Anatomy of the abdominal viscera: Liver, biliary ducts and gallbladder

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Notes

Liver, biliary ducts and gallbladder

Figure 1: A. Surfaces of the liver and related hepatic spaces (potential spaces), right lateral view of schematic parasagittal section B. Anterior view showing lobes. C. Posteroinferior view of lobes, grooves and impressions of the liver. 

Figure 2: Peritoneal reflections (ligaments) and structures forming and occupying hepatic fissures A. Anterior view, diaphragmatic surface. B. Posteroinferior view, visceral surface. 

Figure 3. A. Lesser omentum. B. Portal Triad.

Figure 4: Venous blood flow of the liver. A. Anterior view. B. Enlarged view of a hepatic lobule.

Figure 5: Lymphatic drainage of A. Liver. B. Gallbladder.
Figure 6: Innervation of the liver and gallbladder. 

Figure 7: A. Extrahepatic bile ducts and pancreatic ducts with B. Close-up showing the bile duct and pancreatic duct merging at the hepatopancreatic ampulla and opening into the duodenum.

Figure 8: Cystohepatic Triangle. 

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Preguntas

Preguntas del estilo USMLE Step 1

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A group of investigators are studying the gastrointestinal ligament and the structures housed within. They discover the hepatoduodenal ligament contains the portal triad, which consists of the proper hepatic artery, hepatic portal vein, and common bile duct. Which of the following structures form the hepatic portal vein?  

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The liver is quite an amazing organ, and fact is, the rumors you heard are true - it can actually regenerate itself! If that wasn’t enough, it also plays a major role in digestion, by producing bile, storing energy, detoxifying toxic substances and producing proteins. Let’s get started and look more at the liver along with the other associated organs and structures that help with digestion!

The liver is a large intraperitoneal organ located mostly in the right hypochondriac and epigastric regions of the abdomen, deep to the 7th to the 11th ribs. It sits just to the right of the stomach, with some of the liver covering its anterior surface.

It is superior to the duodenum, right side of transverse colon, and right colic flexure. Most of the liver is anterior to the lesser omentum; and it is anterosuperior to the right kidney and adrenal gland.

The liver has many important functions, including the production of bile to aid in fat digestion, reception and metabolization of absorbed products from digestion, detoxification of toxic substances received from digestion, storage and release of carbohydrates, as well as the production of proteins - primarily plasma proteins such as albumin and clotting factors.

When you look closely, the human liver is actually divided grossly into four parts, referred to as lobes. There is a larger right lobe, which is separated from a smaller left lobe by the falciform ligament. Then comes the caudate as well as the quadrate lobes, which are anatomically included in the right lobe.

Now, the liver is surrounded by potential spaces, which are referred to as hepatic spaces. These spaces usually only contain a small amount of peritoneal fluid, which serves as a lubricant between two membranes in close contact. The hepatic spaces include the right and left subphrenic recesses which are extensions of the peritoneal cavity located on the anterosuperior aspect of the liver, and are separated by the falciform ligament.

Next is the subhepatic space, which is located between the liver and the transverse colon. This space connects with the hepatorenal recess which extends posterosuperiorly from the subhepatic space between the liver and the right kidney.

Fuentes

  1. "THE STRUCTURE OF THE LIVER OF VERTEBRATES" Cells Tissues Organs (1952)
  2. "Liver Anatomy" Surgical Clinics of North America (2010)
  3. "Percutaneous Biliary Drainage in Patients With Nondilated Intrahepatic Bile Ducts Compared With Patients With Dilated Intrahepatic Bile Ducts" American Journal of Roentgenology (2010)
  4. "Anatomy relevant to cholecystectomy" Journal of Minimal Access Surgery (2005)
  5. "Principles of Anatomy and Physiology" John Wiley & Sons (2008)
  6. "Comprehensive Clinical Hepatology" Mosby (2005)
  7. "Imaging Atlas of the Normal Gallbladder and Its Variants" CRC Press (1994)
  8. "Wheater's Functional Histology" Elsevier Health Sciences (2006)
  9. "Identification of cerebral response to balloon distention of the bile duct" World J Gastroenterol. (2010)
  10. "Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts" AJR Am J Roentgenol. (2010)
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