By Sunita Gattu

Department of Anatomy
 Introduction
 (Greek hepar : liver)
 It 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.
 Main functions are
 It secretes bile and stores glycogen.
 It synthesizes the serum proteins and lipids.
 It detoxifies blood from endogenous and exogenous substances (e.g.,
toxins, drugs, alcohol, etc.) that enter the circulation.
 It produces hemopoietic cells of all types during fetal life.
 LOCATION
 The liver almost fully occupies:
 The right hypochondrium.
 Upper part of the epigastrium.
 And part of the left hypochondrium up to the
left lateral (midclavicular) line.
 It extends upward under the rib cage as far as
the 5th rib anteriorly on the right side (below
the right nipple) and left 5th intercostal space
 The sharp inferior border crosses the midline
at the level of trans pyloric plane (at the level
of L1 vertebra.
 SHAPE, SIZE, AND COLOUR
 Shape  Weight
 In males: 1.4 to 1.8kg.
 The liver is wedge shaped and
 In females: 1.2 to 1.4kg.
resembles a four-sided pyramid
 In newborn: 1/18th of the body
laid on one side with its base
weight.
directed towards the right and
 At birth: 150 g.
apex directed towards the left.  Proportional weight: In adult
1/40th of the body weight.
 Colour
 It is red-brown in colour.
 EXTERNAL FEATURES
 The wedge-shaped liver
presents:
 Two well-defined
surfaces: diaphragmatic
and visceral.
 One well-defined border:
inferior border.
 Diaphragmatic Surface
 The dome-shaped diaphragmatic surface includes
smooth peritoneal areas which face superiorly,
anteriorly and to the right.
 And a rough bare area (devoid of the peritoneum)
which faces posteriorly.
 The inferior vena cava (IVC) is embedded in the
deep sulcus in the left part of the bare area.
 In most cases, this sulcus is roofed by the fibrous
tissue termed ligament of IVC which may contain
hepatic tissue converting the sulcus into the
tunnel.
 The peritoneal ligaments are coronary, left and
right triangular and falciform ligaments.
 Visceral Surface (Inferior Surface):
 Relatively flat or concave.
 It is directed downward, backward, and to the
left.
 It is separated in front from the diaphragmatic
surface by the sharp inferior border and behind
from the diaphragm by the posterior layer of
coronary ligament.
 The notable features on the visceral surface are:
1. Fossa for the gallbladder.
2. Fissure for the ligamentum teres hepatis.
3. Porta hepatis.
 The visceral surface is covered by the peritoneum
except at the fossa for gallbladder and the porta
hepatis.
 Inferior Border
 The features of the inferior border are as follows:
 It separates the diaphragmatic surface from the visceral surface.
 It is rounded laterally where it separates the right lateral surface
from the inferior surface.
 It is thin and sharp medially where it separates the anterior surface
from the inferior surface.
 It presents two notches:
 (a) Notch for ligamentum teres or interlobar notch: It is located just
to the right of the median plane.
 (b) Cystic notch: It is located about 5 cm to the right of the median
plane and often corresponds to the fundus of the gallbladder.
 LOBES OF THE LIVER
 Anatomical Lobes:
 On the diaphragmatic surface: the
liver is divided into two lobes, right
and left, by the attachment of the
falciform ligament.
 The right lobe which forms the base of
the wedge-shaped liver is
approximately six times larger than
the left lobe.
 On the visceral surface: the liver is
divided into four lobes:
1. Right lobe: to right of the fossa for
gallbladder.
2. Left lobe: to the left of the fissures for
ligamentum teres and ligamentum
venosum.
3. Quadrate lobe: between the fossa for
gallbladder and the fissure for
ligamentum teres below the porta
hepatis.
4. Caudate lobe: between the groove for IVC
and the fissure for ligamentum venosum.
 Physiological Lobes/Functional Lobes/True
Lobes
 The division of the liver into lobes is based on the intrahepatic
distribution of branches of the bile ducts, hepatic artery, and portal vein.
 The liver is divided into right and left physiological lobes by an imaginary
sagittal plane/line (Cantlie’s plane/line).
 On the posteroinferior surface: this plane passes through the fossa for
gallbladder, to the groove for IVC.
 (Note: Caudate lobe is equally shared between the right and left lobes.)
 The anterosuperior surface: this plane passes from the IVC to the cystic
notch present a little to the right of the falciform ligament.
 The physiological right and left lobes are approximately equal in size.
 HEPATIC SEGMENTS (SEGMENTS OF THE
LIVER)
 There are eight hepatic segments. They
are deduced as follows
 The right physiological lobe is divided
into anterior and
 posterior parts, and the left physiological
lobe into medial and lateral parts.
 Each of these parts is further divided into
upper and lower parts and form eight
surgically resectable hepatic segments.
 The veins draining the hepatic segments
are intersegmental, i.e., they drain more
than one segments.
 Couinaud’s segments: According to
nomenclature of Couinaud, the hepatic segments
are numbered I to VIII.
 I to IV in the left hemi liver and V to VIII in the
right hemi liver.
 According to this nomenclature, the segment I
corresponds to the caudate lobe and segment IV
corresponds to the quadrate lobe.
