Liver position

Hepar Structure
Liver Lobe and Couinauds Liver
Segment

Cantlie line Cantlie line

Innervasi Hepar
N. Splanchnici Major (segmen T6-T9 medulla spinalis)
Plexus
Truncus Vagal Anterior et Posterior Coeliacus

Plexus
Hepaticus
Liver Lymph Node
Embryology of
Liver and
Gallbladder
Arterial blood supply of hepar
Portal and Hepatic bile duct
Hepatic Vein
Drainage
v. Mesenterica inferior v. lienalis

v. Lienalis + v. mesenterica superior

v. porta hepatica

v. Gastrica dextra et sinistra vena

porta hepatica

v. Porta hepatica right and left

divisions vv. Hepatica v.
hepatica dextra, media, sinistra
VCI
 Anastomosis
Portocava
Cardia gaster:
v. gastrica sinistra (P)
v. esophagealis (C)

Periumbilical:
v. paraumbilicalis (P)
v. epigastrica superficial (C)

Retroperitoneal:
[veins of secondary retroperitoneal organ vs
veins of posterior abdominal wall]
v. colica sinistra (P)
v. lumbalis ascendens (C)

Rectum
v. rectalis superior (P)
v. rectalis media et inferior (C)
 Peritoneal Reflection
Bare area

Epiploic
foramen
Hepatitis
Kondisi dimana terjadi inflamasi pada
hepar. Biasanya disebabkan oleh infeksi
virus HAV. HBV, HCV, dkk.

Gejala umum: Fatigue. Nausea/vomiting,

Abdominal pain or discomfort di
epigastrik/RUQ, low grade fever,
jaundice, dsb.

Nyeri pada hepatitis dibawa oleh plexus

hepaticus melalui sympathetic visceral
afferent fiber secara retrograde yg
berjalan bersama trias porta menuju ke Hepar sebagian Innervasi oleh nervus C3-C5
plexus coeliacus lalu ke medulla spinalis ada reffered pain ke n. phrenicus
segmen T6-T9.

BOAS SIGN
Hepatomegaly
Yaitu terjadinya pembesaran
(enlargement) dari hepar, basanya
diakibatkan hepatitis, heart failure,
dengue fever, peningkatan CVP,
tumor, dsb.

Hepatomegaly peregangan pada

capsula glisson abdominal RUQ
pain.
Hepatomegaly terpalpasi di regio
lumbal dextra.
Metastatic tumor : 2 rute
Hematogen, via sistem vena
porta
Limfogen, biasanya dari right
breast (venous drainage sebagian
ke diafragma bare area of liver)
Hepatic Cirrhosis
Chronic Inflammation or liver
damage (alcohol etc) hepatocytes
damage scarring and nodule
Sirosis hepatis portal system
constriction portal
hypertension

Nodulasi pada hepar hobnail

appearance

Portal hypertension many

manifestations
Portal
Hypertension
Biasanya diakibatkan sirosis hepatis
stasis blood flow to hepar
vasodilatasi pre hepaticum ascites,
manifest di anastomosis portocava:

Cardia gaster Varices esophagus

ruptur blood stained vomiting

Periumbilical superficial abdominal

wall vein dilatation caput medusae

Rectal stasis of blood flow

hemorrhoid
 Portosystemic
shunt

Salah satu treatment hipertensi

portal adalah dengan membuat
shunt untuk mengurangi stasis
darah prehepatik dialihkan
langsung ke sistem caval

Ada 3 jenis: Side to side, end to side,

central splenorenal portosystemic
shunt
Subphrenic and
hepatorenal
Abscess

Inflamasi organ viscera

ruptur/perforasi eksudat purulen
di cavitas peritoneum peritonitis
mengalir ke recessus hepatorenal
mengalir ke recessus
subphrenicus

Drainase biasanya dengan pungsi

pada SIC 12 sehingga tidak perlu
menembus cavitas pleura
Hepatic Lobectomy and
Segmentectomy
Right hepatic lobectomy Hepatic segmentectomy

Jika prosedur mengangkat bagian hepar yang sudah nekrosis (cirrhosis)

Resectional Debridement