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    Alvin B. Vibar, M.D.

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    Ditas Chu
    The liver lies mainly in the right upper quadrant of the abdomen and extends into the left hypochondriac region. It has two surfaces - diaphragmatic and visceral, and receives blood supply from the hepatic artery and portal vein. The liver has four lobes and eight segments and carries out important functions such as bile production, metabolism, and detoxification. The pancreas is a retroperitoneal organ that produces enzymes for digestion and hormones like insulin. It has a head, neck, body and tail, and receives its blood supply from branches of the celiac artery and superior mesenteric artery.

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    Alvin B. Vibar, M.D.

    Uploaded by

    Ditas Chu
    419 views49 pages
    The liver lies mainly in the right upper quadrant of the abdomen and extends into the left hypochondriac region. It has two surfaces - diaphragmatic and visceral, and receives blood supply from the hepatic artery and portal vein. The liver has four lobes and eight segments and carries out important functions such as bile production, metabolism, and detoxification. The pancreas is a retroperitoneal organ that produces enzymes for digestion and hormones like insulin. It has a head, neck, body and tail, and receives its blood supply from branches of the celiac artery and superior mesenteric artery.

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    The liver lies mainly in the right upper quadrant of the abdomen and extends into the left hypochondriac region. It has two surfaces - diaphragmatic and visceral, and receives blood supply from the hepatic artery and portal vein. The liver has four lobes and eight segments and carries out important functions such as bile production, metabolism, and detoxification. The pancreas is a retroperitoneal organ that produces enzymes for digestion and hormones like insulin. It has a head, neck, body and tail, and receives its blood supply from branches of the celiac artery and superior mesenteric artery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    419 views49 pages

    Alvin B. Vibar, M.D.

    Uploaded by

    Ditas Chu
    The liver lies mainly in the right upper quadrant of the abdomen and extends into the left hypochondriac region. It has two surfaces - diaphragmatic and visceral, and receives blood supply from the hepatic artery and portal vein. The liver has four lobes and eight segments and carries out important functions such as bile production, metabolism, and detoxification. The pancreas is a retroperitoneal organ that produces enzymes for digestion and hormones like insulin. It has a head, neck, body and tail, and receives its blood supply from branches of the celiac artery and superior mesenteric artery.

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    Download as PPT, PDF, TXT or read online from Scribd
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    of 49
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    The document describes the anatomy of the abdominal regions, liver, and pancreas.

    The nine abdominal regions described are: central (epigastric), umbilical, hypogastric/pubic, right and left hypochondriac, right and left lumbar, and right and left inguinal.

    The liver is the largest visceral organ located mainly in the right upper quadrant. It has diaphragmatic and visceral surfaces covered by peritoneum and is related to other abdominal organs.

    LIVER

    Alvin B. Vibar, M.D.


    Abdominal Regions
    Umbilicus – level of IVD of L3
    – L4
    Subcostal plane – 10th rib ; L3
    Transtubercular – iliac
    tubercle; L5
    Nine regions
    Central – Epigastric
    Umbilical
    Hypogastric / Pubic

    Lateral - R/L Hypochondriac


    R/L Lumbar
    R/L Inguinal
    LIVER:
    Surface Anatomy:
    lies mainly in the
    RUQ of the abdomen;
    occupies most of the
    R hypochondrium,
    the upper
    epigastrium &
    extends into the L
    hypochondrium
    Lies deep to the 7
    through 11 ribs on
    the R side & crosses
    the midline toward the
    L nipple
    Largest visceral organ
    & gland in the body,
    soft and pliable,
    weighs 1500 gms
    Functions:
    Bile production and
    secretion
    Filtration of blood
    Involvement in
    metabolic activities –
    carbohydrate, fat and
    protein metabolism
    Blood-clotting
    mechanisms
    Synthesizes Heparin
    Detoxification
    Surfaces:
    Diaphragmatic –
    dome shaped;
    anterior, superior and
    posterior parts;
    covered with visceral
    peritoneum except
    posteriorly in the bare
    area
    Surfaces:
    Visceral (posteroinf.) –
    covered w/ visceral
    peritoneum except at the
    bed of the gall bladder &
    porta hepatis
    Related to:
    R side of stomach
    1st part of duodenum
    lesser omentum
    Gall bladder
    R colic flexure & R
    transverse colon
    R kidney & adrenal gland
    Impressions and structures
    on visceral surface of liver
    Renal impression
    Colic impression Right lobe

