Anatomy of liver and gall bladder
• https://www.youtube.com/watch?v=Bgr3wwpUoHM
• https://www.youtube.com/watch?v=1oj13Uua00A
• By the end of the session the students should be able to:
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a. Describe the lobes of the liver and anatomical relations.
b. Describe porta hepatis.
c. Identify components of hepato-biliary system.
d. Comprehend the anatomy of the portal vein; portal venous
drainage and porto-systemic anastomosis.
– e. Describe the functional anatomy of the gall bladder.
– f. Identify blood supply, nerve supply and lymphatic drainage of
liver and gall bladder.
Lobes of liver and anatomical relations
• Liver is divided into right and left lobes by the
attachment of falciform ligament.
• Right lobe further divided into:
– Quadrate lobe and caudate lobe
• Relations:
– Anterior- diaphragm, R and L costal margins, R and L pleura,
lower margins both lungs, xiphoid process.
– Posterior-diaphragm, R kidney, R colic flexure, duodenum,
GB, IVC, esophagus , fundus (stomach)
• Peritoneal ligaments:
– Falciform ligament
– Ligamentum teres
– Ligamentum venosum
• Blood supply: hepatic artery
• Nerve supply: Sympathetic and parasympathetic nerves
from celiac plexus.
• Lymphatic drainage: Celiac nodes
Porta Hepatis
• Is hilum (door) of the liver found on the
posteroinferior surface and lies between the
caudate and quadrate lobes.
• Structures in it:
– Right and left hepatic ducts.
– Right and left branches of hepatic artery.
– Portal vein.
– Sympathetic and parasympathetic nerve fibres
– A few hepatic lymph nodes.
Components of hepato-biliary system
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Right and left hepatic ducts
Common hepatic duct (CHD)
Cystic duct (from GB) joins CHD and forms bile duct.
Bile duct (3 inches long)
– Enters the 2nd part of duodenum (at its half) along
with main pancreatic duct, together they open
into ampulla of Vater.
– Terminal parts of both ducts are surrounded by
sphincter of Oddi.
Portal vein
• Drains blood from:
– Lower 3rd of esophagus to ½ of anal canal.
– Spleen, pancreas and gall bladder
• Is 2 inches long and is formed behind the neck
of the pancreas by union of superior
mesenteric and splenic veins.
• Enters the liver to break up into sinusoids
from which the blood passes into hepatic
veins that join IVC.
Tributaries of the portal vein
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Splenic vein
Inferior mesenteric vein
Superior mesenteric vein
Left gastric vein
Right gastric vein
Cystic veins
Porto-systemic anastomosis
• Under normal conditions, the portal venous
blood traverses the liver and drains into the
inferior vena cava of the systemic venous
circulation by way of the hepatic veins. This is
the direct route.
• However, other, smaller communications exist
between the portal and systemic systems, and
they become important when the direct route
becomes blocked.
Communications
• At the lower 3rd of esophagus, the esophageal branches
of left gastric vein (portal tributary) anastomose with
the esophageal veins draining middle third of esophagus
into azygos veins (systemic tributary).
• Halfway down the anal canal, the superior rectal veins
(portal tributary) draining the upper ½ of the anal canal
anastomose with the middle and inferior rectal veins
(systemic tributaries).
• The paraumbilical veins connect the left branch of the
portal vein with the superficial veins of the anterior
abdominal wall (systemic tributaries).
• The veins of the ascending and descending colon,
duodenum, pancreas and liver and liver (portal)
anastomose with renal, lumbar and phrenic veins
(systemic)
Anatomy of gall bladder
• Has three parts:
– Fundus, body and neck
• Relations:
– Anterior= Ant Abdominal wall & inferior surface of liver
– Posterior= T. colon+1st and 2nd parts of duodenum
• Blood Supply: Cystic artery
• Lymph nodes: Cystic lymph nodes
• Nerve supply: Sympathetic and parasympathetic
fibres from celiac plexus.