic sinusoids Mixing of arterial & venous blood Hepatic sinusoids are formed by simple squamous epithelium. It is fenistrated .

10. VENOUS DRAINAGE Hepatic vein of liver arrange in two group:- upper and lower Upper group of hepatic vein consist of three large vein. Right hepatic vein Left hepatic vein hepatic vein Middle hepatic vein lower group of hepatic vein consist of variable no. of small vein from the right lobe and caudate lobe

11. Mixed blood from hepatic sinusoid Central vein Inter lobular vein Sublobular vein Right, left, middle hepatic vein Hepatic vein Inferior vena cava

12. LYMPHATIC DRAINAGE The liver produce large amount of lymph about 1/3 rd to 1/2 nd all body lymph. Lymphatics are divide in to two: Superficial Deep The superficial lymphatics of the liver run on the surface of the organ beneath the peritoneum ant terminate in- a.Caval b.Hepatic c.Paracardial and d.Coeliac lymph nodes Deep lymphatic end partially in the node around, the end of the inferior vana cava and partially in the hepatic node.

13. NERVE SUPPLY Para sympathetic from vagus promotes secretion of bile juice. Sympathetic from coeliac plexus, inhibit secretion of bile juice

14. CLINICAL ASPECT LIVER CIRRHOSIS Shrinking of liver tissue, degeneration of hepatic cell, Dysfunction of liver Cause Malnutrition Alcohol abuse

15. LIVER ABSCESS Localise collection of pus in liver parenchyma Cause by streptococcus, streptophilous bacteria, entamoeba histolytica

16. LIVER BIOPSY In liver biopsy, needle to be done in certain clinical condition. Liver biopsy needle is passed through 9 th intercostal space.

17. Liver resection surgical removal of tumor of liver. 80% liver mass can be remove safely. Liver can regrow to its original size with in 6 to 12 month after resection. Liver transplantation It can be done in patient with end stage of liver disease. some time a right hemiliver comprising segment 5 to 8 can be remove from a healthy donar and transplanted in to the needy patient.

18. Portal hypertension;;; b.p . increase in portal vein Cause : cirrhosis of liver thrombosis of portal vein Riedel’s lobe It is toungue like projection of the right hepatic lobe.

19. Bud cherry syndrome Cause ;. semi solid coagulation of blood in hepatic vein. secondary cancer and metastasis in liver. Symptom: upper abdominal pain, hepatomegally , cirrohsis .