    Duodenal impression
    Gastric impression Left lobe
    Porta hepatis – central area undersurface of liver devoid
    of peritoneum serves as entrance for the structures in
    the portal triad
    Portal triad
    1. Hepatic artery
    2. Bile duct
    3. Portal vein
    Inferior surface and its
    impressions
    Ligaments:
    Falciform ligament
    Coronary ligament
    R / L triangular ligaments
    Ligamentum teres /
    round ligament – remnant
    of umbilical vein; between
    left lobe & quadrate lobe
    Ligamentum venosum –
    remnant of ductus
    venosus; between left lobe
    & caudate lobe
    Falciform ligament –
    2 layered fold of – free
    margin contains the
    Ligamentum teres
    2 layers:
    Right – Coronary
    ligament – Right
    triangular ligament
    Left – Left triangular
    ligament
    Left triangular
    ligament

    Coronary ligament

    Bare area

    Right triangular
    ligament
    Anatomical
    lobes:
    Left lobe

    Right lobe – caudate


    & quadrate
    Functional
    lobes:
    2 – approximately equal
    size
    A line interconnecting
    the GB and IVC
    separates the Left lobe
    from the Right lobe
    Has a separate arterial
    blood supply, venous
    and biliary drainage
    Hepatic Segments
    Segments:
    Medial superior = I
    Lateral superior = II
    Lateral inferior = III
    Medial inferior = IV
    Anterior inferior = V
    Posterior inferior = VI
    Posterior superior=VII
    Anterior superior=VIII
    ABDOMINAL AORTA
    Anterior Visceral
    Celiac
    Superior Mesenteric
    Inferior Mesenteric
    Lateral Visceral
    Suprarenal
    Renal
    Gonadal
    Lateral Abdominal
    Inferior Phrenic
    Lumbar
    Terminal branches
    Common iliac
    Median Sacral
    Celiac artery – T 12
    Left Gastric
    Splenic – Left Gastroepiploic
    Short Gastric
    Hepatic – Right Gastric
    R/L Hepatic
    Gastroduodenal –
    Right Gastroepiploic
    Sup. Pancreaticoduodenal
    Superior Mesenteric Artery – L 1
    Inferior Pancreaticoduodenal
    Middle Colic
    Right Colic
    Ileo-colic
    Jejunal-Ileal
    Inferior Mesenteric Artery – L 3
    Left Colic
    Sigmoid
    Superior Rectal
    PRIMITIVE GUT divisible into:
    FOREGUT – supplied by Celiac trunk
    MIDGUT – Sup. Mesenteric artery
    HINDGUT – Inf. Mesenteric artery
    Foregut derivatives
    Primordial pharynx and it’s derivatives ( oral
    cavity, pharynx, tongue, tonsils, salivary glands,
    upper respiratory )
    Lower respiratory
    Esophagus and Stomach
    Duodenum ( proximal to the opening of bile
    duct )
    Liver, Biliary apparatus ( hepatic ducts, Gall
    bladder and Bile duct ) and Pancreas
    Supplied by Celiac artery
    Midgut derivatives
    Small intestine, including most of the
    duodenum
    Cecum, Vermiform appendix, Ascending
    colon, and the right half to two thirds of the
    Transverse colon
    Supplied by Superior mesenteric artery
    Hindgut derivatives
    Left one third to one half of the transverse
    colon
    Descending colon and Sigmoid colon
    Rectum and Superior part of the Anal
    canal
    Epithelium of the Urinary bladder and most
    of the Urethra
    Supplied by Inferior mesenteric artery
    Blood supply to liver
    Common Hepatic
    artery divides into
    Right and Left
    hepatic arteries
    supplying the Right
    and Left functional
    lobes of the Liver
    Blood supply:
    Portal vein – formed
    by union of superior
    mesenteric & splenic
    veins ; 70%
    Hepatic artery –
    branch of celiac
    artery; 30%
    Blood Flow to liver
    Portal vein
    - 70% blood flow
    - unoxygenated blood , absorbed
    substance from the alimentary tract
    - will drain to the hepatic veins
    Hepatic artery
    - 30% blood flow
    - oxygenated blood
    - branch of the celiac artery from
    abdominal aorta
    Hepatic lobule
    Liver Acinus
    Divisible into 3 zones:
    Zone 1 – closest to
    the portal tract and
    receives the most O2
    Zone 2
    Zone 3 – farthest and
    receives the least O2,
    most susceptible to
    ischemic injury
    LIVER
    PORTAL VENOUS SYSTEM
    Tributaries:

