ANATOMY

OF LIVER
OUTLINE OF THE TOPIC
• Introduction

• Development of liver

• Anatomy of liver

• Anatomical classification

• Functional classification

• Perihepatic spaces

• Anatomical resections
• The liver is the largest gland in the body …

• It is the second largest organ after the skin …

• The liver is wedge-shaped….

• Weighs about 1.5 kg …

• Present Under the diaphragm, within the rib cage in
the upper right quadrant of the abdomen .
outline of the liver on the
anterior body wall:
• Point A is 1 cm below the
right nipple at the level of
the fifth rib
• Point B is located
approximately 2 cm inferior
to and medial to the left
nipple, at the level of the left
fifth intercostal space
• Point C is in the right costal
margin at the anterior
axillary line
DEVELOPMENT OF LIVER
A 3-mm embryo
(~25 days) showing
the primitive
gastrointestinal tract
and formation of the
liver bud.

The bud is formed

by endoderm lining
the foregut.
A 5-mm embryo
(~32 days).

 Epithelial liver
cords penetrate
the mesenchyme
of the septum
transversum.
A 9-mm embryo (~36
days). The liver expands
caudally into the abdominal
cavity.

Condensation of
mesenchyme in the area
between the liver and the
pericardial cavity,
foreshadowing formation
of the diaphragm from part
of the septum transversum.
The liver is entirely
surrounded by peritoneum
except in its contact area
with the diaphragm. This is
the bare area of the liver.
• Liver cords differentiate into the parenchyma
(liver cells) and form the lining of the biliary
ducts.

• Hematopoietic cells, Kupffer cells, and connective

tissue cells are derived from mesoderm of the
septum transversum.
• In the 10th week of development, the weight of the
liver is approximately 10% of the total body weight.
This is attributed partly to the large numbers of
sinusoids, another important factor is its
hematopoietic function.

• This activity gradually subsides during the last 2

months of intrauterine life, and only small
hematopoietic islands remain at birth. The weight of
the liver is then only 5% of the total body weight.
ANATOMY OF LIVER
 The Antero superior convex upper surface of the liver is
molded to the undersurface of the domes of the diaphragm.
• The posteroinferior or visceral surface, is molded to
adjacent viscera and is therefore irregular in shape.

• It lies in contact with the abdominal part of the

esophagus, the stomach, the duodenum, the right
colic flexure, the right kidney and suprarenal gland,
and the gallbladder.
• The liver may be divided into a large right lobe and a
small left lobe by the attachment of the peritoneum
of the falciform ligament.

• The right lobe is further divided into a quadrate lobe

and a caudate lobe by the presence of the
gallbladder, the fissure for the ligamentum teres,
the inferior vena cava, and the fissure for the
ligamentum venosum.
•4 Lobes
Major: left and right
Minor: caudate and
quadrate
• Experiments have shown that, in fact, the quadrate
and caudate lobes are a functional part of the left
lobe of the liver.

• Thus, the right and left branches of the hepatic

artery and portal vein, and the right and left hepatic
ducts, are distributed to the right lobe and the left
lobe (plus quadrate plus caudate lobes), respectively.
• The porta hepatis, or hilum of the liver, is found on
the posteroinferior surface and lies between the
caudate and quadrate lobes.

• The upper part of the free edge of the lesser

omentum is attached to its margins.
• In it lie the right and left hepatic ducts, the right and
left branches of the hepatic artery, the portal vein,
and sympathetic and parasympathetic nerve fibers.

• A few hepatic lymph nodes lie here, drain the liver

and gallbladder and send their efferent vessels to the
celiac lymph nodes.
Important Relations of liver

• Anteriorly: Diaphragm, right and left costal margins,

right and left pleura and lower margins of both lungs,
xiphoid process, and anterior abdominal wall in the
subcostal angle.

• Posteriorly: Diaphragm, right kidney, hepatic flexure

of the colon, duodenum, gallbladder, inferior vena
cava, and esophagus and fundus of the stomach.
Peritoneal Ligaments of the Liver

• The falciform ligament, which is a two-layered fold of

the peritoneum, ascends from the umbilicus to the
liver .

• It has a sickle-shaped free margin that contains the

ligamentum teres, the remains of the umbilical vein.

• The falciform ligament passes on to the anterior and

then the superior surfaces of the liver and then splits
into two layers.
• The right layer forms the upper layer of the coronary
ligament; the left layer forms the upper layer of the
left triangular ligament .

