Liver AP Powerpoint

Largest & most complex organ in the body

Liver

Normal size of liver

15-17 cm

Measurements taken at the liver are typically measured in the

Right lobe

What type of organ is the liver?

Intraperitoneal (surrounded by visceral peritoneum)

What specific regions of the liver are NOT intraperitoneal?

Gallbladder fossa & porta hepatis

What is the liver covered by?

Glisson’s capsule (fibrous capsule)

3 liver lobes

Right

Left

Caudate

Largest lobe of liver

Right lobe

2 segments of the Right Liver Lobe

Anterior & posterior

What separates the right & left lobe?

Falciform ligament

Falciform ligament attaches the liver to

Anterior abdominal wall & diaphragm

What does falciform ligament contain?

Ligamentum teres

How does falciform ligament appear sonographically?

Echogenic pyramidal shape on ultrasound

Ligamentum teres

Remnant of fetal umbilical vein

Another name for Ligamentum Teres

Round ligament

Left liver lobe location

Lies epigastric & left hypochondrium

2 segments of left liver lobe

Medial & lateral

Another name for medial segment

Quadrate lobe

Quadrate lobe location

Anterior mid portion of inferior liver

Smallest lobe of liver

Caudate lobe

Caudate lobe location

Posterior to ligamentum venosum, right lobe & porta hepatis

Superior to main portal vein

Caudate lobe location in relation to the IVC

Anterior & medial to IVC

Which liver lobe has its own blood supply?

Caudate lobe

What does the right hepatic vein divide?

Divides right lobe into segments

Middle hepatic vein divides into

Right and left lobes

How does the middle hepatic vein run?

From IVC to gallbladder fossa

What does the left hepatic vein divide?

Divides the left lobe into medial & lateral segments

What does the right portal vein divide?

Divides right lobe into anterior & posterior segments

What does the left portal vein divide?

Divides left lobe into segments

Blood flows through the portal triad of liver. What’s the portal triad?

Hepatic artery, portal vein, & common bile duct

What does the portal vein do?

Delivers nutrients absorbed from intestines and spleen

What vessels feed the liver?

Hepatic artery & hepatic vein

What vessel drains the liver?

Portal vein

Portal veins supply __% of blood to liver

75%

Main tributaries of portal veins

Splenic vein, Superior mesenteric vein, Inferior mesenteric vein

Portal veins appearance sonographically

High amplitude reflections

Main portal vein location in relation to IVC

Anterior to IVC

Main portal vein divides into

Right and left portal vein

Left portal vein supplies

Medial & lateral segments of LEFT liver lobe

Left portal vein Sonographic appearance

“H” sign

Hepatic veins courses

Between lobes & segments

Hepatic veins drains/dumps into

IVC, which then goes into right atrium

Which hepatic vein is the largest?

Right hepatic vein

Which hepatic vein is the smallest?

Left hepatic vein

Right hepatic vein drains the

Right lobe

Left hepatic vein divides & drains the

Left lobe (medial & lateral)

Middle hepatic vein divides & drains the

Right and left lobe

Sonographic liver appearance

Homogenous, isoechoic to spleen and right kidney

Normal portal vein measurements

13-15 mm

Normal portal veins Doppler

Hepatopetal (aka normal flow)

Phasic with respirations

Little to no Pulsatility

Normal hepatic veins Doppler

Pulsatile

Normal hepatic arteries Doppler

Low resistant

Morrison’s pouch

Space between kidney and liver

Does Morrison’s pouch normally contain fluid?

No!

However, in abnormal cases, fluid may collect in the pouch