Hajnalka HegedHajnalka Heged s, MDs, MD

covered by the Glisson's capsule; intraperitonealorgan (except the bare area [area nuda hepatis] )diaphragmatic surfacevisceral surfaceright lobe(located in the right hypochondrium)

left lobe(in the epigastrium and left hypochondrium)

falciform ligament

inferior border of livernotch for round ligament of liver

derivativederivative ofof thethe embryonicembryonic ventralventral mesogastriummesogastrium

falciform ligamentLig. teres hepatisLig. teres hepatisLig. teres hepatisround ligament

right lobe left lobe

VisceralVisceral surfacesurface (1) (1) HH-- shapedshaped setset ofofgroovesgrooves

left-hand limb of the H :- in the anterior halffissure for round lig.: round lig. (remnant of theumbilical vein)- in the posterior halffissure for lig. venosum: lig. venosum (remnant ofthe ductus venosus)

right-hand limb of the H :- in the anterior half

fossa for gallbladder:gallbladder

- in the posterior halfgroove for vena cava:

_inferior vena cava

cross-bar of the H is the porta hepatis: - common hepatic duct (on the right)- hepatic portal vein- hepatic artery proper (on the left)

Anterior to the porta hepatis, there is a lobe(between the fissure forround lig. and the fossa for gallbladder):

*QUADRATE LOBE

Posterior to the porta hepatis, there is anotherlobe (between the fissurefor lig. venosum and thegroove for venae cava):

*CAUDATE LOBE(papillary and caudate

processes)

remnant of ductus venosus

connective tissue bundle

inferior vena cava

porta hepatis

gallbladder

PeritonealPeritoneal attachmentsattachments ofof liverliver(( intraperitonealintraperitoneal expectexpect forfor thethe BARE AREA)BARE AREA)

falciform lig. of liver(remnant of the ventralmesogastrium)a/ left coronary lig. lefttriangular lig. fibrousappendixb/ right coronary lig.hepatorenal lig. righttriangular lig.BARE AREA of LIVER

LESSER OMENTUM- hepatogastric lig.- hepatoduodenal lig.

- bile duct (choledochal duct) /on the right/- hepatic portal v. /behind theother two items/- a. hepatica propria /on theleft/ChoVA!

BloodBlood supplysupply totothethe liverliver, , andand itsitsvenousvenous drainagedrainage

LymphaticLymphatic drainagedrainageandand innervationinnervation ofof thetheliverliver

hepatic a. proper (from commonhepatic a. ; from coeliac trunk)

hepatic portal v.

interlobar a. and v.

interlobular a. and v.

perilobular a. and v.

hepatic sinuses (mixture)

central v.

sublobular v.

hepatic veins inferior vena cava

- lymphatics originate in the interlobularconnective tissue, the larger lymphatic vesselsleave the liver in some pathways:

- via the porta hepatis hepaticlymphatic nodes

- along the hepatic vv. media-stinal lymphatic nodes

- in the falciform lig. para-sternal lymphatic nodesi and nodesaround the aorta

Innervation: coeliac ganglionvagus n. (cranial n. X)

Parts: fundusbodyneckcystic duct

common hepaticduct

bile duct

Peritoneal attachmentsBlood supply and venousdrainagecystic a. hepatic a. propercystic v. hepatic portal v.Lymphatic drainage: lymphnodes of porta hepatis

gallbladdergallbladder / / bilebile cystcyst / / cholecystacholecysta

PracticalPractical assignmentsassignments (( liverliver))

Study the peritoneal attachments of the liver,surfaces,items of the H-shaped set of grooves and theircontents.

Inferior margin of the liver is lifted, and the following items should be found:

- hepatoduodenal lig. containing(1) bile duct / choledochal duct on the right(2) hepatic portal v. between and behind the other two structures(3) hepatic a. proper on the left) ChoVA!

- porta hepatis

11--22Parts of pancreas Excretory ducts of the

pancreas

head of pancreasuncinate process of pancreas

pancreatic notch

body of pancreasomental eminence(bulges into the omental bursa)

tail of pancreas

at its superior margin splenicvessels (a. and v.)

-- pancreatic duct (Wirsung duct)(in the tail and body)opens into the hepatopancreatic ampullamajor duodenal papilla (papilla of

Vater)

- accessory pancreatic duct (Santoriniduct)(in the head)minor duodenal papilla (papilla ofSantorini)

Topographical relationships ofthe duodenum and the pancreas

PancreasPancreas: : bloodblood supplysupply, , venousvenous andandlymphaticlymphatic drainagedrainage andand innervationinnervation

superior pancreaticoduodenal a.inferior pancreaticoduodenal a.splenic a. (supplies the body and tail)

splenic v. to the hepatic portal v.

Lymphatic drainage:preaortin lymph nodes

Innervation:coeliac ganglionvagus nerve

(supply the head)

PracticalPractical assignmentsassignments (( pancreaspancreas))

Study the topographical anatomy of the pancreas

Find the superior mesenteric vessels (a. and v.)

Explore the vicinity of the superior margin of the

pancreas; examine the splenic a., and the

accompanying splenic v.)

Follow the splenic v. to the hepatic portal v.

Isolate the coeliac trunk above the superior margin aof

the pancreas