THE LIVER

General Characteristics of the Liver

Largest of the abdominal viscera
Occupying a substantial portion of the upper
abdominal cavity
It occupies most of the right hypochondrium and
epigastrium, and frequently extends into the left
hypochondrium as far as the left lateral line
As the body grows from infancy to adulthood the
liver rapidly increases in size
This period of growth reaches a plateau around
18 years and is followed by a gradual decrease
in the liver weight from middle age
The liver weighs approximately 5% of the body
weight in infancy and it decreases to
approximately 2% in adulthood
The size of the liver also varies according to sex,
age and body size
It has an overall wedge shape
Throughout life the liver is reddish brown in
colour, although this can vary depending upon
the fat content
Obesity is the most common cause of excess fat
in the liver, also known as Steatosis
The liver assumes a more yellowish
tinge as its fat content increases
The texture is usually soft to firm, although it
depends partly on the volume of blood the liver
contains and the fat content
Surfaces of the Liver
The liver is usually described as having superior,
anterior, right, posterior and inferior surfaces,
and has a distinct inferior border
However, the superior, anterior and right
surfaces are continuous and no definable
borders separate them
At the infrasternal angle the inferior border is
related to the anterior abdominal wall and is
accessible to examination by percussion, but is
not usually palpable
In the midline, the inferior border of the liver is
near the transpyloric plane, about a hand's
breadth below the xiphisternal joint
In women and children the border often projects
a little below the right costal margin
Superior Surface
Largest surface
Lies immediately below the diaphragm
Separated from it by peritoneum except
for a small triangular area where the two
layers of the falciform ligament diverge
The majority of the superior surface lies
beneath the right dome, but there is a
shallow cardiac impression centrally that
corresponds to the position of the heart
above the central tendon of the
diaphragm
The left side of the superior surface lies
beneath part of the left dome of the
diaphragm
Anterior Surface
Approximately triangular and convex

Covered by peritoneum except at the

attachment of the falciform ligament
Much of it is in contact with the anterior
attachment of the diaphragm
On the right the diaphragm separates it
from the pleura and sixth to tenth ribs
and cartilages, and on the left from the
seventh and eighth costal cartilages
Right surface
Covered by peritoneum
Lies adjacent to the right dome of the
diaphragm which separates it from the
right lung and pleura and the seventh to
11th ribs
The right lung and basal pleura both lie
above and lateral to its upper third,
between the diaphragm and the seventh
and eighth ribs
Rarely, the hepatic flexure and proximal
transverse colon may lie on a long
mesentery over the right and superior
surfaces of the liver, referred to as
Chilaiditi Syndrome
Posterior surface
Convex, wide on the right, but narrow on
the left
A deep median concavity corresponds
to the forward convexity of the vertebral
column close to the attachment of the
ligamentum venosum
Much of the posterior surface is
attached to the diaphragm by loose
connective tissue, forming the triangular
bare area'
The inferior vena cava lies in a groove
or tunnel in the medial end of the bare
area'
The fissure for the ligamentum venosum
separates the posterior aspect of the
caudate lobe from the main part of the
left lobe
The fissure cuts deeply in front of the
caudate lobe and contains the two
layers of the lesser omentum
The posterior surface over the left lobe
bears a shallow impression near the
upper end of the fissure for the
ligamentum venosum that is caused by
the abdominal part of the oesophagus
The posterior surface of the left lobe to
the left of this impression is related to
part of the fundus of the stomach
Together these posterior relations make
up what is sometimes referred to as the
bed' of the liver
Inferior surface
Bounded by the inferior edge of the liver
It blends with the posterior surface in the
region of the origin of the lesser
omentum, the porta hepatis and the
lower layer of the coronary ligament,
and is marked near the midline by a

sharp fissure which contains the

ligamentum teres
The gallbladder usually lies in a shallow
fossa
The quadrate lobe lies between the
fissure for the ligamentum teres and the
gallbladder
Gross Anatomical Lobes of the Liver
Considered to be divided into right, left, caudate
and quadrate lobes by the surface peritoneal
and ligamentous attachments

