Anatomy of the Liver

Page Burns and Lauren Friedman

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Overview
Functions of the liver
Surfaces
Lobes
Segments and Fissures
Ligaments
Vasculature
Histology
Blood flow through the lobule
Flow of bile
Clinical applications

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Functions of the Liver
Largest internal organ and largest gland in the body
Weighs about 1,500 grams (~3 lbs)
Upper right quadrant and part of upper left quadrant of
abdominopelvic cavity
With the exception of lipids, every substance absorbed
by the GI tract is received first by the liver
Stores glycogen, iron, retinol (vitamin A), calciferol
(vitamin D)
Breaks down erythrocytes
Secretes bile
Self-regeneration
Only human organ with this property
If part of the liver is removed, remaining parts grow back to original
size and shape https://www.hepatitis.va.gov/images/va02-pt/basics/liverdet
ox-off.gif
Surfaces

Glisson's capsule
Serous coat derived
from peritoneum
Outermost layer
of liver
Inner fibrous layer
Adhered to serous
layer
Surfaces
Diaphragmatic surface
Covered with peritoneum except
posteriorly in the bare area
Bare area
Lies in direct contact with the diaphragm
Fluid drains from the omental bursa
Subphrenic recess
Separated by falciform ligament
Visceral surface
Covered with peritoneum except:
Bed of gallbladder
Porta hepatis
Hepatorenal recess
Morrison pouch
Gravity dependent when person is in
supine position
1. Hepatorenal recess
2. Subhepatic space
3. Subphrenic recess
Surfaces
Postero-inferior view:
Porta Hepatis
Transverse fissure in the middle
of the visceral surface that gives
passage to the:
Hepatic portal vein
Hepatic artery
Hepatic nerve plexus
Hepatic ducts
Lymphatic vessels
Lobes

Right lobe
Caudate lobe
Quadrate lobe
Left lobe

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Segments and Fissures
Segments
Liver is further divided into 8 segments
Based off of the tertiary branches of the right and
left hepatic arteries, hepatic portal veins, and hepatic
ducts

Fissures
Right portal fissure
Right sagittal fissure
Left sagittal fissure
Median fissure
https://s-media-cache-ak0.pinimg.com/originals/e9/cc/15/e9cc152f4a63618b049003e
Fissure for round 4d1702df5.jpg

ligament
Fissure for ligamentum
venosum
Ligaments

Coronary ligament
Holds liver to inferior
surface of the
diaphragm
Falciform ligament
Remnant of umbilical
vein

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Ligaments - Posterior View of Liver

Right triangular
ligament
Situated at the right
extremity of the bare area
and is a small fold which
passes to the diaphragm
Left triangular ligament
Connects the posterior part
of the upper surface of the
left lobe to the diaphragm

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Ligaments - Superior View
Ligaments

Round ligament
(ligamentum teres)
Obliterated remains of the
umbilical vein
Ligamentum venosum
Posterior side
Fibrous remnant from fetal
ductus venosus
Shunted blood from
umbilical cord to inferior
vena cava
Vasculature
Liver receives blood from two
sources:
Hepatic portal vein
Hepatic artery
Hepatic portal vein
The hepatic portal vein carries
venous blood drained from the
spleen, GI tract, and its associated
organs
Supplies approximately 75% of the
livers blood
Hepatic artery
Supplies other 25% of blood
A branch off of the celiac trunk
Carries oxygenated blood from
the aorta to the liver
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Vasculature
Hepatic portal vein and artery branch to right
and left sides
Branches from the porta hepatis
Supplies right and left sides with blood from GI
tract
Liver is further divided into 8 segments
Based off of the tertiary branches of the right
and left hepatic arteries, hepatic portal veins,
and hepatic ducts
Interlobular veins Right, intermediate
(middle), and left hepatic veins Inferior
vena cava
The attachment of these veins to the inferior
vena cava helps hold the liver in place.

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Histology
Hepatoblasts
Precursor stem cells
Divide and produce hepatocytes
Liver is capable of complete regeneration from as
little as 25% of the original organ
Hepatocytes
Cuboidal cells
Nutrient storage and release
Functional unit of liver: detoxification, modification,
and excretion of exogenous and endogenous
substances
Plasma protein synthesis
Protein storage
Transformation of CHO
Cholesterol synthesis
Bile salts
Phospholipids https://s-media-cache-ak0.pinimg.com/564x/67/76/70/677670d911eed04a45fa096e

Bile production and secretion 2ea9535c.jpg

Histology
Lobules
Hepatocytes are arranged into lobules
Central vein surrounded by cords (cells),
and sinusoids (gaps filled with blood)
Lobules are bordered by hepatic triad
(hepatic vein, artery, and bile duct)
Sinusoids
Vascular channels for blood cells
Fenestrated vessel (window like openings)
Wider than capillaries
Lined with endothelial cells

