DOCSLIB.ORG

Fatty Liver Disease, a Silent Killer of Human Beings

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fatty Liver Disease, a Silent Killer of Human Beings Fatty Liver Disease, a Silent Killer of Human Beings Fatty Liver Disease, a Silent Killer of Human Beings By Ashis Kumar Saha Fatty Liver Disease, a Silent Killer of Human Beings By Ashis Kumar Saha This book first published 2020 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2020 by Ashis Kumar Saha All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-5275-4257-2 ISBN (13): 978-1-5275-4257-0 TABLE OF CONTENTS Preface ....................................................................................................... vi Chapter 1 .................................................................................................... 1 Anatomy and physiology of the liver Chapter 2 .................................................................................................. 45 Liver function tests Chapter 3 .................................................................................................. 71 Ultrasonography of the liver Chapter 4 .................................................................................................. 79 Endoscopic ultrasound of the liver Chapter 5 .................................................................................................. 83 Fibroscan of the liver Chapter 6 .................................................................................................. 85 Alcohol and the liver Chapter 7 ................................................................................................ 128 Lipid metabolism and the role of the liver Chapter 8 ................................................................................................ 151 Etiopathogenesis of nonalcoholic fatty liver disease Chapter 9 ................................................................................................ 178 Clinical spectrum and diagnosis of nonalcoholic fatty liver disease Chapter 10 .............................................................................................. 196 Management of nonalcoholic fatty liver disease PREFACE A large number of people are now suffering from type 2 diabetes mellitus. Due to the development of cooking, more and more high calorific foods are developing consisting of enormous amounts of saturated fat and other constituents. As a result a large percentage of people are now suffering from metabolic syndrome. The patient becomes obese, may develop diabetes and in some cases hypertension. All the factors interact with each other and ultimately lead to fatty liver disease. Most people neglect the early stage of fatty liver disease and continue their unrestricted lifestyle. As a result the disease silently progresses to steatohepatitis. At this stage the patient may develop symptoms which are the warning signs and will need to go to their doctor for treatment. But asymptomatic individuals with steatohepatitis ultimately develop fibrosis which may ultimately develop cirrhosis. So, treatment of metabolic syndrome, diabetes, and hypertension will allow the recovery of patients suffering from fatty liver disease. Again, the patients with fatty liver disease may die from cardiovascular disease which also can be taken care of. This book will open all the doors of fatty liver disease – how it develops, what should be the line of investigations and management. The case of alcohol intake of long duration is similar. The target audiences are of different types: A. Postgraduate students B. Practitioners C. Common people Key words are the following: Diabetes mellitus, metabolic syndrome, hyperlipidemia, alcohol intake of long duration, fatty liver, steatohepatitis, hepatic fibrosis, diagnosis and management. Two books: Sole author A. Clinical Methods and Interpretation B. Manual of Clinical Medicine Fatty Liver Disease, a Silent Killer of Human Beings vii One monograph: Updates of Dengue Fever Two monographs are edited: A. Headache B. Chronic diarrhea Articles: A. 38 original articles in different national and international journals. B. 2 review articles in national journals. CHAPTER 1 ANATOMY AND PHYSIOLOGY OF THE LIVER Morphologically brown-colored and smooth-surfaced, the liver represents 2% of the total body weight in an adult, weighing 1800 grams and 1400 grams respectively in the male and female. Its upper surface