Right Lobe
Largest in volume and contributes to all
surfaces of the liver
It is divided from the left lobe by the
falciform ligament superiorly and the
ligamentum venosum inferiorly
On the inferior face to the right of the
groove formed by the ligamentum
venosum there are two prominences
separated by the porta hepatis
The caudate lobe lies posterior, and the
quadrate lobe anterior, to the porta
hepatis
The gallbladder lies in a shallow fossa to
the right of the quadrate lobe
Left Lobe
Smaller of the two main lobes
Although it is nearly as large as
the right lobe in young children
It lies to the left of the falciform ligament
with no subdivisions
Substantially thinner than the right lobe,
having a thin apex that points into the
left upper quadrant
Quadrate Lobe
Visible as a prominence on the inferior
surface of the liver, to the right of the
groove formed by the ligamentum
venosum
Incorrectly said to arise from the right
lobe although it is functionally related to
the left lobe
It lies anterior to the porta hepatis and is
bounded by the gallbladder fossa to the
right, a short portion of the inferior
border anteriorly, the fissure for the
ligamentum teres to the left, and the
porta hepatis posteriorly
Caudate Lobe
Visible as a prominence on the inferior
and posterior surfaces to the right of the
groove formed by the ligamentum
venosum
It lies posterior to the porta hepatis
To its right is the groove for the inferior
vena cava
Above, it continues into the superior
surface on the right of the upper end of
the fissure for the ligamentum venosum

In gross anatomical descriptions this

lobe is said to arise from the right lobe,
but it is functionally separate
Vascular
Supply,
Lymphatic
Drainage
and
Innervation of the Liver
The vessels connected with the liver are the
portal vein, hepatic artery and hepatic veins
The portal vein and hepatic artery ascend in the
lesser omentum to the porta hepatis, where
each bifurcates
The hepatic bile duct and lymphatic vessels
descend from the porta hepatis in the same
omentum
The hepatic veins leave the liver via its posterior
surface and run directly into the inferior vena
cava.
Arterial Supply
Hepatic Artery
In adults the hepatic artery is
intermediate in size between the
left gastric and splenic arteries
In fetal and early postnatal life it
is the largest branch of the
coeliac axis
The hepatic artery gives off right
gastric, gastroduodenal and
cystic branches as well as direct
branches to the bile duct from
the right hepatic and sometimes
the supraduodenal artery
At the porta hepatis it divides
into right and left branches
before these run into the
parenchyma of the liver
Venous Drainage
Has two venous systems
The Portal System conveys venous
blood from the majority of the
gastrointestinal tract and its associated
organs to the liver
The Hepatic Venous System drains
blood from the liver parenchyma into the
inferior vena cava
Portal Vein
The portal vein begins at the
level of the second lumbar
vertebra and is formed from the
convergence of the superior
mesenteric and splenic veins
Lymphatic Drainage
Lymph from the liver has abundant
protein content
Lymphatic drainage from the liver is
wide and may pass to nodes above and
below the diaphragm
Obstruction of the hepatic venous
drainage increases the flow of lymph in
the thoracic duct. Hepatic collecting
vessels are divided into superficial and
deep systems
Innervation
The liver has a dual innervations

The parenchyma is supplied by hepatic

nerves which arise from the hepatic
plexus and contain sympathetic and
parasympathetic (vagal) fibres
They enter the liver at the porta hepatis
and most accompany the hepatic
arteries and bile ducts
The capsule is supplied by some fine
branches of the lower intercostal nerves,
Distension or disruption of the
liver capsule causes quite well
localized sharp pain
Hepatic Plexus
The hepatic plexus is the largest
derivative of the coeliac plexus
and receives branches from the
anterior and posterior vagi
It accompanies the hepatic
artery and portal vein and their
branches into the liver
Porto-systemic Shunts of the Liver
Note: Please see Table 1.8
Increased pressure within the portal venous
system may result in dilatation of the portal
venous tributaries
a reversal of flow may occur where these veins
form anastomoses with veins which drain into
the systemic venous circulation
LIVER
Largest internal organ
Adults- weight 1.5 kg or 2% of the body weight
Located in the right upper quadrant just below
the diaphragm
Has major left and right lobes with two smaller
inferior lobes, most of w/c are covered by a thin
capsule and mesothelium of the visceral
peritoneum
Main digestive fxn: production of bile, required
for the emulsification, hydrolysis and uptake of
fats in the duodenum.
Hepatocytes: key cell of liver, are amongst the
most functionally diverse cells of the body.
Secretion of bile components (exocrine
fxn)
Synthesis and endocrine secretion into
the blood of major plasma proteins,
including albumins, fibrinogen,
apolipoproteins, transferrin, and many
others
Conversion of amino acids into glucose
(gluconeogenesis)
Breakdown and conjugation of ingested
toxins
Amino acid deamination, producing urea
removed from blood in kidneys
Storage of glucose in glycogen granules
and triglycerides in small lipid droplets

