Anatomy of the Liver and Biliary System
-
Upload
api-3723290 -
Category
Documents
-
view
155 -
download
1
Transcript of Anatomy of the Liver and Biliary System
![Page 1: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/1.jpg)
Anatomy of the liver and biliary system
![Page 2: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/2.jpg)
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 %
![Page 3: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/3.jpg)
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.
![Page 4: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/4.jpg)
• 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.
![Page 5: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/5.jpg)
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.
![Page 6: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/6.jpg)
The gall bladder and bile ducts :
![Page 7: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/7.jpg)
The wall of the gall bladder:
• The muscle fibers in the wall are arranged in a criss-cross 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 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
![Page 8: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/8.jpg)
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
•
![Page 9: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/9.jpg)
• 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
![Page 10: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/10.jpg)
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
![Page 11: Anatomy of the Liver and Biliary System](https://reader033.fdocuments.us/reader033/viewer/2022061115/5464d04bb4af9f41658b4653/html5/thumbnails/11.jpg)
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 )