Malavika T R Calicut Medical College

3. LIVER
 Right hypochondrium extent into Epigastrium & Left
hypochondrium
 1.5 kg

4. Ligaments
 Right triangular ligament
Fixes right lobe to under surface of right dome of
diaphragm

5.  Left triangular ligament
Fixes left lobe to to the diaphragm in a similar
fashion

6.  Falciform Ligament
Remnant of Umbilical vein
From umbilicus to liver
Divide to Rt & Lt lobes passing into interlobar
fissure

9. Blood supply
 80 % Portal vein
 20 % Hepatic artery
 Hepatc Artery
Rt branch Lt branch
Rt lobe Lt lobe

10. Venous drainage
 3 Hepatic veins
Right , Middle , & Left
IVC

11. Hilum of liver – PORTA HEPATIS
 Hepatic artery
 Bile duct - anterior
 Portal vein - posteriorly

12. Gall bladder
 Pear shape
 7.5 – 12 cm
 Capacity = 5 ml

13. ANATOMICAL
DIVISION
HARTMANN’S POUCH
Narrow angulated distal
portion of neck
m/c site where stones occur

14. CRYPTS OF
LUSCHKA

15.  Cystic duct = 3 cm (variable )
 Lumen = 1-3 mm
 Valves of Heister =
spiral folds
 Sphincter of
Lutkens
= surrounding the wall

16. CHD = < 2.5 cm
CBD = 7.5 cm

17. Supraduodenal portion
Retroduodenal portion
Infraduodenal portion
Intraduodenal portion
PARTS OF COMMON BILE
DUCT

20. 2nd part
Ampulla of
vater

22. CALOT’S TRIANGLE
 Left = CHD
 Below = Cystic duct
 Above = Inf. Surface of liver
 Content = LN of Lund

23. ARTERIAL SUPPLY
 Cystic artery = br .of right hepatic artery
 Accessory cystic artery = gastroduodenal artery
( occasionally )

25. LYMPHATICS
 Subserosal & Submucosal lymphatic vessels
 Cystic LN of Lund ( sentinal LN )
(Junction of Cystic & CHD)
 Efferent vessels
 Hilum of liver 
 Coeliac LN

27. LIVER
FUNCTIONS
 Removal of endotoxins & foreign antigens
 Synthesis of all proteins except globulins
 Glucose metabolism ,Glycolysis ,Gluconeogenesis
 Drug & hormone metabolism
 Synthesis of clotting factors
 Urea formation
 Bilirubin formation

28. GALL BLADDER
FUNCTIONS
 Reservoir
 Concentration
 Mucus secretion

29. BILE FORMATION
Hepatocytes
Bile into
canaliculi
R & L Hepatic
ducts
CHD

30. Cystic duct
Gall bladder
Concentration of
bile

32. BILE
 250 – 1000 ml / day
 98% water
 Capacity of GB = 40 – 50 ml
 Absorption of water concentration
Fatty food CCK  GB contract Sphincter of Oddi
relax

33. COMPOSITION OF BILE
 Bile salts = cholate , chenodeoxy cholate , deoxy
cholate
 Cholesterol & Phospholipids
 Bilirubin
 Protein & Inorganic ions
 Water

34. BILIRUBIN METABOLISM
RETICULO
ENDOTHELIAL
SYSTEM

35. Hb
HEME GLOBIN

36. HEME
OXIDATION
OXYGENASE
BILI
VER
DIN
REDUCTION
BILIRU
BIN
BV
REDUC
TASE

37. BILI
RUBI
N
BILIARY
TREE

39. BILI
RUBI
N
BILIARY
TREE
PREHEPATIC
JAUNDICE

40. BILI
RUBI
N
BILIARY
TREE
HEPATO CELLULAR
JAUNDICE

41. BILI
RUBI
N
BILIARY
TREE
OBSTRUCTIVE
JAUNDICE