Liver and Biliary System

By
Dr. Rania Elsyade
lecturer of Anatomy and Embryology
Helwan Faculty of Medicine
 Objectives
• Mention the anatomy of the liver (def, site,
lobes, surfaces, porta hepatis and blood
supply).
• Enumerate hepatic ligaments ( falciform,
triangular, coronary, hepatogastric and
hepatoduodenal) and mention their
attachment and contents.
• Subphrenic spaces.
• Mention the anatomy of the gallbladder (def,
site, parts, blood supply).
 Liver (Def and Site)
Def :
The liver is the largest visceral organ in
the body and weighs about 1.5 kg in
the adult.
Site:
✓in the right
hypochondrium and
epigastric region, extending
into the left hypochondrium.

✓or in the right upper

quadrant, extending into the
left upper quadrant)
 Surfaces
1- Diaphragmatic Surface
• a diaphragmatic surface includes:
the anterior surface superior surface right surface

• It is smooth and domed

• lies against the inferior surface of the diaphragm
 Surfaces
2- Visceral Surface
• It is in the
inferior
direction

• It is covered
with visceral
peritoneum
except
✓ in the fossa for
the gallbladder.
✓ at the porta
hepatis
✓ the bare area
 2- Visceral Surface
structures related
✓ Abdominal
esophagus
✓ right anterior part
of the stomach
✓ superior part of the
duodenum
✓ lesser omentum
✓ gallbladder
✓ right colic flexure
✓ right transverse
colon
✓ right kidney
✓ right suprarenal
gland.
 Liver (Lobes)

➢ The liver is divided into right and left lobes by the falciform ligament anterosuperiorly.
➢ The right lobe of the liver is the largest lobe, whereas the left lobe of the liver is
smaller.
 Liver (Lobes)

• The liver is divided into right and left lobes by the fissure for the ligamentum venosum and
ligamentum teres on the visceral surface.
• The quadrate and caudate lobes are described as arising from the right lobe of liver, but
functionally are distinct.
 Notes
➢The ligamentum venosum is a remnant of the
ductus venosus which, in the fetus, connects
the umbilical vein and inferior vena cava and
allows blood to bypass the liver.

➢The ligamentum teres is the obliterated left

umbilical vein.
 The quadrate lobe

✓The quadrate lobe is visible on the anterior part of the visceral surface of the
liver.
✓ It is bounded on the left by the fissure for ligamentum teres and on the right by
the fossa for the gallbladder.
✓Functionally it is related to the left lobe of the liver.
 The caudate lobe

✓The caudate lobe is visible on the posterior part of the visceral surface of
the liver.
✓It is bounded on the left by the fissure for the ligamentum venosum and on
the right by the groove for the inferior vena cava.
✓Functionally, it is separate from the right and the left lobes of the liver.
 The porta hepatis

➢ It serves as the point of entry into the liver for the hepatic
arteries and the portal vein, the exit point for the hepatic
ducts and lymph vessels.

➢ It separates the caudate and quadrate lobes.

 The bare area
• The liver is almost
completely
surrounded by
visceral peritoneum
except for a small
area of the liver
against the
diaphragm (the bare
area).

• The anterior
boundary of the
bare area is
indicated by a
reflection of
• the posterior boundary of the bare area is
peritoneum-the
indicated by a reflection of peritoneum-
anterior coronary
the posterior coronary ligament
ligament.
 Associated peritoneal ligaments
The right and left
triangular ligaments
and anterior and
posterior coronary
ligaments:
connect the liver to
the diaphragm.
where the coronary
ligaments come
together laterally,
they form the right
and left triangular
ligaments.
 Associated peritoneal ligaments
• The falciform ligament:
✓ connects the liver to the
anterior abdominal wall.
✓ Contains in its free
margin the ligamentum
teres which is the
obliterated left umbilical
vein.

• The hepatogastric
ligament: connects the
liver to the stomach.

