Anatomy of the liver and biliary system

Anatomy of the liver Ligaments and prietoneal reflections: • • • • The left triangular ligament The right triangular ligament The falciform ligament The lesser omentum

Liver blood supply: • • Hepatic artery ( a branch of the coeliac trunk ) à 20 % The portal vein à 80 %

Structures in the hilum of the liver: The hepatic A., portal V., and bile duct are present within the free edge of lesser omentum: • • The bile duct; within the free edge The hepatic A.; ant. & med.

The portal V.; post.

• • •

The venous drainage of the liver: Is via the hepatic veins into the IVC. IVC lies within a groove in the posterior wall of the liver.

Lobes of the Liver:

Surgical lobes

Anatomical lobes

The hepatic lobule: • • The functional unit of the liver. Consists of hepatocytes separated by the sinusoids that carry blood from the portal tracts toward the central veins

In an opposite direction, bile drain toward the bile duct tributaries within the portal tracts.

The gall bladder and bile ducts :

The gall bladder: • • • Pear-shaped, 7.5 – 12 cm long 5 ml capacity, but capable of considrable distension Divided into: a fundus, a body, and a neck that tterminate in a narrow infundibulum

: The wall of the gall bladder • • The muscle fibers in the wall are arranged in a crisscross manner, particularly well developed in the neck. The mucus membrane contains indentations that sink into the muscle coat, these are the crypts of Luschka.

The cystic duct:

• • • • •

About 3 cm in length but variable Its lumen diameter is usually 1-3 mm The mucosa is arranged in spiral folds known as the valves of Heister. The muscle fibers form a sphincteric structure called the sphincter of Lutkens

• • • • •

In 80 % of cases, the cystic duct joins the common hepatic duct in its supraduodenal segment It may extend to retroduodenal or retropancreatic part Occasionally, it may join the right hepatic duct The common hepatic duct is less than 2.5 cm long The common bile duct is about 7.5 cm long

The common bile duct: • • • • • It’s divided into four parts: The supraduodenal portion, about 2.5 cm long, running in the free edge of the lesser omentum The retroduodenal portion, The infraduodenal portion, lies in a groove or a tunnel on the post. surface of the pancreas The intraduodenal portion, passes obliquely through the wall of the 2nd part of the duodenum, where it’s surrounded by the sphincter of Oddi, and terminates by opening of the ampulla

The Arterial supply of the gallbladder and the bile duct: • • • • Cystic A.: a branch of Rt. hep. A. Pass behind the common hep duct ( >80%) In 15%, pass in front The most dangerous anomaly:

tortuous hep. A. on the front of the origin of cystic duct or tortuous Rt. Hep. A. & short cystic A * post.op. comp.: ischemia à stricture * * damage to Rt. Hep A ( laparoscopically )

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