Hepat

ANATOMY
SYLLABUS
Liver, Gallbladder, Bile duct and Hepatoportal system: (p. 185)

Gross features, Applied anatomy,

Microscopic structure: (p. 190)

Liver and Gall bladder

Hepatobiliary Apparatus: (p. 191)

Parts, Gross anatomy, Development, Congenital anomalies of hepatobiliary system

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ANATOMY

LIVER Gross features [09, 10]

Past Questions: ♦ The liver is the largest gland of the body and
1. Mention different lobes of liver. Draw a neat consist of both (I) exocrine and (II) endocrine
labeled diagram to explain histological features parts.
of liver. (1 +4 = 5) [09 July] I. Exocrine part: Secrets bile, which is conveyed
2. List the vascular segments of liver. Draw a by biliary passages.
labeled diagram to describe its microscopic II. Endocrine part: Liberates glucose from
anatomy. (2 +3 =5) [08 Dec] glycogen, most of plasma protein except
3. Draw a labeled diagram to show the microscopic (immunoglobulin) and heparin.
structure of liver. Name two clinical conditions ♦ Highly vascular organ, reddish brown in colour,
related to this organ (5) [11 July] soft, solid and friable to the touch
4. Give shape, situation of the organ which secretes ♦ Shape: Wedge–shaped, with the broad base
bile. Name the surface and lobes. Name two directed to right.
organs related to its inferior surface. ♦ Situation: Occupies whole of right
(2 +2 +1 =5) [10, 08 July] hypochondrium, upper part of epigastrium and
5. a. Draw a labelled diagram to show the part of the left hypochondrium upto left lateral
histological structure of liver (no description plane.
required) (3) [06 Dec] ♦ Weight:
b. Mention the formation and termination of the In adult male → 1400gm to 1800 gm V
bile duct. (2) [06 Dec] In adult female → 1200 gm to 1400 gm
6. Give an account of the inferior (visceral) surface At birth → 150 gm
of the liver with a suitable labelled diagram. Parts
(5) [10 July, 04 Nov] a. Five surfaces
10.Describe briefly the course with relations of the I. Anterior surface
common bile duct. Add a note on its applied II. Posterior surface
anatomy. (4)[06 June] III. Superior surface
11.Write short notes on: (1+2+2=5) [03 Nov] IV. Inferior surface
a. Hepato-renal pouch of Morison V. Right surface
b. Lobes [O9]
b. Source of nutrition of liver
I. Anatomical right and left lobes.
c. Sphincters of oddi at the termination of bile
II. Physiological right and left lobes
duct.
c. Borders
12.Write short notes on:
I. Inferior border (Prominent border):
a. Intrahepatic circulation of blood (2) [06 June] - Separates inferior surface from anterior
and right lateral surface.
II. Posterior – Inferior border:
- Separates the inferior surface from
posterior surface.

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III. Posterior – superior border: - Bare areas:

- Separates posterior surface from I. A triangular bare area: on the posterior
superior surface. surface of right lobe, limited by the upper and
d. Fissures: non peritoneal, 'H' shaped lower layers of coronary ligament and by the
I. Right limb of fissure: Includes groove for right triangular ligament.
IVC and fossa for Gallbladder. II. The groove for the IVC: On the posterior
II. Left limb of fissure: Includes fissures for surface of right lobe of liver.
ligamentum venosum and ligamentum III. The fossa for the Gall bladder: Lies on inferior
teres. surface of right lobe to the right of quadrate
lobe.
Relation:
IV. The coronary ligament
1. Peritoneal relation of liver and bare areas
V. The lesser omentum
Bare area of liver:
- The area of liver which is devoid of peritoneal VI. Portahepatis: Is false gate way.
covering are called bare areas

2. Visceral relation of liver: II. Posterior surface

I. Anterior surface - Triangular and middle part shows deep
- Triangular and slightly convex concavity for vertebral column.
- Possess bare area: Related to diaphragm and
- Related to: right suprarenal gland.
• Xiphoid process - Possess groove for IVC
• Anterior wall in median plane - Caudate lobe lies superior recess of this lesser
Sac, which is related to
• Diaphragm on each side
• Crura of diaphragm above aortic opening
• 6th – 10th costal cartilage on the right • Right inferior phrenic artery
side, 6th – 8th on left side. • Coeliac trunk