• The right extremity of the coronary ligament is

known as the right triangular ligament of the liver .
• The peritoneal layers forming the coronary ligament
are widely separated, leaving an area of liver devoid
of peritoneum.
• Such an area is referred to as a bare area of the liver.
• In the fetus, oxygenated blood is brought to the liver
in the umbilical vein (ligamentum teres).

• The greater proportion of the blood bypasses the

liver in the ductus venosus (ligamentum venosum)
and joins the inferior vena cava.

• At birth, the umbilical vein and ductus venosus close

and become fibrous cords.
• The ligamentum teres passes into a fissure on the
visceral surface of the liver and joins the left branch
of the portal vein in the porta hepatis .

• The ligamentum venosum, a fibrous band that is the

remains of the ductus venosus, is attached to the
left branch of the portal vein and ascends in a fissure
on the visceral surface of the liver to be attached
above to the inferior vena cava .
• The lesser omentum arises from the edges of the
porta hepatis and the fissure for the ligamentum
venosum and passes down to the lesser curvature of
the stomach.
Arteries
• The Hepatic Artery, a branch of the celiac artery,
divides into right and left terminal branches that
enter the porta hepatis.
Veins
• The Portal vein divides into right and left terminal
branches that enter the porta hepatis behind the
arteries.
•The Hepatic Veins (three or more) emerge from the
posterior surface of the liver and drain into the
inferior vena cava.
BLOOD CIRCULATION THROUGH THE LIVER :

• The blood vessels conveying blood to the liver are

the hepatic artery (30%) and portal vein (70%).

• The hepatic artery brings oxygenated blood to the

liver, and the portal vein brings venous blood rich in
the products of digestion, which have been
absorbed from the gastrointestinal tract.
• The arterial and venous blood is conducted to the
central vein of each liver lobule by the liver sinusoids.

• The central veins drain into the right and left hepatic
veins, and these leave the posterior surface of the
liver and open directly into the inferior vena cava.
• The liver is completely surrounded by a fibrous
capsule but only partially covered by peritoneum.
The liver is made up of liver lobules.

• The central vein of each lobule is a tributary of the

hepatic veins.
• Liver lobules – hexagonal
structures consisting of
hepatocytes

• Hepatocytes radiate
outward from a central
vein

• At each of the six corners

of a lobule is a portal triad

• Liver sinusoids
• In the spaces between the lobules are the portal
canals, which contain branches of the hepatic artery,
portal vein, and a tributary of a bile duct (portal
triad).

• The arterial and venous blood passes between the

liver cells by means of sinusoids and drains into the
central vein.
LYMPH DRAINAGE

• The liver produces a large amount of lymph about

one third to one half of all body lymph. The lymph
vessels leave the liver and enter several lymph nodes
in the porta hepatis.

• The efferent vessels pass to the celiac nodes. A few

vessels pass from the bare area of the liver through
the diaphragm to the posterior mediastinal lymph
nodes .
SUPERFICIAL
LYMPHATIC DRAINAGE
OF THE LIVER
DEEP LYMPHATIC DRAINAGE OF THE LIVER
NERVE SUPPLY
• Sympathetic and parasympathetic nerves form the
celiac plexus. The anterior vagal trunk gives rise to a
large hepatic branch, which passes directly to the
liver.
BILE DUCTS OF THE LIVER

• Bile is secreted by the liver cells at a constant rate of

about 40 ml per hour.

• When digestion is not taking place, the bile is stored

and concentrated in the gallbladder;

• later, it is delivered to the duodenum. The bile ducts

of the liver consist of the right and left hepatic ducts,
the common hepatic duct, the bile duct, the
gallbladder, and the cystic duct.
• The smallest interlobular tributaries of the bile ducts
are situated in the portal canals of the liver; they
receive the bile canaliculi.

• The interlobular ducts join one another to form

progressively larger ducts and, eventually, at the
porta hepatis, form the right and left hepatic ducts.

• The right hepatic duct drains the right lobe of the

liver and the left duct drains the left lobe, caudate
lobe, and quadrate lobe.
HEPATIC DUCTS
• The right and left hepatic ducts emerge from the
right and left lobes of the liver in the porta hepatis .
After a short course, the hepatic ducts unite to form
the common hepatic duct.

• The common hepatic duct is about 1.5 in. (4 cm) long

and descends within the free margin of the lesser
omentum. It is joined on the right side by the cystic
duct from the gallbladder to form the bile duct.
BILE DUCT

• The bile duct (common bile duct) is about 3 inches

(8 cm) long.