 Segment I to IV of the left lobe are supplied by
the left branch of hepatic artery, left branch of
portal vein and drained by left hepatic duct.
 The segments V to VIII of right lobe are supplied
by right hepatic artery, right branch of portal
vein and drained by right hepatic duct.
 PERITONEAL RELATIONS
 Most of the liver is covered by the peritoneum.
 The areas which are not covered by the peritoneum are:
 Bare area of the liver: It is a triangular area on the posterior aspect of
the right lobe.
 Fossa for gallbladder, on the inferior surface of the liver between
right and quadrate lobes.
 Groove for IVC, on the posterior surface of the right lobe of the liver.
 Groove for ligamentum venosum.
 Porta hepatis.
 LIGAMENTS
 False Ligaments: are actually peritoneal
folds and include:
1. Falciform ligament.
2. Coronary ligament.
3. Right triangular ligament.
4. Left triangular ligament.
5. Lesser omentum.
 True Ligaments: are actually the
remnants of fetal structures and include:
1. Ligamentum teres hepatis.
2. Ligamentum venosum.
 RELATIONS
 Diaphragmatic Surface:
 Superior Surface:-
 The convex right and left parts of this surface fit into the corresponding domes of
the diaphragm, which separate them from the corresponding lung and pleura.
 The central depressed area of this surface is related to the central tendon of the
diaphragm, which separates it from the pericardium of the heart. Hence, this area is
often termed cardiac impression.
 Anterior Surface:-
 Xiphoid process and anterior abdominal wall in the median plane and diaphragm
on each side. The falciform ligament is attached to this surface a little to the right of
the median plane.
 Right Lateral Surface:-
 Diaphragm opposite 7th to 11th ribs in the midaxillary line.
 Posterior Surface:-
 This surface presents: bare area of the liver, groove for IVC, caudate lobe,
fissure for ligamentum venosum, and posterior surface of the left lobe.
 The bare area of the liver is a triangular area to the right of groove for the IVC
between the two layers of coronary and right triangular ligaments.
 It is in direct contact with the diaphragm.
 The right suprarenal gland is related to the inferomedial part of this area, i.e.,
near the groove for IVC.
 The groove for IVC as the name indicates lodges the IVC.
 The caudate lobe is related to the superior recess of the lesser sac.
 Esophagus, just to the left of the upper part of fissure for ligamentum venosum
and causes esophageal impression.
 The fundus of the stomach is related just to the left of the esophageal
impression.
 Visceral Surface (Inferior Surface):-
 The inferior surface of the left lobe is related to the stomach, which produces a
gastric impression.
 Near the left side of the fissure for ligamentum venosum, this surface presents a
slight elevation that comes in contact with the lesser omentum. Hence, it is called
tuber omentale/ omental tuberosity.
 The quadrate lobe is related to the pyloric end of the stomach and the first part of
the duodenum.
 The fossa for gallbladder, occupied by the gallbladder with its cystic duct.
 The right colic flexure is related to the inferior surface to the right of the
gallbladder colic impression.
 The junction of first and second parts of the duodenum is related to the right upper
part of the fossa for gallbladder produces the duodenal impression.
 The right kidney is related to the inferior surface posterior to the colic impression
and to the right of the duodenal impression and causes renal impression.
Relations of diaphragmatic and visceral surfaces of the liver.
 BLOOD SUPPLY
 The liver is a highly vascular organ.
 It receives blood from two sources. The arterial blood
(oxygenated) is supplied by the hepatic artery and venous
blood (rich in nutrients) is supplied by the portal vein.
 Through the liver. About 80% of this is delivered through
the portal vein and 20% is delivered through the hepatic
artery.
 VENOUS DRAINAGE
 Most of the venous blood from liver is drained by three large hepatic
veins:
(a) left hepatic vein between medial and lateral segments of the left
true lobe,
(b) middle hepatic vein between true right and left true lobes,
(c) right hepatic vein between anterior and posterior segments of the
right true lobe.
 NERVE SUPPLY
 The liver is supplied by both sympathetic and parasympathetic
fibres.
 The sympathetic fibres are derived from the coeliac plexus.
 The parasympathetic fibres are derived from the hepatic branch of
the anterior vagal trunk.
 FACTORS KEEPING THE LIVER IN
POSITION
 Hepatic veins connecting the liver to the IVC.
 Intra-abdominal pressure maintained by the tone of abdominal
muscles.
 Peritoneal ligaments connecting the liver to the abdominal walls.
 Clinical correlation
 Cirrhosis of the liver: The hepatocytes sometimes may undergo necross
following their injury and death caused by infection, toxins, alcohol, and
poisons.
 The dead hepatocytes are replaced by fibrous tissue by the proliferation of
the perilobular connective tissue.
 The resultant hepatic fibrosis is clinically termed cirrhosis of the liver.
 The patient develops jaundice due to obstruction of bile flow.
 Needle biopsy of the liver:
 In needle biopsy of the liver, the needle is
inserted in the midaxillary line through
9th or 10th intercostal space.
 The needle passes through the chest
wall,costodiaphragmatic recess of the
pleura, diaphragm, and right anterior
intraperitoneal space to enter the liver.
 Needle inserted above the 8th intercostal
space will injure the lung.