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- The fissure for ligament venosum b. Between two lobes:

- Posterior surface of left lobe is marked by
oesophageal impression.
III. Superior surface
- Posses cardiac impression in the middle
- On each side of cardiac impression, surface is
convex to fit dome of diaphragm.
- The diaphragm separates this surface from
pericardium and heart in middle and from
pleura and lung on each side.
IV. Inferior surface [04, 10]
- The inferior surface is quadrilateral and is
directed downwards, backward and to left.
- It is marked by impression for neighboring
viscera as follows:
a. On left lobe: posses
- Gastric impression
- Tuber omentale
• Rounded elevation between gastric
impression and lower end of fissure for
ligamentum venosum.
• Comes in contact with lesser omentum.
- Posses fissure for ligamentum teres
c. Right lobe: Posses
- Quadrate lobe
Which is related to:
• Pyloric part of stomach and 1st part of
duodenum
• Right free margin of lesser omentum
with its content
• Transverse colon in its lower part
- The fossa for gall bladder
- Right to the fossa for G.B. there are:
• Colic impression for hepatic flexure of
colon.
• Renal impression of rt. kidney
• Doudenal impression for 2nd part of
duodenum
- Portahepatis
- Caudate lobe and papillary process

V. Right surface - Middle one third to: diaphragm, costo-

- Quadrilateral and convex diaphragmatic recess.
- Related to diaphragm opposite to the 7th to - Lower one third to diaphragm alone.
11th ribs in midaxillary line. Lobes of liver [09]
- Upper third of surface related to: diaphragm, I. Anatomic lobe
pleura and lung - Anatomically liver is divided into left and right
lobe by attachment of falciform ligament
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anteriorly and superiorly. By fissure for
ligamentum teres inferiorly and by fissure for
the ligamentum venosum posteriorly.
1. Right lobe
- Right lobe is much larger than left lobe
(approximately 5/6th of liver is Rt. lobe)
- Presents two distinct lobe:
a. Caudate lobe
b. Quadrate lobe
a. Caudate lobe
- Situated on posterior surface
- Boundaries:
• On right: By grove for IVC
• On left: by fissure for ligamentum
venosum
• Inferiorly: by portahepatis
• Above: Continuous with superior surface
- Below and to the right, just behind the
portahepatis, it is connected to right lobe of
V liver by caudate process below and to the
left, it presents a small rounded elevation
called papillary process.
b. Quadrate lobe
- Situated on the inferior surface and is
rectangular in shape
- Boundaries:
• Anteriorly: Inferior border of liver
• Posteriorly: Portahepatis
• On right: Fossa for Gall bladder
• On left: Fissure for the ligamentum
teres.
- Right lobe presents porta-hepatis which is
gate way of liver.
2. Left lobe:
- Left lobe of liver is much smaller than right
lobe and forms only 1/6th of the liver.
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- It is flattened from above downward
- Near fissure for ligamentum venosum, its
inferior surface presents a rounded
elevation, called tuber omentale.
II. Physiological lobes
- On the basis of intrahepatic distribution of
hepatic artery, portal vein and biliary ducts,
the liver can be divided into right and left
physiological lobes or entire liver is divided into
eight segments.
- The lobes are demarcated by a imaginary line
(Cholecysto-venacaval line) which extend along
the floor of fossa for G.B. and above for IVC.
- On the anterosuperior surface of liver, the line
passes a little to right to falciform ligament.
- Right lobe is divided into anterior and
posterior segments.
- Left lobe is divided into medial and lateral
segments.
- Each segments of functional lobe is supplied with
branch of hepatic artery, portal vein and bile duct.
- Numerical identity
• Caudate lobe (Posterior segment):
Segment-I
• Remaining segments in clockwise manner
upto VIII.
- Segments I, II, III, IV: Confined to left
lobe(physiological) and
- segment V, VI, VII andVIII : Confined to right
lobe(physiological).
- Segment I: Caudate lobe
- Segment IV: Quadrate lobe.
Applied Aspects:
- During partial resection of liver, intersegmental
veins are considered as surgical landmarks
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Portahepatis [11] II. Ligamentum venosum