    Superior mesenteric

    Splenic

    Inferior mesenteric

    Left gastric

    Paraumbilical
    Tributaries of the Portal Veins
    Venous drainage,
    lymphatic & nerve
    supply
    Hepatic veins formed
    by the union of central
    veins drain into IVC
    Hepatic lymph
    nodes drain into
    celiac lymph nodes
    – cisterna chyli
    Hepatic nerve
    plexus from celiac
    plexus
    Portal-Caval Anastomoses
    Normal route – portal
    vein – liver – hepatic
    vein – IVC
    If blocked:
    Esophageal branch of L
    gastric = esophageal of
    Azygos
    Superior rectal = middle &
    inferior rectal
    Paraumbilical = superficial
    veins of ant. Abd’l wall
    Colic veins =
    retroperitoneal veins
    Portal Hypertension
    Esophageal plexus of
    veins
    Azygous vein Para-umbilical veins
    Hemorrhoidal plexus
    of veins

    Left gastric
    vein
    Clinical
    Correlation:
    Liver biopsy usually
    done at R 10th ICS in
    MAL
    Rupture of liver
    Hepatomegaly
    Liver cirrhosis – causes
    portal HPN w/c can
    produce esophageal
    varices, caput medusae
    and hemorrhoids
    PANCREAS
    Pancreas ( exocrine and
    endocrine)
    Parts
    Head – expanded part; is embraced by the
    C shaped curve of the Duodenum
    Neck – short and overlies the Superior
    mesenteric vessels
    Body – to the left of SMA and SMV
    Tail – closely related to the hilum of
    spleen and left colic flexure
    Parts of the Pancreas
    Head
    Neck
    Body
    Tail
    Uncinate process
    – projection from
    the inferior part of
    head; extends
    medially to the left
    post. to SMA
    Relations:
    Lies Posterior to the
    Stomach between
    the Duodenum on
    the right and Spleen
    on the Left
    Ducts of the Pancreas
    Main pancreatic
    duct (Wirsung)
    begins in the tail of
    the pancreas and
    runs through the
    parenchyma to the
    head where it turns
    inferiorly and
    merges with the Bile
    duct
    Blood supply:
    Superior pancreaticoduodenal artery
    from Gastrodudenal ( Hepatic – Celiac)

    Inferior pancreaticoduodenal from SMA

    Pancreatic arteries from Splenic


    Blood supply of Pancreas
    Blood supply to the body and
    tail
    Venous drainage:
    Pancreatic veins
    which are tributaries
    of the Splenic and
    Superior
    mesenteric; most of
    them empty into the
    Splenic vein
    Rupture of the Pancreas
    Pancreatic injury can result from sudden,
    severe, forceful compression of the
    abdomen
    Rupture frequently tears its duct system
    allowing pancreatic juice to enter the
    parenchyma of the gland and to invade
    adjacent tissues – digestion of pancreatic
    and other tissues by pancreatic juice is
    painful
    Pancreatic cancer
    Cancer involving the pancreatic head
    accounts for most cases of extrahepatic
    obstruction of the biliary system
    Compresses and obstructs the Bile duct
    causing Obstructive jaundice resulting in
    the retention of bile pigments, enlargement
    of GB and jaundice

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