- The liver is the largest gland in the body and has a wide variety of functions
- Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
- It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen)
Function of the liver :
- Secretion of bile & bile salt
- Metabolism of carbohydrate, fat and protein
- Formation of heparin & anticoagulant substances
- Detoxication
- Storage of glycogen and vitamins
- Activation of vita .D
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Surgical Anatomy of the Liver : Ηepatectomies - Dimitris P. Korkolis
1. Surgical Anatomy of the Liver -Surgical Anatomy of the Liver -
ΗΗepatectomiesepatectomies
Dimitris P. Korkolis
Surgeon
Saint Savvas Anticancer - Oncological Hospital of Athens
2. Liver
• The liver is the largest gland in the body and has a wide variety of
functions
• Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
• It is exocrine(bile) & endocrine organ(Albumin , prothrombin &
fibrinogen)
• Function of the liver
• Secretion of bile & bile salt
• Metabolism of carbohydrate, fat and protein
• Formation of heparin & anticoagulant substances
• Detoxication
• Storage of glycogen and vitamins
• Activation of vita .D
3. EmbryologyEmbryology
44thth
Week of DevelopmentWeek of Development
– Projection from ventral wall of MidgutProjection from ventral wall of Midgut
Cranial BudCranial Bud →→ LiverLiver
Caudal BudCaudal Bud →→ Gallbladder, extrahepaticGallbladder, extrahepatic
biliary treebiliary tree
Ventral PancreasVentral Pancreas
4. EmbryologyEmbryology
Bile ducts develop from hepatocytes,Bile ducts develop from hepatocytes,
originating at hilumoriginating at hilum
77thth
WeekWeek
– Biliary lumen recanalizeBiliary lumen recanalize
1212thth
WeekWeek
– Liver begins to secrete bileLiver begins to secrete bile
5. DevelopmentalDevelopmental
AnomaliesAnomalies
Agenesis rareAgenesis rare
– Left lobe agenesis reportedLeft lobe agenesis reported
Reidel’s LobeReidel’s Lobe
– Long tongue of liver extending inferiorlyLong tongue of liver extending inferiorly
from right lobefrom right lobe
– Usually asymptomatic, may beUsually asymptomatic, may be
associated with colonic or pyloricassociated with colonic or pyloric
obstructionobstruction
Heterotopic liver tissueHeterotopic liver tissue
– Gallbladder, pancreas, adrenals,Gallbladder, pancreas, adrenals,
6. AnatomyAnatomy
PositionPosition
– Between 4Between 4thth
intercostalintercostal
space and costal marginspace and costal margin
– extends across midlineextends across midline
7. AnatomyAnatomy
Glisson’s CapsuleGlisson’s Capsule
– Peritoneal MembranePeritoneal Membrane
PeritoneumPeritoneum
– Bare patch under diaphragm next to IVCBare patch under diaphragm next to IVC
8. LigamentsLigaments
FalciformFalciform
– Attaches to anterior abdominal wall fromAttaches to anterior abdominal wall from
diaphragm to umbilicusdiaphragm to umbilicus
– Includes Ligamentum Teres (roundIncludes Ligamentum Teres (round
ligament) at inferior borderligament) at inferior border
Former Umbilical VeinFormer Umbilical Vein
May recanalize in portal hypertension, orMay recanalize in portal hypertension, or
malignant hematologic disordersmalignant hematologic disorders
9. LigamentsLigaments
Right and Left CoronaryRight and Left Coronary
– Connect diaphragm to liverConnect diaphragm to liver
– Lateral aspects become TriangularLateral aspects become Triangular
LigamentsLigaments
10. LigamentsLigaments
GastrohepaticGastrohepatic
– Anterior layer of lesser omentumAnterior layer of lesser omentum
– Continuous with Left Triangular LigamentContinuous with Left Triangular Ligament
HepatoduodenalHepatoduodenal
– Anterior border of Foramen of WinslowAnterior border of Foramen of Winslow
– Contains Portal TriadContains Portal Triad
11. The Ligamentum
Venosum
-Fibrous band that is the
remains of the ductus
venosus
-Ligament of Aranthius
- It 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
13. Lobar AnatomyLobar Anatomy
(American System)(American System)
Right and Left Lobe determined by Cantlie’sRight and Left Lobe determined by Cantlie’s
Line (portal fissure)Line (portal fissure)
– Gallbladder Fossa to IVCGallbladder Fossa to IVC
15. Segmental AnatomySegmental Anatomy
(Couinaud System)(Couinaud System)
Caudate LobeCaudate Lobe
– Segment ISegment I
Left LobeLeft Lobe
– Segments II – IVSegments II – IV
Right LobeRight Lobe
– Segments V-VIIISegments V-VIII
16. Segmental AnatomySegmental Anatomy
(Couinaud System)(Couinaud System)
Caudate LobeCaudate Lobe
– Segment ISegment I
Left LobeLeft Lobe
– Segments II – IVSegments II – IV
Right LobeRight Lobe
– Segments V-VIIISegments V-VIII
17. Blood supply of the liver
• Proper hepatic artery
The right and left hepatic
arteries enter the porta
hepatis.