Storage of vit A and other fat-soluble

vitamins
Removal of effete erythrocytes (by
Kupffer cells)
Storage of iron in complexes with the
protein ferritin

Hepatocytes and Hepatic Lobules

Hepatocytes
Large cuboidal or polyhedral
epithelial cells, with large, round
central uclei and eosinophilic
cytoplasm rich in mitochondria.
frequently binucleated and about
50% of them are polypoid
Hepatic lobules
Consists the liver parenchyma
Hepatocytes form hundreds of
irregular plates arranged radially
around a central vein and are
supported by a delicate stroma of
reticulin fibers.
Portal triad
Portal vein; venule branch with
blood rich in nutrients but low in O2
Hepatic artery; arteriole branch that
supplies O2
Bile ductules (1 or 2)
Sinusoids
Emerge from the peripheral
branches of the portal vein and
hepaic artery and converge on the
lobules central vein
Where venous and arterial blood
mixes
Have thin, discontinuous linings of
fenestrated endothelial cells
surrounded by sparse basal lamina
and reticular fibers
Discontinuities and fenestrations
allow plasma to fill a narrow
perisinusoidal space (space of
Disse) and directly bathe the
microvilli projecting from the
hepatocytes into this space.
Other fxnally important cells w/in the
sinusoids
a. Stellate macrophages
(Kupffer cells)
- found w/in sinusoid
lining
- recognize and
phagocytose aged

erythrocytes, freeing
heme and iron for reuse
or storage in ferritin
complexes.
- are also antigenpresenting cells and
remove any bacteria or
debris present in the
portal blood

gradually merge, enlarge and form

right and left hepatic ducts leaving
the liver

mixture of bile acids, bile salts,

electrolytes, fatty acids,
phospholipids, cholesterol and
bilirubin.
Some bile components are
synthesized in hepatocyte SER, but
most are taken up from the
perisinusoidal space; all are quickly
secreted into the bile canaliculi
Bile acids/ salts; emulsify the lipids
in the duodenum, promoting their
digestion and asorption.
Bilirubin; pigmented breakdown
product of heme that is released
from splenic macrophages primarily,
but also from Kupffer cells, and is
carried to hepatocytes bound to
albumin

Bile

b. Hepatic stellate cells (Ito

cells)
- found in perisinusoidal
space with small lipid
droplets that store vit A
and other fat-soluble
vitamins.
- produce ECM
components (becoming
myofibroblasts after
liver injury) and
cytokines that help
regulate Kupffer cell
activity.

Bile canaliculi
Formed by smaller apical surfaces
of two adherent hepatocytes, sealed
by tight junctions, into which bile
components are secreted.
Are elongated spaces (total length
>1 km) with lumens only 0.5-1 um in
diameter with large surface areas
due to many short microvilli from the
constituent hepatocytes.
Form a complex anastomosing
network of channels through the
hepatocytes plates that end near the
portal tracts.
Smallest branches of the biliary tree
or bile conducting system
They empty into bile canals of
Hering composed of cuboidal
epithelial cells (cholangiocytes)

Bile ductules
Quickly merges with short bile
canals in the portal areas; lined by
cuboidal or columnar cholangiocytes
and w/ a distinct connective tissue
sheath.