- It is deep transverse, non peritoneal fissure - Remnant of obliterated ductus venosus.
about 5cm which is situated on the inferior - In foetal life, most of blood of left
surface of right lobe of liver. umbilical vein shunts to the IVC via
- It lies between the caudate lobe above and ductus venosus after by-passing hepatic
qudarate lobe below and infront. circulation.
- Structures entering liver via portahepatis are: Blood supply [03, 06]
• Portal vein: Right and left division Liver receives it blood supply from
i. Portal vein 80%
• Hepatic artery: Right and left branch
ii. Hepatic artery 20%
• Hepatic plexus Portal vein 80% Hepatic artery 20%
- Structure leaving liver via portahepatis are ↓ ↓
• Right and left hepatic ducts Brings deoxygented Brings oxygenated
• Cystic dust blood blood

• Lymphatics ↓
Both of them divided into right and left

- Arrangements of principal structures at the
portahepatis from before backward (@DAV)
• Right and left hepatic ducts (D)
• Right and left hepatic arteries (A)
• Right and left division of portal vein (V)
- Porta–hepatis is not true gateway.
Ligaments of liver
- It consists of five peritoneal folds/false
ligaments and two developmental/true
ligaments.
1. Peritoneal folds
I. Falciform ligament
II. Coronary ligament
III. Right triangular ligament
IV. Left triangular ligament
V. Lesser omentum
2. True ligaments
I. Liagmentum teres hepatis
- Remnant of obliterated left umbilical vein
- In foetal life, left umbilical vein conveys
oxygenated blood from placenta to fetus.
Blood supply
branches before entering liver
↓
Within liver, they again divide is form of
segmental vessels which inturn again divide
into interlobular vessels
↓
Ramification of interlobular branches open into
V
hepatic sinusoids where arterial blood mixes
[07] with portal venous blood. Here blood comes
into close contact with liver cells.
↓
Hepatic sinusoid drain to interlobular veins
which join to form sublobular vein Venous drainage
↓
Sublobular vein unite to form hepatic veins,
arranged in two group i.e. upper (Right, left and
middle) and Lower (variable no of vein from right
lobe and caudate lobe
↓
Hepatic vein drain to IVC
Lymphatic drainage
I. Superficial lymphatics: Terminate in caval,
hepatic, paracardial, coeliac lymph node.
II. Deep lymphatics: Drains partly to nodes around
end of IVC and partly in the hepatic nodes.
Nerve supply
- Supplied with autonomic nervous system.

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I. Parasympathetic fibre: Vagal fibre 7. Portal tracts or portal canals are areas of
II. Sympathetic fibre: (T5 – T12) segment of connective tissue at the periphery of a hepatic
spinal cord. lobule where the portal triad, formed by
Applied Aspects: branches of portal vein, hepatic artery, bile
- Inflammation of liver parenchyma is called duct and lymphatics is present.
hepatitis which may be infective hepatitis or
8. Tubular space is present in between two
amoebic hepatitis.
hepatocytes called bile canaliculus.
- For liver biopsy, needle is inserted through right 8th
intercostal space, which transverses both pleural
and peritoneal cavities.
- Pringles maneuver: Bleeding from liver can be
stopped by compressing the free edge of lesser
omentum. Since, the margin of lesser omentum
contain hepatic artery and portal vein, this is
called Pringles maneuver.
- Liver is common site of metastatic tumors derived
from cancer of colon.