is related entirely to the dome of the diaphragm and its visceral surface is related to the following structures (Fig 1): A. Abdominal esophagus B. Stomach C. Upper duodenum D. Hepatic flexure E. Right colon F. Right kidney G. Suprarenal gland. Externally, the liver has been subdivided into right, and approximately 6 times smaller, left lobes by the falciform ligament; this ligament attaches the liver to the anterior abdominal wall. Its base contains the ligamentum teres or round ligament which contains in its free border, a remnant of the vestigial umbilical vein. In the case of cirrhosis with portal hypertension this vein will be recanalized. This vein runs along the free edge of the falciparum ligament in fetal life and actually joins with the left branch of the portal vein. The falciform ligament, while it passes over the dome of the diaphragm, divides into the following forms: A. Its right limb joins the upper layer of the coronary ligament. B. Its left limb will be stretched out as the long and narrow left triangular ligament; it joins the lesser omentum as this arises from the fissure of the ligamentum venosum. 2 Chapter 1 Fig 1: Relation of the liver with other structures Anatomical subdivision of the liver: The superior aspect of the liver will be subdivided by the falciparum ligament into two lobes: A. Large right lobe B. Smaller left lobe Posteroinferiorly in the liver an “H” shaped arrangement of fossa as following: A. Anteriorly and towards the right: There is the presence of the gall bladder fossa. B. Anteriorly and towards the left: There is a groove for the ligamentum teres. C. Posteriorly and to the right: There is the presence of a groove for the inferior vena cava. D. Posteriorly and towards the left: There is a fissure for the ligamentum venosum. The cross bar of the “H” is the porta hepatis. It measures 5 cm in length, and contains the following structures: Anatomy and physiology of the liver 3 A. Anteriorly and to the right: The right and left hepatic ducts fuse into the common hepatic duct. B. Posteriorly and to the left: The hepatic artery divides into two branches, left and right. C. Posteriorly: The portal vein divides into left and right branches. D. Other structures entering the porta hepatis are: a. Parasympathetic nerves arising from the hepatic branch of the anterior vagus nerve. b. Sympathetic nerves from the celiac axis. On the inferior surface of the liver there are two lobes separated by the portal vein: A. The quadrate lobe presents anteriorly between the gall bladder and the round ligament. B. The caudate lobe with the papillary tubercle and the caudate process presents posteriorly along the inferior vena cava in front of the porta hepatis. This lobe is drained by both the right and left hepatic ducts. The right and left portal veins and the hepatic artery provide the arterial supply and this lobe is drained through small venous branches which directly drain into the inferior vena cava. According to the Couinaud classification, the liver has been subdivided into eight independent functional segments in a clockwise manner. Each of these segments has its own portal triad consisting of A. Hepatic arterial branch B. Portal branch C. Bile duct D. Hepatic venous branch for providing outflow. The following segments of the liver are (Fig 2): A. Segment II: Anterior segment of the left lobe B. Segment III: Posterior segment of the left lobe C. Segment IV: Medial segment of the left lobe. Segments II and III are collectively called the left lateral segment. Segments II, III and IV are collectively known as the functional left lobe of the liver. 4 Chapter 1 D. Segment V: Anterior segment of the right lobe E. Segment VII: Anterior segment of the right lobe F. Segment VI: Posterior segment of the right lobe G. Segment VII: Posterior segment of the right lobe. H. Segment I: This represents the caudate lobe of the liver located posteriorly. Outflow of the liver occurs through the three hepatic veins: A. The right hepatic vein divides the right lobe into two segments: a. Anterior segment b. Posterior segment. B. The middle or central hepatic vein divides the liver into two lobes: a. Right lobe b. Left lobe. C. The left hepatic vein divides the left lobe into two segments: a. Medial segment b. Lateral segment. These hepatic veins pass through the substances of the liver in the postero superior direction and ultimately drain into the inferior vena cava at the postero superior aspect of the liver. But the middle hepatic vein opens into the left vein prior to termination. The portal vein divides the liver into two segments: A. Upper segment B. Lower segment. Anatomy and physiology of the liver 5 Fig 2: Different segments in the liver The segmental anatomical description of the liver is of immense importance to the radiologist as well as the surgeon.1,2 Because a resection of the liver depends upon the accurate localization
