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19 Cards in this Set

  • Front
  • Back
Livers fibrous capsule
capsule of glisson
What rib does the pleura and lung end?
And the liver start and finish?
Pleura rib 10
Lung rib 7
Liver rib 6-11
Visceral relations of liver
Visceral surface of liver is related to oesophagus, stomach, duodenum, transverse colon, right colic flexure, right suprarenal gland & right kidney
Falciform ligament
- demarcates left and right anatomical lobes
- double layer of peritoneum reflecting from liver to diaphragm and anterior abdominal wall to level of umb
Ligamentum teres
Ligamentum teres is a thickening in lower free edge of falciform ligament (fibrous remnant of umbilical vein)
H shape of liver
H-shaped region postero-inferiorly formed on left side by fissures for ligmentum teres and ligamentum venosum and on right side by groove for IVC and fossa for gallbladder

Cross-bar of H is porta hepatis (region where vessels, nerves and ducts enter or leave)
Above cross bar is caudate lobe, below is the quadrate lobe
the anatomical lobes
right and left
Left and right functional lobes
Approximate line of division through IVC and gallbladder (more equal in mass than anatomical lobes)
Receive left and right branches of proper hepatic artery & portal vein (bile from each functional lobe drains to left & right hepatic ducts)
Eight liver segments:
Eight liver segments:
4 sectors - based on branches of portal vein
Then each sector is sub-divided into segments (usually two) based on their supply by tertiary divisions of the portal triad
Blood Supply to Liver
Liver has a dual blood supply:
proper hepatic artery (oxygenated blood to liver)
portal vein (poorly oxygenated blood, nutrients & toxins absorbed from GIT)

The venous drainage of the liver is by 2-3 large hepatic veins into the IVC
Significance of Portal Vein and its Tributaries
1. metastasis
2. portal hypertension
a. oesophageal varices
b. splenomegaly
c. caput medusae
d. haemorrhoids
1. metastasis
2. portal hypertension
a. oesophageal varices
b. splenomegaly
c. caput medusae
d. haemorrhoids
Peritoneal Relationships of Liver
Liver is “intraperitoneal” and covered by peritoneum, except at bare area & attachments of lesser omentum and fossa for gallbladder
Bare area
Anterior and posterior coronary ligaments reflect from liver to diaphragm; between them is the bare area of the liver
Hepatorenal recess
(pouch of Morrison)
Most commonly infected space in abdominal cavity

Communicates with right subphrenic space, lesser sac and right paracolic gutter
Extrahepatic biliary system
comprises the gallbladder, cystic duct, left & right hepatic ducts, common hepatic duct and bile duct
hepatopancreatic ampulla (ampulla of Vater)
Bile duct joins main pancreatic duct  forms hepatopancreatic ampulla (ampulla of Vater) and is surrounded by hepatopancreatic sphincter (sphincter of Oddi). It opens into duodenum at major duodenal papilla
Course of bile duct
1. supraduodenal – in hepatoduodenal ligament,
2. retroduodenal - behind 1st part of duodenum,
3. infraduodenal - within or behind head of pancreas,
4. intraduodenal - in wall of 2nd part of duodenum.
Causes of Bile duct obstruction
Causes of obstruction of the bile duct, with jaundice, include gallstones and cancer of head of pancreas
Gall Bladder Pain referrals and relationships
Proximity of fundus to abdominal wall:
Inflamed gallbladder irritates structures of abdominal wall  right upper quadrant pain (somatic) &  positive Murphy’s sign

Right upper quadrant pain if gallbladder irritates somatic structures on anterior abdominal wall, occasional referral to right shoulder (via right phrenic nerve, which innervates gallbladder).

Gallstone may erode through gallbladder wall & into duodenum or transverse colon. If a large stone (>2.5cm) passes into duodenum it may impact at ileocaecal junction (“gallstone ileus”)  bowel obstruction.

Gas (from intestine) in gallbladder is a diagnostic sign of gallbladder perforation.