the liver and biliary ducts

7/29/2019 the liver and biliary ducts

1/6

THE LIVER AND BILE DUCTS

The liver is a big glandular organ belonging to the GI system weighing about 1.5kg.

It is the largest gland and abdominal organ in the body.

The liver receives venous blood returning from the GI tract through theportal vein.

This venous blood is laden with the products of digestion, especially fats.In addition to its many metabolic activities, the liver secretes bile. Bile passes to the gall-

bladder, where it is concentrated by absorption of water.

The liver lies in the upper part of the abdominal cavity occupying most of the right

hypochondrium and epigastrium, and extending into the left hypochondrium.

It lies just beneath the diaphragm and almost under cover of the ribs. Its lower borderfollows the contour of the right costal margin.

In normal individuals, it should not be palpable below the right costal margin.

Its surfaces are in contact with the diaphragm and the anterior abdominal wall.

The falciform ligament attaches the liver to both of these structures.

Additional folds of peritoneum connect the liver to the stomach (hepatogastric ligament),duodenum (hepatoduodenal ligament), and kidney (hepatorenal ligament).

The liver is completely surrounded by a fibrous capsule/Glisson's capsule but partially

covered by peritoneum.

The functional unit of the liver is a lobule.

SURFACES OF THE LIVER

The liver has diaphragmaticand visceral surfaces.These surfaces are separated from each other by the sharp inferior border, except

posteriorly.

The Diaphragmatic Surface of the Liver

This is smooth and convex as it conforms to the concavity of the inferior surface of the

diaphragm. Although this surface fits into the dome of the diaphragm, it is largely

separated from the diaphragm by part of the peritoneal cavity called the subphrenic recessexcept at the bare area. This is a triangular area between coronary ligaments and IVC. It

is in direct contact with the diaphragm.

Therefore, the superior part of the liver is covered withperitoneum, except posteriorly atthe bare area. The IVC occupies a fossa in the left part of the bare area, just to the right of

the median plane.

The Visceral Surface of the LiverThis surface is flat, directed posteroinferiorly and to the left.

It is separated from the diaphragmatic surface of the liver by the inferior border.

Under cover of the visceral surface are:1. right anterior part of the stomach;

2. superior part/1st part of the duodenum;

3. lesser omentum;4. gall-bladder;

1
http://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/abdominal_wall.htm#anterolateral_abdominal_wallhttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#visceral_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#visceral_surface_of_liverhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/stomach.htmhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/peritoneum.htm#lesser_omentumhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/abdominal_wall.htm#anterolateral_abdominal_wallhttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#visceral_surface_of_liverhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/stomach.htmhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/peritoneum.htm#lesser_omentum


2/6

5. right colic flexure/hepatic flexure;

6. right transverse colon

7. right kidney8. right suprarenal gland

9. Many associated vessels and nerves.

The visceral surface of the liver when seen from behind has an H-shaped group of deepfissures and fossae.

The crossbar of the H is the porta hepatis/hilum of the liver, a deep transverse fissure,about 5 cm long. It is between the quadrate lobe above and caudate lobe below.

At the porta hepatis the hepatic artery,portal veinand hepatic nervous plexus enter the

liver, the right and left hepatic ducts and some lymph vessels exit from it. The hepatic

ducts are anterior, portal vein and its branches posterior and the hepatic artery with itsbranches intermediate.

They lie from posterior to anterior in the order VAD (portal triad).

The porta hepatis is enclosed between the two layers of lesser omentum.

xx list the vessel at the porta hepatis

The left sagittal limbs of the H are deep fissures containing theligamentum teres and theligamentum venosum.

The right sagittal limbs of the H are fossae for the gallbladder and IVC.

Lobes of the Liver

The liver anatomically consists of a large right lobe and a smaller left lobe.

These two are separated on the diaphragmatic surface by the falciform ligament and on

the visceral surface by the fissures for the ligamentum venosum and ligamentum teres.The caudate lobe and most of the quadrate lobe are part of the right lobe anatomically.

