Chapter 12 - Liver Anatomy

What is the largest organ in the abdomen?

Liver

Where is the liver located in response to the right hypochondriac region?

It fills it

Where is the liver located in response to the epigastric region?

It extends into it

Where is the liver located in response to the left hypochondriac region?

It ends in it

What is the liver’s location?

Anterior displacement across the spine

What is the Glisson’s Capsule?

Tight, fibrous capsule, covering the liver (peritoneum)

What area on the liver is not covered with the Glisson’s Capsule?

Bare area

What does the liver have relationships with?

Lesser sac, greater sac, and epiploic foramen

What are the surrounding recesses around the liver?

Hepatorenal, Subphrenic, and area of Porta Hepatis

What is the Area of Porta Hepatis?

Area of the liver hilum where the portal vein enters and the common bile duct exit

Where is the Subphrenic recess located?

Between the liver and diaphragm

What is another name for the Hepatorenal recess?

Morrison’s pouch

Where is the Hepatorenal recess?

Posteriorly to the liver and anteriorly to the kidney

The liver moves with: inspiration or expiration

Inspiration

Where is the Falciform ligament located?

Superior surface, and attaches the liver to the diaphragm

Where does the Falciform ligament run?

Divides the liver into right and left lobes, ends at the ligamentum teres or round ligament inferiorly

What is the Ligamentum teres ?

Internal attachment of the Falciform ligament

The ligamentum teres extends externally to become the _____________

Round ligament

The ligamentum teres is ___________ before birth?

Umbilical vein

What are the coronary ligaments?

Fold of peritoneum at the bare area

Where do the coronary ligaments run?

Anterosuperior surface of the liver that runs superiorly, then posteriorly on the right to the anterior leaf of the coronary ligaments

What is the ligamentum venosum?

Boundary of the caudate lobe

The ligamentum venosum is ___________ before birth?

Ductus venosum

Where does the ligamentum venosum run?

Extends from the posterior border of the liver to the porta hepatis

What does the Main Lobar Fissure do?

GB fossa to IVC (holds gallbladder)

What division does the main lobar fissure create?

Hemiliver

What does the main lobar fissure divide?

Right and left lobes of the liver

With the main lobar fissure, there is an ________________ connecting them

Echogenic line

What are the Couinaud segments based on?

Hepatic/portal veins

How many segments are there to divide the liver?

8

How do we count the sections of the liver?

Begin with the caudate lobe and move counterclockwise (Axial view)

What numbers are to the right and left when describing the sections of the liver?

2-4 left : 5-8 right

What makes up the portal triad?

Portal vein, hepatic artery, and bile duct

How much and what type of blood does the portal vein carry?

70-80% nutrient rich

How much and what type of blood does the hepatic artery carry?

20-30% oxygenated blood

The portal vein and hepatic artery both divide…

Into right and left at the porta hepatis

Where does the bile duct come from?

Gallbladder

Where does the bile duct exit?

Porta hepatis

What are the hepatic veins?

Right, middle, and left

Where do the hepatic veins drain?

At the most superior part of the IVC

What is the first step of liver processing?

Blood comes to the liver via portal vein (from bowel and abdominal organs)

What is the second step of liver processing?

The blood reached the sinusoids of the liver

What is the third step of liver processing?

The blood is collected and drained through the central veins

What is the fourth step of liver processing?

The blood is collected into the hepatic veins and drains into the IVC

What is the normal measurement of the right lobe?

Approx 13-17cm (@ a midclavicular measurment)

What is the normal measurement of the left lobe?

Highly variable, varies in size

If the right lobe is greater than ________ it is known as _________

20cm, Hepatomegaly

What does Riedel’s lobe mean?

Touguelike inferior extension of the right lobe, can be seen as far caudally as the iliac crest

What does an elongated left lobe mean?

Has a tip that can extend left laterally, all the way to the spleen

The liver should have a _________ echotexture

Homogeneous