Chapter 3: Liver

1. Liver Fixation:

• Means of fixation:

• Falciform ligament (inferior to liver)

• Venous ligament

• Hepatic-diaphragmatic ligament, coronary, triangular p-t, falciform, round

• Lesser omentum

2. Morphology:

• Visceral surface: Has 3 grooves forming a H-shape:

• Right vertical groove: Gallbladder fossa and inferior vena cava groove

• Left vertical groove: Round ligament notch and ligamentum venosum fissure

• Horizontal groove is the porta hepatis: Includes proper hepatic artery, common bile duct, portal vein

3. Structure:

• Encapsulation:

• Serous membrane

• Fibrous layer inside

• Fibrous layer:

• At the porta hepatis, the fibrous layer moves blood vessels and bile ducts into the liver, forming a fibrous sheath around the vessels.

• Lobule space:

• Branch of hepatic artery

• Portal vein

• Bile duct

4. Main interlobar fissure:

• Diaphragmatic surface: Connects gallbladder notch to left border of IVC

• Visceral surface: Connects gallbladder fossa to left border of IVC

5. Intersegmental fissure:

• Right intersegmental fissure: Divides the right lobe into anterior and posterior segments. Runs from right border of IVC, parallel to the interlobar fissure, 3 fingerbreadths away.

• Left intersegmental fissure: Divides the left lobe into medial and lateral segments.

• Diaphragmatic surface is the falciform ligament.

• Visceral surface corresponds to the left vertical groove.

6. Accessory fissure between left lobes:

• Diaphragmatic surface: Connects left border of IVC with the point where the posterior 1/3 and anterior 2/3 of the lower border of the left lobe meet.

7. Segments:

• Medial segment:

• Diaphragmatic surface: Inferior segment IV

• Visceral surface: Inferior segment IV and I (caudate lobe)

• Lateral segment:

• Inferior segments II, III

• Right lobe:

• Anterior segment: Inferior segments V and VIII

• Posterior segment: Inferior segments VI, VII

8. Portal vein:

• Source of supply: Superior mesenteric vein and splenic vein.

• Additionally: Cystic vein, right-left gastric vein, prepyloric vein, periumbilical veins.

9. Hepatic pedicle:

• Components: Portal vein (runs obliquely to the right, forward into the lesser omentum), proper hepatic artery (in the middle), common bile duct (the shallowest).

10. Portal-Caval anastomosis:

• There are 4 anastomoses:

• 1. Esophageal anastomosis: Left gastric vein – esophageal veins (single vein).

• 2. Rectal anastomosis: Superior rectal vein connects to middle and inferior rectal veins (internal iliac veins).

• 3. Periumbilical anastomosis: Round ligament vein connects to superior and inferior epigastric veins and internal thoracic vein.

• 4. Transperitoneal anastomosis: Intestinal veins – inferior vena cava.

11. Common bile duct:

• Divided into 4 segments:

• Supraduodenal segment: To the left is the proper hepatic artery, behind is the portal vein.

• Retroduodenal segment.

• Retropancreatic segment.

• Intraduodenal segment: Empties into the lower 1/3 and upper 2/3 of the duodenum.