• The hepatoduodenal
ligament: connects the
liver to the duodenum.
 The subphrenic and hepatorenal recesses
• the subphrenic recess
✓ separates the diaphragmatic
surface of the liver from the
diaphragm.
✓ is divided into right and left areas
by the falciform ligament.

• the hepatorenal recess

✓ is a part of the peritoneal cavity on
the right side between the liver and
the right kidney and right
suprarenal gland.

• The subphrenic and hepatorenal

recesses are continuous
anteriorly.
 Surface anatomy of liver
Upper border:
Concave upwards extending from the left 5th
intercostal space at midclavicular plane
(apex of the heart) to right 5th rib in
midclavicular plane through xiphisternal
joint. Then curves downward to reach the
right 7th rib at midaxillary line.

Right border:
Line with slight convexity to the right
extending from the right 7th rib to a point
0.5 inch below the right 10th rib in
midaxillary line.

Inferior border:
Passes to the left from the last point close to
costal margin till tip of the right 9th costal
cartilage. Then, crosses median plane to the
left cutting transpyloric plane to the tip of
the left 8th costal cartilage.
Segmental (surgical) anatomy of the liver
 Blood supply to the liver
1- The hepatic artery.
2- The portal vein.
3- The hepatic veins end in the inferior vena
cava.
 The arterial supply to the liver

The right and left hepatic artery from the hepatic

artery proper (a branch of the common hepatic artery)
from the celiac trunk).
 All venous drainage from the gastrointestinal
system passes through the liver
✓ Venous blood from the digestive tract,
pancreas, gallbladder, and spleen enters
the inferior surface of the liver through
the large hepatic portal vein.
✓ This vein then ramifies like an artery to
distribute blood to small endothelial-
lined hepatic sinusoids, which form the
vascular exchange network of the liver.
✓ After passing through the sinusoids, the
blood collects in a number of short
hepatic veins, which drain into the
inferior vena cava just before the inferior
vena cava penetrates the diaphragm and
enters the right atrium of the heart.
✓ Normally, vascular beds drained by the
hepatic portal system interconnect,
through small veins, with beds drained
by systemic vessels, which ultimately
connect directly with either the superior
or inferior vena cava.
 Portacaval anastomoses
• Around the inferior end of the esophagus.
• Around the inferior part of the rectum
• Para-umbilical regions of the abdominal wall, the
round ligament of the liver connects the umbilicus of
the anterior abdominal wall with the left branch of the
portal vein as it enters the liver.
• Others
✓ where the liver is in direct contact with the diaphragm
(the bare area of the liver)
✓ where the wall of the gastrointestinal tract is in direct
contact with the posterior abdominal wall
(retroperitoneal areas of the large and small intestine)
✓ the posterior surface of the pancreas (much of the
pancreas is secondarily retroperitoneal).
 Blockage of the hepatic portal vein or of
vascular channels in the liver
✓ Affect the pattern of venous return from abdominal
parts of the gastrointestinal system.
✓ Vessels that interconnect the portal and caval systems
can become greatly enlarged and tortuous, allowing
blood in tributaries of the portal system to bypass the
liver, enter the caval system, and thereby return to the
heart.
✓ Portal hypertension can result in esophageal and rectal
varices and in caput medusae in which systemic vessels
that radiate from para-umbilical veins enlarge and
become visible on the abdominal wall
 Gallbladder
•The gallbladder is a
pear-shaped sac lying on
the visceral surface of
the right lobe of the liver
in a fossa between the
right and quadrate lobes.

•The gallbladder receives,

concentrates, and stores
bile from the liver.

•Biliary ducts …………….

 Gallbladder
• It has:
1- fundus of gallbladder:
✓ a rounded end.
✓ may project from the inferior border of
the liver.

2- body of gallbladder
✓ a major part in the fossa.
✓ may be against the transverse colon and
the superior part of the duodenum.

3- neck of gallbladder
✓ a narrow part.
✓ with mucosal folds forming the spiral
fold.
 The arterial supply to the gallbladder

the cystic artery from the right hepatic artery (a branch

of the hepatic artery proper).
 Reference
• Greys anatomy for students p. 328 – 332.