• In the first part of its course, it lies in the right free

margin of the lesser omentum in front of the opening
into the lesser sac.

• Here, it lies in front of the right margin of the portal

vein and on the right of the hepatic artery.
• In the second part of its course, it is situated behind
the first part of the duodenum to the right of the
gastroduodenal artery.

• In the third part of its course, it lies in a groove on

the posterior surface of the head of the pancreas.

• Here, the bile duct comes into contact with the main
pancreatic duct.
 FUNCTIONAL CLASSIFICATION

• Although a variety of definitions have been used to

describe the anatomy of the liver segments, the most
widely accepted clinical nomenclature is that
described by Couinaud (1957), and Healey and
Schroy (1953).
• The internal architecture of the liver is divided into
segments, commonly referred to as Couinaud's
segments.

• Couinaud based his work on the distribution of the

portal and hepatic veins whilst Healey and Schroy
studied the arterial and biliary anatomy.
 20 %

80 %
PERIHEPATIC SPACES

• Suprahepatic Spaces
Right - Anterior
Posterior
Left - Anterior
Posterior
• Infrahepatic Spaces
Right
Left
• The suprahepatic potential space is divided into right
and left spaces by the falciform ligament.

Right Supra hepatic space boundaries are:

• Left — falciform ligament

• Posterior — right superior coronary and right

triangular ligaments

• Inferior — right lobe and medial segment of the left

lobe of the liver
• The left suprahepatic space is between the
diaphragm and the superior surface of the lateral
segment of the left lobe of the liver and the fundus
of the stomach.
• Each suprahepatic space may be divided into anterior
and posterior portions.
• The right infrahepatic space (subhepatic space,
hepatorenal space, pouch of Morison)

Boundaries :

Superiorly and anteriorly by the right lobe and

medial segment of the left lobe of the liver and the
gallbladder.

Superiorly and posteriorly by the inferior layer of the

coronary ligament and the posterior layer of the right
triangular ligament.
Inferiorly bounded by the hepatic flexure of the colon
and the transverse mesocolon
Medially, by the hepatoduodenal ligament.
• The left infrahepatic space may be divided into the
smaller antegastric space and the larger lesser sac of
the peritoneum.
 FUNCTIONS OF LIVER

• Metabolic
 Synthesis
 Breakdown
 Other functions – storage of vitamin A,D,B12,F…

• Excretion of waste products from bloodstream into bile

• Vascular – storage of blood

 Synthesis
• Protein metabolism
 Synthesis of amino acids

• Carbohydrate metabolism
 Gluconeogenesis
 Glycogenolysis
 Glycogenesis

• Lipid metabolism
 Cholesterol synthesis
 Lipogenesis
• Production of coagulation factors I, II, V, VII, IX, X and
XI, and protein C, protein S and antithrombin.

• Main site of red blood cell production

• Produces Insulin-like growth factor 1 (IGF-1), a

polypeptide protein – anabolic effects

• Production of Thrombopoetin
 Breakdown

• Breaks down insulin and other hormones.

• Breaks down hemoglobin.

• Breaks down or modifies toxic substances

(methylation) → sometimes results in toxication.

• Converts ammonia to urea

 Other functions

• Produces albumin, the major osmolar component of

blood serum.

• Synthesizes angiotensinogen, the hormone

responsible for raising blood pressure when activated
by renin (enzyme released when the kidney senses
low blood pressure)
Common Major Anatomic Hepatic Resections
(COUINAUD, GOLDSMITH AND WOODBURNE, BRISBANE TERMINOLOGY)

Right hepatectomy,
Right hepatic lobectomy, or
Right hemi-hepatectomy
(segments V-VIII).
Left hepatectomy,
Left hepatic lobectomy, or
Left hemi-hepatectomy
(segments II-IV).
Right lobectomy,
Extended right hepatic lobectomy, or
Right trisectionectomy
(trisegmentectomy) (segments IV-VIII).
Left lobectomy,
Left lateral segmentectomy, or
Left lateral sectionectomy
(segments II-III).
Extended left hepatectomy,
Extended left lobectomy, or Left
trisectionectomy
(trisegmentectomy)
(segments II, III, IV, V, VIII).
BIBLIOGRAPHY

Surgical Anatomy – Skandalakis.

Gray’s Anatomy 39th Edition.

LangmanMedEmbryology 10th Edition.

Schwartz's Principles of Surgery, 9th Edition.

Clinical Anatomy by Regions – 8th Ed.