Load more

Recommended publications
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • Hyperbilirubinemia
    Porphyrins Porphyrins (Porphins) are cyclic tetrapyrol compounds formed by the linkage )). of four pyrrole rings through methenyl bridges (( HC In the reduced porphyrins (Porphyrinogens) the linkage of four pyrrole rings (tetrapyrol) through methylene bridges (( CH2 )) The characteristic property of porphyrins is the formation of complexes with the metal ion bound to nitrogen atoms of the pyrrole rings. e.g. Heme (iron porphyrin). Proteins which contain heme ((hemoproteins)) are widely distributed e.g. Hemoglobin, Myoglobin, Cytochromes, Catalase & Tryptophan pyrrolase. Natural porphyrins have substituent side chains on the eight hydrogen atoms numbered on the pyrrole rings. These side chains are: CH 1-Methyl-group (M)… (( 3 )) 2-Acetate-group (A)… (( CH2COOH )) 3-Propionate-group (P)… (( CH2CH2COOH )) 4-Vinyl-group (V)… (( CH CH2 )) Porphyrins with asymmetric arrangement of the side chains are classified as type III porphyrins while those with symmetric arrangement of the side chains are classified as type I porphyrins. Only types I & III are present in nature & type III series is more important because it includes heme. 1 Heme Biosynthesis Heme biosynthesis occurs through the following steps: 1-The starting reaction is the condensation between succinyl-CoA ((derived from citric acid cycle in the mitochondria)) & glycine, this reaction is a rate limiting reaction in the hepatic heme synthesis, it occurs in the mitochondria & is catalyzed by ALA synthase (Aminolevulinate synthase) enzyme in the presence of pyridoxal phosphate as a cofactor. The product of this reaction is α-amino-β-ketoadipate which is rapidly decarboxylated to form δ-aminolevulinate (ALA). 2-In the cytoplasm condensation reaction between two molecules of ALA is catalyzed by ALA dehydratase enzyme to form two molecules of water & one 2 molecule of porphobilinogen (PBG) which is a precursor of pyrrole.
    [Show full text]
  • Characterisation of Bilirubin Metabolic Pathway in Hepatic Mitochondria Siti Nur Fadzilah Muhsain M.Sc
    Characterisation of Bilirubin Metabolic Pathway in Hepatic Mitochondria Siti Nur Fadzilah Muhsain M.Sc. (Medical Research) 2005 Universiti Sains Malaysia Postgrad. Dip. (Toxicology) 2003 University of Surrey B.Sc.(Biomed. Sc.) 2000 Universiti Putra Malaysia A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2014 School of Medicine ABSTRACT Bilirubin (BR), a toxic waste product of degraded haem, is a potent antioxidant at physiological concentrations. To achieve the maximum benefit of BR, its intracellular level needs to be carefully regulated. A system comprising of two enzymes, haem oxygenase-1 (HMOX1) and cytochrome P450 2A5 (CYP2A5) exists in the endoplasmic reticulum (ER), responsible for regulating BR homeostasis. This system is induced in response to oxidative stress. In this thesis, oxidative stress caused accumulation of these enzymes in mitochondria — major producers and targets of reactive oxygen species (ROS) — is demonstrated. To understand the significance of this intracellular targeting, properties of microsomal and mitochondrial BR metabolising enzymes were compared and the capacity of mitochondrial CYP2A5 to oxidise BR in response to oxidative stress is reported. Microsomes and mitochondrial fractions were isolated from liver homogenates of DBA/2J mice, administered with sub-toxic dose of pyrazole, an oxidant stressor. The purity of extracted organelles was determined by analysing the expressions and activities of their respective marker enzymes. HMOX1 and CYP2A5 were significantly increased in microsomes and even more so in mitochondria in response to pyrazole-induced oxidative stress. By contrast, the treatment did not increase either microsomes or mitochondrial Uridine-diphosphate-glucuronosyltransferase 1A1 (UGT1A1), the sole enzyme that catalyses BR elimination through glucuronidation.