Microscopic Structure
Liver
1. It is covered by Glisson's capsule which is
made up of connective tissue.
V
2. Paranchyma is formed by hepatocytes. The other
cells present are perisinusoidal or Ito cells,
endotheliocytes, hepatic macrophages (Kupffer's
cells), blood cells, and lining epithelial cells of
intrahepatic part of biliary ducts.
3. Hepatocytes are polyhedral cells with central
spheroidal euchromatic nuclei.
4. Adjacent plates are separated from each other
by spaces called hepatic lacunae that are filled
with endothelium lined sinusoids. This
endothelium is highly fenestrated. The
fenestrae allow the blood plasma into
perisinusoidal space, space of disse.
5. The sinusoids receive blood from branches of
portal venules and the hepatic arterioles which
are present in the portal tracts.
6. Blood from the sinusoid drain into central vein.
Gall Bladder
1. Muscular bag which stores and concentrates
the bile secreted by the liver.
2. The mucosa is lined by tall columnar
epithelium with basal nuclei and faintly
eosinophilic cytoplasm. The epithelium has
microvilli. Near the cystic duct, the epithelium
invaginates into the lamina propria forming
tubuloacinar glands with wide lumen. These
are mucous secreting.
3. Mucosa is thrown into folds.
4. Lamina propria is highly vascular.
5. Outer to this is a layer of smooth muscle.
6. On one surface the outer most layer is
adventitia and on the other surface serosa.

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a. Intra hepatic apparatus – includes

i. Bile canaliculi
ii. Canals of Hering
iii. Bile ductules
iv. Right and left hepatic ducts
b. Extra–hepatic biliary apparatus include
i. Common hepatic duct
ii. Gall bladder
iii. Cystic dust
iv. Common bile duct (CBP)

EXTRAHEPATIC BILIARY
APPARATUS
Past Questions:
1. Name the constituent structures of extrahepatic
biliary apparatus. Mention the parts and blood
supply of gall bladder. Mention its source of
development. (2+1+1+1=5) [05 June]
2. Name the components of extrahepatic part of
the biliary apparatus. Describe the gall bladder
under the following headings parts, capacity and
blood supply. Mention its source of
development. (1+3+1=5) [05 Dec] V
7. Discuss gall bladder under the following
headings; (1+3+1=5) [09 Dec]
a. Shape, colour, capacity
Common hepatic duct
b. Parts of gall bladder with relations.
- It is formed close to right end of portahepatis by
c. Applied importance union of right and left hepatic duct.
8. Name the constituent structures of extra hepatic
- Passes downward within right free margin of
biliary apparatus. Mention different parts,
lesser omentum, for about 3 cm and joined on
capacity, blood supply and source of
development of gall bladder. (1+3+1=5) [03 June] right side at acute angle by the cystic duct to form
the bile duct.
9. Discuss the portal vein under the following
headings: (1+3+1=5)[07 July] Relation:
a. Extent - Behind: Portal vein, right branch of hepatic
b. Course with relations artery (Sometimes)
c. Applied anatomy - Left side: Principal hepatic artery
♦ Biliary/Excretory apparatus of liver includes the - Below and to right: Cystic duct
passages through which hepatic bile and gall Gall bladder (G.B) [03, 09]
bladder bile are conveyed into the second part of ♦ Pear shaped hollow viscus
the duodenum.
♦ Colour: Slate blue or Bluish green
♦ The apparatus is divided into
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♦ Situation: Situated obliquely in nonperitoneal - 'S' shaped curve as it passes upward,