Functionally, the liver is divided into two lobes, the left and right lobes. This is by a planethat passes through the gallbladder fossa and fossa for the IVC.

Each lobe has its own arterial supply, venous drainage and biliary drainage.

The caudate lobe and most of the quadrate lobe are part of the left lobe because,

They receive blood supply from the left hepatic artery and left portal vein.

They deliver bile to the left hepatic duct

The Right Lobe

The functional right lobe is demarcated by:

Visceral surface: the fossae for gallbladder and IVC (right limb of H);

Diaphragmatic surface: imaginary line that runs from fundus of gallbladder to the IVC.

The Caudate Lobe

This lobe lies between the fissure for the ligamentum venosum and the fossa for the IVC.It is bounded inferiorly by the porta hepatis.

It is a functional part of the left lobe.

On the right, the caudate lobe has a small, tail-like caudate process.This process separates theportal vein from the IVC and forms a bridge to theright lobe.

2
http://download.videohelp.com/vitualis/med/large_intestine.htmhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/large_intestine.htmhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liver


3/6

The Quadrate LobeThe four sided lobe lies between the fissure forligamentum teres and the gall bladder

fossa. It is bounded posteriorly by the porta hepatis.Most of it is functionally part of the left lobe.

The part of the inferior border of the liver between the notch for the ligamentum teres and

the gallbladder is formed by the quadrate lobe.

The Left Lobe

The functional left lobe includes thecaudate lobe and most of the quadrate lobe.On the visceral surface it is separated from the caudate and quadrate lobes by the fissures

forligamentum teres and ligamentum venosum, and on the diaphragmatic surfaceby the

attachment of the ligamentum teres.

Peritoneal Attachments of the Liver

Ligamentum teres

This is the obliterated left umbilical vein, connecting the left branch of the portal vein tothe umbilicus.

This ligament runs in the free edge of the falciform ligament and in a groove named afterit in the visceral surface of the liver.

The left umbilical vein is of great importance as it carried all the blood from the placenta

to the foetus.

Falciform ligament

This is a fold ofperitoneum, which connects the liver to the diaphragm and

supraumbilical part of the anterior abdominal wall.It is attached to the anterior and superior surface of the liver and to the notch for the

ligamentum teres.

It contains the small paraumbilical veins and the ligamentum teresin its free edge.Its left layer continues as the anterior layer of theleft triangular ligament.

Its right layer continues as the upper layer of the coronary ligament.

The line of attachment of the falciform ligament (together with the grooves for theligamentum venosum and teres) is said to the divide theleft and right lobes.

Coronary ligament

This is a reflection ofperitoneumfrom the diaphragm to the liver's superior and posteriorsurfaces.

It has upper and lower layers, which are continuous at the right as the right triangular

ligament and enclose the bare area of the liver.To the left, the upper layer becomes the right layer of the falciform, while the lower layer

becomes the posterior layer of the left triangular ligament.

The lower layer of the coronary ligament may reflect onto the upper pole of the rightkidney (as the hepatorenal ligament) instead of the diaphragm.

3
http://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#caudate_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#caudate_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#quadrate_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#visceral_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#visceral_surface_of_liverhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/abdominal_wall.htm#anterolateral_abdominal_wallhttp://download.videohelp.com/vitualis/med/abdominal_wall.htm#anterolateral_abdominal_wallhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#left_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#left_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#left_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/liver.htm#right_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#right_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#left_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#caudate_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#quadrate_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#diaphragmatic_surface_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#visceral_surface_of_liverhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/abdominal_wall.htm#anterolateral_abdominal_wallhttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#ligamentum_tereshttp://download.videohelp.com/vitualis/med/liver.htm#left_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#left_lobe_of_liverhttp://download.videohelp.com/vitualis/med/liver.htm#right_lobe_of_liverhttp://download.videohelp.com/vitualis/med/peritoneum.htmhttp://download.videohelp.com/vitualis/med/liver.htm#right_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#right_triangular_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#left_triangular_ligament


4/6

Left triangular ligament

This is formed from the left layer of the falciformand lower layer of thecoronaryas they

meet at the left.Right triangular ligament

This is formed from the two layers of the coronary ligament meeting at the right.