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Histology
Kupffer cells
Stellate macrophages (resident macrophages)
Comprise largest population of resident tissue
macrophages in the body
Line the walls of the sinusoids
Play a role in the innate immune response
First line of defense
Efficiently phagocytize pathogens entering
from portal or arterial circulation
Change in activity in these cells is associated with
disease
Chronic inflammation of liver, alcoholic, and
nonalcoholic fatty liver disease

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Blood flow through the lobule
Blood from the GI tract drains into the
hepatic portal vein
At this point, the blood is oxygen poor,
but nutrient rich
Terminal branches of the hepatic
portal vein and hepatic artery empty
into sinusoids
Space of Disse
Space between endothelium and
hepatocytes https://embryology.med.unsw.edu.au/embryology/images/thumb/0/02/Liver_structure_cartoon.jpg/800px-Liver_structure_cartoon.jpg

Plasma is filtered in this region

Provides a major fraction of the body's
lymph.
Blood flows through the sinusoids and
empties into the central vein of each
lobule
Circulation from the liver to the heart
Central veins coalesce into
interlobular veins
Small branches in each of the 8
segments
Interlobular veins coalesce into
right, intermediate (middle), and
left hepatic veins
Hepatic veins empty into the
inferior vena cava.
The detoxified, clean blood will
enter the inferior vena cava to be
brought back to the heart

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 Flow of bile
Hepatocytes secrete bile into the bile
canaliculi
Canaliculi= Small drainage tubes
Drains into the small interlobular biliary
ducts
Then to large collecting bile ducts of the
intrahepatic portal triad
Merge to form the right and left hepatic
ducts

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Flow of bile
Right and left hepatic ducts
merge to form the common
hepatic duct
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Common hepatic duct

merges with cystic duct from
gallbladder into the common
bile duct
Bile will pass through the
common bile duct for immediate
use in the duodenum
Or will pass through the cystic
duct and enter the gallbladder
for storage
Clinical Application

Cirrhosis of the Liver

Scar tissue replaces healthy tissue
Over time, liver becomes lumpy and hard
leading to failure
Tough for blood to flow through hepatic portal
vein because of lumps/hardness
No cure - just liver transplant
Stages
Compensated: no symptoms
Decompensated: symptoms
Esophagus bleeding
Fluid build-up in stomach http://cirrhosispictures.org/large/14/Cirrhosis-Of-The-Liver-Pictures-3.jpg

Encephalopathy - confusion from toxin

build-up in blood
Jaundice
Gallstones
Prone to bruising and bleeding
Clinical Application
Cirrhosis of the Liver
Causes
Alcohol liver disease
Viral hepatitis (inflammation)
Fatty liver disease

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Clinical Application

Liver Failure
Rapid impairment of hepatocyte function
May result from acute liver lesion
May be asymptomatic for several
months/years
Fulminant hepatic failure
Severe impairment of hepatic functions
or severe necrosis of hepatocytes - in
absence of preexisting liver disease
Jaundice (yellow tint of skin or membrane
of eyes) is the presenting symptom in
most patients (children)
Progress to coma, develop ascites,
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Mostly caused by acute viral hepatitis pg
References
Bowen, Richard. "Architecture of the Liver and Biliary Tract." Architecture of the Liver and Biliary Tract. Colorado State University, n.d.

Web. 29 Mar. 2017. <http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/anatomy.html>.

Dixon, Laura J., Mark Barnes, Hui Tang, Michele T. Pritchard, and Laura E. Nagy. "Kupffer Cells in the Liver." Comprehensive

Physiology (2013): n. pag. Web. 30 Mar. 2017. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748178/>.

"Falciform Ligament." ANATOMIC.US. N.p., n.d. Web. 30 Mar. 2017. <http://www.anatomic.us/atlas/falciform-ligament/>.

Liver Failure." WebMD. WebMD, 2015. Web. 27 Mar. 2017.

<http://www.webmd.com/digestive-disorders/digestive-diseases-liver-failure#1>.

Moore, Keith L., Anne M. R. Agur, and Arthur F. Dalley. Essential Clinical Anatomy. Philadelphia: Wolters Kluwer Health, 2015. Print.

"What Is Cirrhosis?" Web MD. Web MD, 2015. Web. 27 Mar. 2017. <http://www.webmd.com/a-to-z-guides/cirrhosis-liver#1-2>.

Zhou, Wen-Ce. "Pathogenesis of Liver Cirrhosis." World Journal of Gastroenterology 20.23 (2014): 7312. Web.

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064077/>.