fossa on the under surface of right lobe. forward then abruptly downward and
backward.
♦ Extent: Extends from right end of portahepatis to
- From the neck, a small diverticulum known
anterior border of liver.
as Hartmann's pouch projects downward
♦ Measurement: and backward towards the duodenum.
- Length: 7 to 10 cm Relation:
- Breadth: 3 cm Above : Nonperitoneal
- Capacity: 30 – 50 ml Related to liver separated by
connective tissue
♦ Parts:
Below : Covered with peritoneum
- Present from below upward and backward 1st part of duodenum
I. Fundus Blood supply [05]
II. Body i. Arterial supply
III. Neck - Cystic artery: Branch of right branch of
I. Fundus hepatic artery. (MCQs 2013)
ii. Venous drainage
- Lower expanded free end of G.B. that
- Cystic vein pierces the liver through the
project below liver.
fossa for G.B. and drains into intrahepatic
- Directed downward, forward and to right part of portal vein.
- Entirely invested by peritoneum from all iii. Lymphatic drainage
sides. - Hepatic lymph nodes
Relation: Nerve supply
In front: Anterior Abdominal wall just below - Mainly by sympathetic nerves via coeliac and
the tip of 9th costal cartilage. hepatic plexus.
Behind: Transverse colon.
V Applied Aspects:
II. Body Gall Bladder [09]
- Lies in fossa of Gall baldder. - Important site of formation of Gall stone
(cholelithiasis)
- Extends from fundus to neck and is directed
- Gall stone may be (i) Cholesterol stone (ii)
upward, backward and to the left
Pigmented stone
- Upper surface of body is non peritoneal, - Inflammation of G.B. is called cholecystitis
and lower surface and sides are covered • Patient complains of pain over right
with peritoneum. hypochondrium radiating to angle of right scapula.
Relation: • When finger is placed just below the costal
Above : Liver separated by loose margin at the tip of 9th costal cartilage the
areolar tissue with deep patient feels sharp pain on inspiration, this is
branch of cystic artery and called murphy's sign.
vein - Calot's tingle: Triangular space formed by cystic
Below : Transverse colon duct, common hepatic duct and segment-V of right
hemiliver forms calot's triangle. [MCQs 2013]
1st part of duodenum
• Space contain cystic artery, cystic lymph node
Right Side : Right colic flexure and autonomic fibres reaching gall bladder.
Superior duodenal flexure - Cystic artery is a branch of right hepatic artery.
Left Side : Pyloric part of stomach [MCQs 2013]
III. Neck - Referred pain: Pain of stretch of CBD or G.B. is
- Narrow upper end of G.B. referred to epigastrium, also referred to right
- Extend from body to cystic duct shoulder, inferior angle of right scapula.

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Cystic duct Common Bile duct [03, 06, 10]

♦ Length: 3 – 4 cm Formation: Formed by union of cystic and common
♦ Begins from the neck of G.B. passes downward, hepatic duct near porta hepatis
backwards and the left. Length: 7.5 cm, 6 cm in diameter
♦ Ends by joining the right side of common hepatic Course:
duct at an acute angle - Bile duct runs downward and backward, first in
♦ The interior of cystic duct presents about 5 to 12 the free margin of lesser omentum:
crescentic valves known as spiral valves of
supraduodenal part.
Heister which makes the lumen patent.
♦ Spiral valve of Heister is not true valve. - Behind the first part of the duodenum:
Relation: Retroduodenal part
- Close to neck: Cystic duct, artery and vein - Infraduoderal part.
(before backward) - Pancreatic duct accompanies it through the wall of
- Behind: Portal vein duodenum (intraduodenal part), the course within
- Medially: Common hepatic duct wall is very oblique and both ducts unite to form
- Above and laterally: Cystic artery hepatopancreatic ampulla or ampulla of vater,
that opens by piercing the medial wall of 2ndpart of
duodenum 8–10cm distal to pylorus.
Relation:
Common bile duct part Anterior relation Posterior relation To left
I. Supraduodenal part - Liver - Portal vein - Hepatic artery
- Epiploic foramen
II. Retroduodenal part - 1st part of duodenum IVC - Gastroduodenal artery
III. Infraduodenal part - A groove in upper and lateral part of IVC -
posterior surface of head of the V
pancreas