Lesser Omentum

This lesser omentum connects the liver to thestomach and the1st part of the duodenum.

It inserts along the groove for the ligamentum venosum and encircles the porta hepatis.The groove for the ligamentum venosum contains the obliterated remnant of the ductus

venosus, which in foetal life connected the left branch of the portal vein to the IVC, or

the left hepatic vein, just before it enters the IVC.

Arterial Supply to the Liver

The liver has a double blood supply from hepatic artery (30%) andportal vein (70%).

Oxygenated arterial blood is from the hepatic artery, which divides into right and left

hepatic arteries in the porta hepatis.Portal vein carries products of digestion absorbed from the GI tract. The portal vein

divides into right and left portal veins in the porta hepatis.The arterial blood is conducted to the central vein of each liver lobule.

Venous Drainage of the Liver

Branches of the portal vein and hepatic artery transport blood thru portal canals into a

central vein by way of sinusoids which traverse the lobules.

Portal canals are spaces between the liver lobules.

The central veins unite to form the hepatic veins.Portal canals also contain tributaries of the hepatic duct which drain bile from the lobule.

The hepatic veins empty into the IVC while in the deep groove just inferior to the

diaphragm. The attachment of these veins to the IVC helps to hold the liver in position.

Lymphatic Drainage of the Liver

Most of the lymph vessels from the liver converge at the porta hepatis and end in thehepatic lymph nodes that drain into celiac nodes.

A few vessels drain from the bare area thru the diaphragm to the mediastinal nodes.

Innervation of the Liver

The nerves to the liver contain both sympathetic and parasympathetic fibres.

These nerves reach the liver via the hepatic plexus, the largest derivative of the coeliac

plexus, which also receives filaments from the vagus and right phrenic nerves.

4
http://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/peritoneum.htm#lesser_omentumhttp://download.videohelp.com/vitualis/med/stomach.htmhttp://download.videohelp.com/vitualis/med/stomach.htmhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/liver.htm#common_hepatic_arteryhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#common_hepatic_arteryhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#falciform_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/liver.htm#coronary_ligamenthttp://download.videohelp.com/vitualis/med/peritoneum.htm#lesser_omentumhttp://download.videohelp.com/vitualis/med/stomach.htmhttp://download.videohelp.com/vitualis/med/duodenum.htm#first_part_of_duodenumhttp://download.videohelp.com/vitualis/med/liver.htm#common_hepatic_arteryhttp://download.videohelp.com/vitualis/med/liver.htm#portal_veinhttp://download.videohelp.com/vitualis/med/liver.htm#common_hepatic_arteryhttp://download.videohelp.com/vitualis/med/liver.htm#portal_vein


5/6

Bile ductsBile is secreted by the liver at a constant rate of about 40mls/hr.When digestion is not taking place; the bile is stored and concentrated in the gall bladder,

later it is delivered to the duodenum.

Bile is secreted by hepatocytes into the bile canaliculi, the smallest branches of the

intrahepatic duct system.Most of the canaliculi drain into small interlobular ducts situated in the portal canals,

which join with others to form progressively larger ducts.

Eventually the right and left hepatic ducts which drain the corresponding liver lobes areformed at the porta hepatis.

Thebile ducts of the liver consist of;1. Right and left hepatic ducts

2. Common hepatic ducts

3. Bile duct

4. Gall bladder

5. Cystic duct

Hepatic ducts: the left and right hepatic ducts emerge from the left and right lobes of theliver in the porta hepatis. After a short course, they unite to form common hepatic duct.

Common hepatic duct: This is about 4cm long and descends inferiorly to the rightbetween layers of lesser omentum.

