DISEASES OF THE LIVER
Normal liver Anatomy
Site: it occupies the right upper quadrant of the abdomen. It could be on the left side in case of
. It is fixed in its site by several ligaments such as ligamentum falcifarum and ligamentumteres.
Surface anatomy: from 5th intercostal space till lower border of costal margin. In case of hepatomegaly, it exceeds the 5th space and can be palpated under the costal margin.
Normal weight: about 1500g. If it weighs more, this may indicates hepatomegaly.
Circulation: Liver has dual blood supply:
Portal vein, which is the main source, accounting for 2/3 of blood supply. This vein branchesin tree manner to become central hepatic vein.
Hepatic artery, from systemic circulation which terminates, together with portal vein, as centralhepatic vein. Hepatic vein, then, drains into inferior vena cava.
Portal vein + hepatic artery
inferior vena cava.
N.B.: due to its dual blood supply, liver infarction is rare.
Excecretion: common bile duct
Canaliculi are entangled (found) between hepatocytes to collect bile which they produce.
canal of Herin
right and left hepatic duct
common hepatic duct +biliary (cystic duct) duct
common bile duct + pancreatic duct
opens in ampulla of Vater in theduodenum. (Revise your 2
year anatomy for more).
Histology (fig. 1)
Lobule concept: hepatic lobule is the smallest functional unit.
acinus concept: physiologic concept based on the blood supply.
Terminal central hepatic vein.
Peripheral portal triads, which consist of hepatic artery, portal vein and bile duct.
Hepatic cords radially set.
Central zone: around the central hepatic vein.ii.
Mid zone: in between.iii.
Peripheral zone: away from central hepatic vein.
Metabolic concept, i.e. based on blood supply.
Triangle in shape, the apex is at terminal hepatic vein, and the base is at portal tracts.
Least oxygenated area (zone 3) is the apical, around terminal hepatic vein. This zoneis most vulnerable area to lesions and toxins.