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Applied Aspects:
- Obstructive jaundice is caused by interruption of
bile passage to duodenum (2nd part) due to
obstruction of the bile duct. It is encountered in
carcinoma of head of pancreas.
- Failure of bile duct to canalize during development
causes atresia, jaundice may appear soon after birth.
Sphincter of oddi [03]
♦ The fibroelastic coat contains a few smooth
muscle fibres which are mostly longitudinal in
direction along the duct.
♦ Around the ampulla, however the muscles are
circularly arranged and form a system of sphincter
known as sphincter of oddi.
♦ It consists of 3 sets of sphincter.
a. Sphincter choledochus (Sphincter of Boyden):
- Around the pre-ampullary part of bile duct
- Strongest one
b. Sphincter pancreaticus
- Around the preampullary part of the
pancreatic duct
c. Sphincter of oddi (Proper):
V - Around the termination of ampulla.
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Applied Aspect:
- Ampullary sphincter is surgically divided to allow
asscess the CBD during Endoscopic retrograde
cholangiopancreatography.
Hepato-portal system
Definition:
♦ Hepato–Portal system is a system of blood
circulation in which blood flow through the gut
itself (from capillaries of intestine) plus blood
flows through, spleen, pancreas, all courses into
liver by way of portal vein which again passes
through minute liver sinusoids and finally leaves
the liver by the of hepatic veins.
♦ The water soluble nutrients absorbed form the gut
are transported in portal venous blood to liver
sinusoids
Portal vein [03, 07]
- Drains the blood from the abdominal part of
alimentary tract, except the lower part of
rectum and anal canal.
- Cardinal component of Hepato portal system.
- Collect blood from:
a. The alimentary tract
b. The gall bladder
c. The pancreas
d. The spleen
Conveys it to liver, in the liver, the portal vein
forms sinusoids.
Formation of portal vein
• Portal vein is formed by the union of
superior mesenteric and splenic veins
behind the neck of pancreas, in front of
IVC, and at the level of L2 vertebra.
Course:
- The course of portal vein is divided into
extrahepatic and intrahepatic parts.
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Relation of extra hepatic part

Extra hepatic Part Course Anterior relation Posterior relation
i. Infraduodenal Part – Behind the neck of – Neck of pancreas – IVC
pancreas
V
ii. Retro-duodenal part – Behind the 1st part of – 1st part of duodenum – IVC
duodenum – Bile duct
– Gastro-duodenal artery
iii.Supra-duodenal part – In the right free margin – Hepatic artery – IVC Separated by epiploic
of lesser omentum – Bile duct (within free foramen
margin of lesser omentum)
Relation of Intra hepatic part Applied Aspects:
- Portal blood circulates in liver successively - In portal obstruction, there be following
through portal vein → Portal canal → hepatic manifestation
sinusoids → central veins → sublobular veins a. Portal hypertension:
- Pressure is greater than 40 mmHg
→ hepatic veins → IVC
- Caused by
Tributaries • Cirrhosis
I. Sup. mesenteric vein⎫ • Bantis disease
⎬Formative tributaries
II. Splenic vein ⎭ • Thrombosis of portal vein
III. Right gastric vein⎫ Outcome
⎬
IV. Left gastric vein ⎭Received by trunk of portal vein - Ascites
V. Cystic vein ⎫ - Congestive splenomegaly
⎬
VI. Paraumbilical vein⎭Received by 2 division of portal vein - Collateral circulation through the porto–
Systemic communication

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Collateral anastomosis between portal and systemic veins (Porto–caval anastomosis)

Site of portacaval Vein of portal vein Systemic vein Changes due to portal
anastomosis hypertension
i. At lower end of Left gastric vein Hemi-azygous vein Oesophageal varix
oesophagus
ii. At lower end of rectum Superior rectal vein Middle and inferior rectal Internal rectal piles
and Anal canal vein
iii. At umbilicus Paraumbilical vein Superior epigastric,lateral Caput medusa
thoracic, posterior
intercostal
iv. Bare area of liver Hepatic venules Phrenic and intercostal –
vein
Development of Hepato–biliary system and Gall bladder and cystic duct [10, 03]
congenital anomalies - Developed from pars cystica: outgrowth of
Liver hepatic diverticulum.
- Liver primordium appears during 3rd week as - Bile duct is formed by joining of cystic duct
outgrowth of endodermal epithelium at distal with hepatic duct.
end of foregut → Hepatic diverticulum. Congenital anomalies of liver and G.B.
- Hepatic diverticulum is divided into - Common anomalies
1. Pars Hepatica:
V - Usually asymptomatic but become clinically
• Forms liver parenchyma (liver cells) important under pathological condition.
2. Pars Cystica: - G.B. divided into two part → duplication
- Hepatic sinusoids: It is formed by intermingling - Extrahepatic biliary apparatus
of epithelial liver cords with vitelline • Biliary passage fail to recanalize
membrane and umbilical vein.
• Occur in 1/15,000 live birth
- Hematopoietic cell: Kupffer cells and
• 15 to 20% able to live and remaining die.
connective tissue cells → are derived from
- Intra hepatic biliary duct atresia
mesoderm of the septum transversum.
- Falciform ligament and lesser omentum: • Duct formation lies within liver itself.
developed from mesoderm of septum
transversum lying between liver and foregut.