    [Show full text]
  • Accessory Organs of the Gastrointestinal Tract ـــ ھــــــــ دي
    .د ـــ ھــــــــدي ـــــــن Accessory Organs of the Gastrointestinal Tract Liver The liver is the largest gland in the body and lies mainly in the right upper quadrant of the abdomen (occupies most of the right hypochondrium and upper epigastrium and extends into the left hypochondrium ) where it is protected by the thoracic cage (lies deep to ribs 7-11 on the right side) and diaphragm and crosses the midline toward the left nipple. The liver may be divided into a large right lobe and a small left lobe by the attachment of the peritoneum of the falciform ligament . The right lobe is further divided into a quadrate lobe and a caudate lobe by the presence of the gallbladder, the fissure for the ligamentum teres, the inferior vena cava, and the fissure for the ligamentum venosum. Experiments have shown that, in fact, the quadrate and caudate lobes are a functional part of the left lobe of the liver. The porta hepatis, or hilum of the liver, is found on the posteroinferior surface and lies between the caudate and quadrate lobes . The upper part of the free edge of the lesser omentum is attached to its margins. In it lie the right and left hepatic ducts, the right and left branches of the hepatic artery, the portal vein, and sympathetic and parasympathetic nerve fibers . A few hepatic lymph nodes lie here; they drain the liver and gallbladder and send their efferent vessels to the celiac lymph nodes. The liver is completely surrounded by a fibrous capsule but only partially covered by peritoneum.
    [Show full text]
  • Annual Meeting in Tulsa (Hosted by Elmus Beale) on June 11-15, 2019, We Were All Energized
    37th ANNUAL Virtual Meeting 2020 June 15-19 President’s Report June 15-19, 2020 Virtual Meeting #AACA Strong Due to the unprecedented COVID-19 pandemic, our 2020 annual AACA meeting in June 15-19 at Weill Cornell in New York City has been canceled. While this is disappointing on many levels, it was an obvious decision (a no brainer for this neurosurgeon) given the current situation and the need to be safe. These past few weeks have been stressful and uncertain for our society, but for all of us personally, professionally and collectively. Through adversity comes opportunity: how we choose to react to this challenge will determine our future. Coming away from the 36th Annual meeting in Tulsa (hosted by Elmus Beale) on June 11-15, 2019, we were all energized. An informative inaugural newsletter edited by Mohammed Khalil was launched in the summer. In the fall, Christina Lewis hosted a successful regional meeting (Augmented Approaches for Incorporating Clinical Anatomy into Education, Research, and Informed Therapeutic Management) with an excellent faculty and nearly 50 attendees at Samuel Merritt University in Oakland, CA. The midyear council meeting was coordinated to overlap with that regional meeting to show solidarity. During the following months, plans for the 2020 New York meeting were well in motion. COVID-19 then surfaced: first with its ripple effect and then its storm. Other societies’ meetings - including AAA and EB – were canceled and outreach to them was extended for them to attend our meeting later in the year. Unfortunately, we subsequently had to cancel the plans for NY.
    [Show full text]
  • Intrahepatic Pancreatic Pseudocyst: Case Series
    JOP. J Pancreas (Online) 2016 Jul 08; 17(4):410-413. CASE SERIES Intrahepatic Pancreatic Pseudocyst: Case Series Dhaval Gupta, Nirav Pipaliya, Nilesh Pandav, Kaivan Shah, Meghraj Ingle, Prabha Sawant Department of Gastroenterology, Lokmanya Tilak Municipal Medical College &Hospital, Sion, Mumbai, India ABSTRACT Intrahepatic pseudocyst is a very rare complication of pancreatitis. Lack of experience and literature makes diagnosis and management of intrahepatic pseudocyst very difficult. Majority of published cases were managed by either percutaneous or surgical drainage. Less than 30 cases of intrahepatic pseudocysts have been reported in the literature and there is not a single report of endoscopic ultrasound guided management of intrahepatic pseudocysts. Here we report a case series of 2 patients who presented with intrahepatic pseudocysts and out of which first case was successfully managed by EUS guided drainage. Our second case is also the youngest patient presented with intrahepatic pseudocyst till now. INTRODUCTION abdominal distention since last 1 month. However he did located in or around t not have significant weight loss, gastrointestinal bleeding, A pancreatic pseudocyst is a collection of pancreatic fluid pedal edema, jaundice, fever. His past medical history and he pancreas. Pancreatic pseudocysts family history was not significant. He was chronic alcoholic are encased by a non-epithelial lining of fibrous, necrotic since last 15 years with intake of approximately 90 gram and granulation tissue secondary to pancreatic injury.