• The right hepatic artery
usually gives off the cystic
artery, which runs to the
neck of the gallbladder.
20. Portal VeinPortal Vein
Laminar Blood flowLaminar Blood flow
– Affects distribution of amebic abscesses andAffects distribution of amebic abscesses and
tumor metastasestumor metastases
21. Portal-SystemicPortal-Systemic
communicationcommunication
Submucosal veins of distal esophagus andSubmucosal veins of distal esophagus and
proximal stomachproximal stomach
Umbilical and periumbilical veinsUmbilical and periumbilical veins
– Caput MedusaeCaput Medusae
– Cruveilhier-Baumgarten bruitCruveilhier-Baumgarten bruit
Tributaries of inferior mesenteric veinsTributaries of inferior mesenteric veins
– Superior hemmorhoidalsSuperior hemmorhoidals
Retroperitoneal communicationRetroperitoneal communication
– Adrenal veinsAdrenal veins
23. Hepatic ArteryHepatic Artery
CautionsCautions
– Only 55-65% of population has “normal”Only 55-65% of population has “normal”
hepatic arterial anatomyhepatic arterial anatomy
– Aberrant R hepatic artery may beAberrant R hepatic artery may be
mistaken for cystic arterymistaken for cystic artery
– Cystic artery may originate from theCystic artery may originate from the
gastroduodenal artery, the left hepaticgastroduodenal artery, the left hepatic
artery, or the common hepatic arteryartery, or the common hepatic artery
24. Biliary SystemBiliary System
Triangle of CalotTriangle of Calot
– Cystic Duct, Common Hepatic Duct, andCystic Duct, Common Hepatic Duct, and
hilum of liverhilum of liver
26. Hepatic VeinsHepatic Veins
Short extrahepaticShort extrahepatic
segmentsegment
– RightRight
– MiddleMiddle
Usually joins leftUsually joins left
– LeftLeft
Direct communication to IVC fromDirect communication to IVC from
Segment I (caudate)Segment I (caudate)
28. LIVER Histology
• lobules >> roughly
hexagonal structures
consisting of
hepatocytes. Radiate
outward from a central
vein.
• At each of the six
corners of a lobule is a
portal triad
( p.arteriole,p.venule &
bile duct)
•Between the
hepatocytes are the
liver sinusoids.
29. Where do the two blood supplies mix?
• Liver surrounded by a thin capsule at
portahepatic(it is thick)Glisson’s
capsule invests the liver and send septa
into liver subset subdivide the
parenchyma into lobules
30.
31. Segmental anatomy of the liver
• Rt .& Lt. lobes anatomically no
morphological significance.
Separation by ligaments
(Falciform, lig. Venoosum &
Lig.teres)
• True morphological and
physiological division by a line
extend from fossa of GD to fossa
of I.V.C each has its own arterial
blood supply, venous drainage
and biliary drainage
• No anastomosis between
divisions
• 3 major hepatic veins Rt, Lt &
central
• 8 segments based on hepatic and
portal venous segments
32. Segmental anatomy of the liver
– Liver segments are based on the portal and
hepatic venous segments
33.
34. •Source: HPB 2000; 2(3):333-39
•Terminology Committee of the International Hepato-Pancreato-Biliary Association