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SPECIAL POINTS FOR MCQs

Liver:
1. Riedels lobe: A tongue like extension of right lobe of liver.
2. Lies in right upper quadrant of the abdomen, wt: 1500 g.
3. G.B. lies in dorsal surface of the liver in transpyloric plane.
4. Covered by peritoneal membrane i.e. Glisson's capsule.
5. Described lobe: Rt, Lt, quadrate and caudate.
6. The blood supply of liver is → Supplied 2/3rdby portal vein and 1/3rd by hepatic artery
7. Wt. of liver in (infant): wt. of liver in adult 1:40
8. Caudate lobe is related with anterior to right with inferior phrenic artery.
9. Sphincter of oddi consist of 3 sphincters
10. Arrangement of duct (D) artery (A) and vein (V) entering via portahepatis is DAV (before
backward)
11. Ligamentum teres hepatis is remanant of left umbilical vein.
12. Falciform ligament contains ligamentum teres.
13. Portosystemic shunt is not seen in Anorectum.
14. Kupffer cells of liver develop from mesoderm of septum transversum. V
15. When stomach is empty, quadrate lobe of liver is related to first part of duodenum.
16. Venous blood of liver is drained by hepatic veins.
Gall bladder:
1. Capacity: 30–50ml of bile.
2. Cystic duct has spiral valve of heister that regulates bile flow.
3. Triangle formed by cystic duct, common hepatic duct and inferior border of liver is called Triangle
of calot. Content of triangle: (i) Cystic artery (ii) LN → Lymph node of lund
4. G.B. is supplied by cystic artery, a branch of right hepatic artery. [MCQs 2013]
5. Venous drainage mainly in portal vein.
6. Cystic lymph node of lund near superior aspect of cystic duct → drains into cystic duct.
7. 'Monihyan's Hump" → an abnormal bend in the course of right hepatic artery throwing it into the
configuration of a caterpillar hump. It invites injury unless it is carefully dissected.
8. G.B is lined by → Simple columnar epithelium.
9. Referred pain of G.B. is felt at Tip of right shoulder.
10. Pouch at the exit of G.B. into cystic duct is called Hartman's pouch.

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11. Bile duct open in a separate opening from main pancreatic duct.
12. Sphincter of oddi consist of 3 sphincters.
13. Bile duct opens into 2nd part of duoderum 8–90 cm distal to pylorus
14. Calot's triangle: Triangular space formed by cystic duct, common hepatic duct and segment-V of
right hemi liver forms calot's triangle. [MCQs 2013]
Portal vein:
1. Provides 3/4th or 2/3rd of liver's blood supply.
2. Formed by superior mesenteric vein and splenic veins combination behind the neck of pancreas at
level of L2 vertebra.
3. Length 5–8cm, diameter 1–3 cm.
4. Divides into left and right hepatic branches in portal fissure. The Lt. branch is longer.
5. Divides into small veins and venules and finally open into hepatic sinusoids.
6. The portal vein has no valves.
7. Normal portal venous pressure is 6–12 mm Hg.
8. To create porto-caval anastomosis in portal hypertension, Left splenic to left renal vein
anastomosis should be performed.

-198- FAST TRACK BASIC SCIENCE MBBS