Anatomy - Liver And Biliary System

Front 1

Relations of Liver

Back 1

- Right dome of diaphragm superiorly

- Posteroinferiorly (visceral surface), location of gall bladder

Front 2

Lobes of the Liver

Back 2

1) Anatomically: Left, Right, caudate & quadrate

2) Functionally: Couinards classification of 8 different lobes.

- Each has its own vascular inflow, outflow & biliary drainage

Front 3

Back 3

Anatomy of lier - visceral view

Front 4

Back 4

Porta Hepatitis

Front 5

Peritoneum

Back 5

- Small posterior bare area

- Coronary ligaments (anterior & posterior)

- Right & left triangular ligaments

- Falciform ligament - Ventral mesentry

- Lesser omentum (Arises from port hepatic & ligamentum venosum)

Front 6

Blood supply

Back 6

Coeliac trunk (25%)

Hepatic Portal System of Veins (75%)

- Splenic & SMV meet posterion to head of pancreas to form portal vein.

Front 7

Cirrhosis

Back 7

- A consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue & regenerative nodules (lumps)

- This leads to loss of liver function

Front 8

Portal Hypertension

Back 8

Portal pressure gradient >10 mmHg

Normal portal pressure = 9

IVC = 2-5

--> Splenmegaly

Front 9

Oesophageal Varicies

Back 9

- Occur at the anastomoses of left gastric vein with esophageal veins at gastro-oesophhageal junction.

- Present with haematemesis

- Can be treated with gastric banding

Front 10

Causes of Oesophageal Varicies

Back 10

- Peptic/GD ulcers

- Tumours

- Erosion of oesophagus

- Gastroenteritis

Front 11

Ascites

Back 11

Fluid in Peritoneal Space

Front 12

Causes of Ascites

Back 12

1) Portal hypertension

2) Hypoalbuminaemia

3) Aldosterone related renal sodium retention, with consequent blood volume expension

- Further exacerbated by additional pressure on kidneys - ischaemia)

Front 13

Back 13

Caput Medusae

- Recanalised umbilical vein within the falciform ligament.

- Paraumbilical veins radiate superiorly to intercostal veins and inferiorly to the inferior epigastric vein.

Front 14

Anorectal varices

Back 14

- Rectal varices NOT haemorrhoids

- Form due to portal hypertension due to formation of portosystemic shunts.

- May bleed massively

- 53% of patients with portal hypertension & 78% of individuals with esophageal varicose have anorectal varicose

Front 15

Back 15

Veins of rectum and anal canal

Front 16

Recto-anal junction

Back 16

Recto-anal junction

Front 17

Back 17

Porto-systemic anastomoses

Front 18

Back 18

Biliary Tree

Front 19

Bile ducts of the liver

Back 19

- Bile secreted by the liver at a constant rate - 40ml/hour

- Bile canaliculi drain into interlobular ducts

- Form right (right lobe)& left (left, caudate and quadrate lobes) hepatic ducts at port hepatis

- Ducts leave porta hepatic --> Common bile duct

Front 20

Free margin of lesser omentum

Back 20

Common hepatic duct

- Lies in the free margin of the lesser momentum (4cm). It's joined on the right side by the cystic duct --> Form bile duct

Bile duct

- Bile duct (8cm), in the free margin of lesser momentum, anterior to hepatic portal vein & right of the hepatic artery

- Behind the duodenum (1st)

- Lies in a groove on posterior head of pancreas, joined by pancreatic duct

Front 21

Gall Bladder

Back 21

- 50ml bile/day

- Concentrates bile

- Supplied by cystic artery (RHA)

- Related to hepatic flexure of colon & duodenum

- Inflamed gall bladder (cholecystitis) therefore herniates into these structure

- Pain in the right upper quadrant, referred to right flank and right scapula

Front 22

Back 22

Gall bladder and Extrahepatic ducts

Front 23

Back 23

Pancreas and Gall bladder

Front 24

Gallstones in cystic duct

Back 24

Biliary colic (acute inflammation)- Acute cholecystitis -> Pain in right hypochondrium

NO JAUNDICE

Front 25

Gallstones in common bile duct

Back 25

Frequently but moderate jaundice

Front 26

Gallstones at the hepatopancreatic ampulla

Back 26

Jaundice & Pancreatitis