It is joined at an acute angle by the cystic duct from the gall bladder to form the bile duct.

Bile duct/common bile duct

8-10 cm long, runs in the free edge of lesser omentum with hepatic artery and portal vein.

It passes inferiorly, anterior to omental foramen& portal vein and right of hepatic artery.The bile duct passes posterior to the 1st part of duodenum and head of pancreas.On the left side of the 2nd part of duodenum, the bile duct comes into contact with the

main pancreatic duct. The two run obliquely thru the wall of the duodenum where they

usually unite to form the hepatopancreatic ampulla (ampulla of Vater).The distal constricted end of the ampulla opens into the 2nd part of the duodenum at the

summit of the major duodenal papilla, about 8-10 cm from the pylorus.

The thickened circular muscle around distal end of bile duct forms the sphincter of thebile duct (choledochal sphincter), its contraction pushes bile into the gallbladder.

There is also hepatopancreatic sphincter (sphincter of Oddi) around the hepatopancreatic

ampulla, which controls both discharge of bile and pancreatic juice into the duodenum.

Vessels of the bile duct

Proximal part: cystic artery

Middle part: right hepatic arteryDistal part: posterior superior pancreaticoduodenal artery and Gastroduodenal branches

Veins from the proximal part and the hepatic ducts enter the liver directly.

Vein that correspond to artery of distal part empty into the portal vein.Lymph goes to cystic nodes and hepatic nodes, then to celiac nodes

5


6/6

Gallbladder

This is a pear-shaped sac adherent to the visceral surface of the liver in the transpyloricplane. It lies along the right edge of the quadrate lobe in the gallbladder fossa from where

it hangs inferiorly.

In vivo it is a thin walled bluish-green sac covered by peritoneum.It concentrates the bile secreted by the liver and can store 30-60mls of bile.

The gallbladder is divided into 3 parts; fundus, body and neck.

Fundus: this is wide rounded end that projects beyond the inferior border of the liver.It is located at the tip of the 9th costal cartilage in the midclavicular line.

The fundus is related to the anterior abdominal wall and 2 nd part of duodenum.

Body: lie in contact with the visceral surface of the liver to which it is attached by loose

connective tissue. It is related to right transverse colon and 1st part of duodenum.

Neck: this is directed towards porta hepatis and makes an S-shaped bend as it becomes

continuous with the cystic duct.

It serves as a guide to the omental foramen which lies to its immediate left, posterior to

the free margin of the lesser omentum.The neck is twisted and its mucosa thrown into a spiral fold (valve of Heister).

Cystic duct

This is about 2-4cm long. At first it runs superiorly and to the left from the gallbladder.

It then turns posteroinferiorly to join the common hepatic duct to form the bile duct.The cystic duct runs between layers of lesser omentum, usually parallel to the hepatic

duct, before joining it near the porta hepatis.

It has a spiral fold continuous with that of the neck of gallbladder.

This fold keeps the duct constantly open so that;1. Bile can easily pass into the gallbladder when the bile duct is closed by the

choledochal sphincter and/or the hepatopancreatic sphincter.

2. Bile can pass the opposite direction, into the duodenum when the gallbladdercontracts (contraction involves cholecystokinin hormone).

Vessels of gallbladder and cystic duct

Cystic artery is usually a branch of right hepatic artery. Cystic vein drains directly to

portal vein. Several small arteries and veins are also present.

Veins of the fundus and body pass directly to the liver.

Lymph drains into cystic nodes and hepatic nodes. Efferent vessels go to celiac nodes

The nerves follow the cystic artery and include;

1. Celiac plexus (sympathetic and parasympathetic)2. Right phrenic nerve (sensory) - referred shoulder pain in gallbladder pathology.

The hepatic plexus also gives fibres to the cystic artery.

Gall stones are composed of cholesterol and bile pigments. When gall stones migrate

down the biliary tree they cause acute cholecystitis, biliary colic, cholongitis or

pancreatitis.

6

the liver and biliary ducts

Documents