Liver Anatomy

Right hypochondriac region; Epigastric region; Extends into the left hypochondriac region

When the liver is enlarged (hepatomegaly), or sometimes during deep inspiration in a normal individual

Falciform ligament; Ligamentum teres; Ligamentum venosum; Anterior and posterior coronary ligaments; Right and Left triangular ligaments

Caudate; Quadrate; Right; Left

Intraperitoneal, except for the bare area and other areas not covered by peritoneum

Common bile duct; Hepatic artery proper; Hepatic portal vein

Divides the liver anatomically into right and left lobes; Anchors the liver to the anterior abdominal wall and diaphragm

Attaches the liver to the diaphragm and defines the boundaries of the bare area

Area of the liver not covered by visceral peritoneum, in direct contact with the diaphragm

Formed by lateral convergence of the layers of the coronary ligament; Anchors the liver to the diaphragm

Space where fluid accumulates in the supine position; Key site for detecting intrabdominal bleeding or fluid; Indicator of pathology; Guides clinical decision making

Morison’s pouch

Blood from the gastrointestinal tract and spleen is delivered to the liver via the hepatic portal vein before passing through the liver and returning to the heart via the hepatic veins and IVC

Carries blood between the heart and the lungs for gas exchange

Carries blood between the heart and all body tissues

So absorbed substances from the gut can be processed, stored, modified or detoxified by the liver before reaching the systemic circulation

Digestive organ capillaries —> Tributary veins —> Hepatic portal vein —> Liver sinusoids —> Central veins —> Hepatic veins —> IVC —> Heart

Coeliac trunk; Superior mesenteric artery; Inferior mesenteric artery

A smaller vein that joins a larger vein

Superior mesenteric vein and splenic vein

Midgut

Spleen and foregut structures, including the stomach and pancreas

Hindgut; usually drains into the splenic vein

Hepatocytes

Hepatocytes —> Bile canaliculi —> Intrahepatic ducts —> Right and left hepatic ducts —> Common hepatic duct —> Joins cystic duct to form common bile duct

Descending (second) part of the duodenum, at the major duodenal papilla

Jaundice; Dark urine; Pale stools; Pruritus; Possible cholestatic liver enzyme elevation

Stores and concentrates bile; Releases bile into the duodenum during digestion

Via the cystic duct, with bile flowing from the common hepatic duct into the cystic duct when the gallbladder is filling

CCK (cholecystokinin)

Carries nutrient-rich, relatively deoxygenated blood from the gastrointestinal tract and spleen to the liver

Carries oxygenated blood from the coeliac trunk to the liver

Carry blood from the liver into the inferior vena cava

Common bile duct; Hepatic portal vein; Hepatic artery proper

The umbilical vein carries oxygenated blood from the placenta; the ductus venosus allows some blood to bypass the liver and enter the inferior vena cava, which then enters the right atrium

Connections between portal venous tributaries and systemic veins that allow blood to bypass the liver when portal pressure is elevated

Paraumbilical veins; Left gastric vein; Superior rectal vein; Veins of the duodenum, pancreas and colon

Intercostal and inferior epigastric veins; Inferior rectal veins; Azygos vein; Lumbar veins

Chronic liver disease characterised by fibrosis and regenerative nodules, causing distortion of the normal liver architecture and potentially impaired liver function

Fibrosis and regenerative nodules increase resistance to blood flow through the liver, raising pressure in the portal venous system

Dilated submucosal veins in the oesophagus caused by portal hypertension, commonly involving connections between the left gastric vein and oesophageal veins; They can rupture and cause severe bleeding

Dilated superficial veins radiating around the umbilicus due to portal hypertension and reopening of paraumbilical venous connections

Connections between portal venous tributaries from the duodenum, pancreas and colon and systemic veins of the posterior abdominal wall, such as lumbar veins

Solid deposits that form in the gallbladder or biliary tract, usually composed of cholesterol or pigment

Pain caused by a gallstone temporarily blocking the gallbladder outlet or cystic duct, typically causing episodic right upper abdominal or epigastric pain

Acute inflammation of the gallbladder, usually caused by obstruction of the cystic duct by a gallstone

Pain and sudden cessation of inspiration when the examiner palpates the right upper abdomen over the gallbladder during inspiration; suggests acute cholecystitis

A gallstone obstructs the ampulla of Vater or distal bile duct, blocking pancreatic drainage and causing acute inflammation of the pancreas