Liver

Question 1

Site

Answer 1

Right hypochondrium, epigastrium and may extend slightly in left hypochondrium

Question 2

Size

Answer 2

Largest gland in the body, weighing 1-2.5 kg

Question 3

Shape

Answer 3

Wedge shaped with its base on right side

Question 4

Borders

Answer 4

It has 5 surfaces:
- Anterior
- Posterior
- Superior
- Inferior
- right
Borders separating them are rounded and ill-defined except inferior border which is sharp

Question 5

Surface anatomy: upper border

Answer 5

Concavo-convex line passing through:
1. 5th intercostal space in left midclavicular line (close to heart apex and stomach fundus)
2. Xiphisternal junction (7th Sternocostal junction level)
3. 5th rib in right midclavicular line (represents liver highest point)
4. 7th rib in right mid Axillary line

Question 6

Surface anatomy: right border

Answer 6

Curved line to right between 2 points:
1. 7th rib in right midaxillary line
2. 1cm below costal margin in right midaxillary line

Question 7

Inferior border

Answer 7

Passes through 5 points:
1. 1 cm below costal margin in right midaxillary line
2. 9th costal cartilage in midclavicular line (Murphy’s point) which represents surface anatomy of gall bladder fundus
3. Transpyloric plane in midline (hand’s breadth below xiphisternal junction or midway between xiphisternal junction and umbilicus
4. Left 8th costal cartilage tip
5. 5th intercostal space in left midclavicular line

Question 8

Blood supply

Answer 8

1. Mainly portal vein (70%) and hepatic artery (30%)
2. Inside liver blood coming from both are mixed in sinusoids
3. Blood is collected from each hepatic lobule in a central vein which are collected forming 3 hepatic veins (right, left, and middle) which join IVC

Question 9

Lymph vessels

Answer 9

1. Superficial vessels
2. Deep vessels: join forming ascending and descending trunks

Question 10

Superficial vessels

Answer 10

Run in subserous areolar tissue

Question 11

Ascending trunks

Answer 11

Accompany hepatic veins and pass in diaphragm IVC opening

Question 12

Descending trunks

Answer 12

Emerge from porta hepatis

Question 13

Lymph nodes

Answer 13

1. Lateral diaphragmatic nodes
2. Paracardial nodes
3. Hepatic nodes
4. Coeliac nodes

Question 14

Lateral diaphragmatic nodes

Answer 14

Around IVC end

Question 15

Paracardial nodes

Answer 15

Around esophagus lower part

Question 16

Hepatic nodes

Answer 16

In porta hepatis and lesser omentum free border around hepatic artery

Question 17

Coeliac nodes

Answer 17

Around coeliac artery drain hepatic nodes

Question 18

Factors supporting liver in position

Answer 18

1. Hepatic veins: connecting it with IVC
2. Peritoneal folds and ligaments: attaching liver to diaphragm and anterior abdominal wall
3. Intra-abdominal pressure and anterior abdominal wall tone

Question 19

Applied anatomy: position

Answer 19

1. In living adult, normal liver is soft and cannot be felt but its position can be determined by percussion
2. If liver is felt, it indicates pathology

Question 20

Applied anatomy: bleeding

Answer 20

To stop liver tear bleeding, lesser omentum free border of is compressed by clamp for a period up to 20 minutes to occlude hepatic artery and portal vein

Question 21

Applied anatomy: vascular segments

Answer 21

Liver physiological vascular segments are essential to perform partial hepatectomy and partial liver transplantation