LIVER

Five surfaces

Borders

Lobes

Peritoneal relations

Visceral Relations

Anterior surface

Posterior surface

Superior surface

Inferior surface

Right surface

• LIVER
  • Diaphragmatic surface
    • Superior part
      • Cardiac impression
    • Anterior part
    • Right part
    • Posterior part
    • Bare area
      • Groove for vena cava
      • Fissure for ligamentum venosum
      • Ligamentum venosum Arantii
  • Visceral surface
    • Fossa for gallgladder
    • Fissure for ligamentum teres; fissure for round ligament
      • Round ligament of the liver
    • Porta hepatis
    • Omental tuberosity
    • Oesophageal impression
    • Gastric impression
    • Duodenal impression
    • Colic impression
    • Renal impression
    • Suprarenal impression
    • Inferior border
      • Notch for ligamentum teres
  • Right lobe of liver
  • Left lobe of liver
    • Fibrous appendix of liver
  • Quadrate lobe
  • Caudate lobe
    • Papillary process
    • Caudate process
  • Hepatic segmentation
    • Umbilical fissure
    • Main portal fissure
    • Right portal fissure
    • Left liver; left part of liver
      • Left lateral division
        • Left posterior lateral segment; segment II
        • Left anterior lateral segment; segment III
      • Left medial division
        • Left medial segment; segment IV
      • Posterior liver; posterior part of liver; caudate lobe
        • Posterior sgment; caudate lobe; segment I
    • Right liver; right part of liver
      • Right medial division
        • Anterior medial segment; segment V
        • Posterior medial segment; segment VIII
      • Right lateral division
        • Anterior lateral segment; segment VI
        • Posterior lateral segment; segment VII
  • Serosa; serous coat
  • Subserosa; subserous layer
  • Fibrous capsule
  • Perivascular fibrous capsule
  • Lobules of liver
  • Interlobular arteries
  • Interlobular veins
  • Central veins
  • Interlobular bile ducts
  • Common hepatic duct
    • Right hepatic duct
      • Anterior branch
      • Posterior branch
    • Left hepatic duct
      • Lateral branch
      • Medial branch
    • Right duct of caudate lobe
    • Left duct of caudate lobe

• GALLBLADDER
• Fundus of gallbladder
• Infundibulum of gallbladder
• Body of gallbladder
• Neck of gallbladder
• Serosa; serous coat
• Subserosa; subserous layer
• Muscular layer; muscular coat
• Mucosa; mucous membrane
  • Mucosal folds; rugae
• Cystic duct
  • Spiral fold
• Bile duct
  • Sphincter of bile duct
  • Superior sphincter
  • Inferior sphincter
  • Hepatopancreatic ampulla; biliaropancreatic ampulla
  • Sphincter of ampulla Oddi
  • Glands of bile duct

liver

• location
  • situated
    • right quadrant
      • right hypochondrium
      • greater part of epigastrium
        • extends in to left hypochondrium
    • most of liver covered by ribs
    • nomenclature
    • hepatic
• biliary tree
  • epithelial cells lining system are called
    • cholangiocytes
      • cuboidal in small ductules
      • columnar in large ductules
  • hepatocytes secrete bile in to
    • bile canaliculi
      • partially loop around hepatocytes
        • canals of herring
          • flow of bile is opposite of blood flow
          • posess hepatic stem cells
          • flow in to intrahepatic bile ductules
            • interlobular bile duct
              • lined by cuboidal or columnar cells
  • these ducts travel towards porta hepatis
  • interlobular ducts join
    • right and left hepatic ducts
      • common hepatic duct
        • columnar epithelial cells
        • cystic duct branches from it
          • gives bile to gall bladder
• Features
  • liver is a large solid gland
  • reddish brown
  • soft in consistency
  • weight
    • 1600 grams in males
    • 1300 grams in females
  • EXTERNAL FEATURES
    • five surfaces
      • anterior
      • posterior
      • superior
      • inferior
        • well defined
      • right
  • inferior border
    • sharp anteriorly
      • separates anterior surface from inferior surface
      • it is marked by
        • interlobar notch
          • notch for ligamentum teres
        • cystic notch
          • for fundus of gall bladder
    • rounded laterally
      • separates right surface from inferior surface
  • LOBES
    • right lobe
      • much larger than left lobe
    • left lobe
    • divided in to two lobes by
      • falciform ligament anteriorly
      • fissure for ligamentum teres inferiorly
      • fissure for ligamentum venosum posteriorly
  • function
    • it secretes bile

• HISTOLOGY
  • it is covered by glissons capsule
  • histological components
    • parenchyma
      • hepatocytes
        • polyhedral
        • contain 2 to 4 nuclei
          • large and spherical
          • 2 nucleoli
        • lifespan 5 months
        • cytoplasm
          • acidophilic
        • lysosomes
          • responsible for iron storage
            • ferritin
        • villi that extend in perisinusoidal space
      • adjacent hepatocytes leave a space
        • bile canaliculi
        • cell membrane have tight junctions
    • stroma
      • continuation of the surrounding glissons capsule
      • has connective tissue
        • type 3 collagen (reticulin)
      • caspule covered by a layer of mesothelium
        • arising from peritoneum
    • space of disse
      • perisinusoidal space
        • has special cells
          • hepatic stellate cell
            • storage of vitamin A
              • released as retinol
            • cells responsible for fibrosis
              • they secrete collagen
      • located between hepatocytes and sinusoids
    • sinusoids
      • capillaries travelling between hepatocytes
  • microscopic structure
    • hepatic lobule (classic lobule)
      • traditional description
      • hexagonal plates of hepatocytes
        • stacked on top of each other
        • each plate
          • hepatocytes radiate outwards from a central vein
          • similar to the spokes of a cartwheel
          • hepatic sinusoids
            • hepatic sinusoids travel between the strips of hepatocytes
              • drain in to central vein
            • have discontinuous epithelium
              • presence of fenestra
            • contain kuppfer cells
              • oval nuclei
              • monocyte derivative
        • portal canal
          • one portal canal is located at each corner
            • 6 canals for each lobule
          • composed of
            • portal triad
              • surrounded by loose connective tissue
              • periportal space (space of mall)
                • lymph is produced
              • 1. bile duct
              • 2.hepatic artery
              • 3.hepatic portal vein
              • drains in to central vein
    • portal lobule
      • exocrine function of the liver
        • bile secretion
      • each functional unit
        • is a triangle
          • area covered by triangle is
            • hepatic regions that secrete bile in to same bile duct
        • central axis through a portal field
        • imaginary vertices
          • closest portal canals
    • liver lobule
      • liver acinus
        • functional unit shape is
          • oval
            • short axis
              • shared border between two adjacent lobules
              • together with portal canals
            • long axis
              • imaginary line
              • between two adjacent central vein
        • each half can be divided in to 3 zones
          • zone 1
            • one closest to short axis
            • receive highest amount of oxygen
          • zone 3
            • farthest from short axis
            • closest to central vein
            • least amount of oxygen
  • vasculature
    • liver receives blood from
      • hepatic portal vein 75%
        • rich in nutrients
      • hepatic artery 25%
    • central vein drains
      • in to sublobar veins
        • hepatic veins drain in to inferior venacava
    • blood vessels travelling through portal canals
      • called as interlobular blood vessel