    [Show full text]
  • Normal Anatomy of Porta Hepatis—A Cadaveric Study
    THIEME 22 Original Article Normal Anatomy of Porta Hepatis—A Cadaveric Study Dhanalaxmi D. Neginhal1 Umesh K. Kulkarni1 1Department of Anatomy, Belagavi Institute of Medical Sciences, Address for correspondence Umesh K. Kulkarni, MS (Anat), Belagavi, Karnataka, India Department of Anatomy, Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India (e-mail: [email protected]). Natl J Clin Anat 2019;8:22–26 Abstract Background and Aim Porta hepatis (PH) of the liver acts as a gateway for exit and entry of important structures like portal vein, hepatic artery, and hepatic duct. Having knowledge of variations about the dimensions and structures at PH becomes important to avoid complications during surgical and radiological interventions. Our study aims to observe the dimensions of PH and also the number, arrangement, and variations of structures passing through PH. Materials and Methods Fifty adult cadaveric human livers which were preserved in formalin were studied. Transverse diameter, anteroposterior diameter, and circumference of PH were measured using vernier calipers, measuring scale, and thread. PH was carefully dissected to study the number, arrangement, and combination of arteries, veins, and ducts at PH. Results The mean transverse diameter, anteroposterior diameter, and total circumference of PH was 3.17 ± 0.50, 1.68 ± 0.36, and 10.46 ± 1.415 cm, respectively. Eighteen specimens showed presence of two arteries, two veins, and one duct at PH. Keywords Maximum number of arteries, veins, and ducts passing through PH were 5, 4, and 1, ► porta hepatis respectively. The ducts were anterior, arteries in the middle, and veins were posterior ► portal vein in PH of all the livers.
    [Show full text]
  • Vascular Architecture in Anomalous Right-Sided Ligamentum Teres: Three-Dimensional Analyses in 35 Patients
    DOI:10.1111/j.1477-2574.2011.00398.x HPB ORIGINAL ARTICLE Vascular architecture in anomalous right-sided ligamentum teres: three-dimensional analyses in 35 patients Junichi Shindoh1, Masaaki Akahane2, Shoichi Satou1, Taku Aoki1, Yoshifumi Beck1, Kiyoshi Hasegawa1, Yasuhiko Sugawara1, Kuni Ohtomo2 & Norihiro Kokudo1 1Hepato-biliary-pancreatic Surgery Division, Department of Surgery and 2Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan Abstracthpb_398 32..41 Background: Right-sided ligamentum teres (RSLT) is a congenital anomaly that is sometimes encoun- tered during hepatobiliary surgeries. However, a valid protocol for describing the segmental anatomy of livers with RSLT has not been established, and confusions or anatomic misunderstandings have been a major problem. Methods: The vascular architecture and morphological characteristics were investigated in 35 livers with RSLT using three-dimensional (3D) simulations. Results: Couinaud's four sectors and three hepatic veins were clearly distinguished in the liver with RSLT using 3D simulations. The ligamentum teres was connected with the right paramedian portal pedicle, and the long axis of the cystic fossa was always observed on the left of the ligamentum teres in all 35 livers. However, when the main portal scissura was visualized using 3D simulation, the gallbladder was always located on the border of either side of the hemilivers, and the malposition of the gallbladder was not confirmed. Conclusions: Although the right-sided components of the livers are well developed as a result of the right-dominant distribution of the feeding vessels in livers with RSLT, the basic segmental structure defined by the four sectors and the three hepatic veins are as well preserved as those in the typical liver anatomy.
    [Show full text]
  • Porta Hepatis) - Bile Ducts, Portal Vein, Hepatic Arteries
    10 Al-Mohtaseb Faisal Nimri Shada gharaibeh The Liver continued The superior surface of the liver You can see * The right and left lobes. * Cut edge of the Falciform ligament. * The coronary ligament, continues on both sides as: * The left triangular ligament * The right triangular ligament * Between the edges of the coronary ligament is the Bare area of the liver (where there is no peritoneum covering the liver). * Groove for the inferior vena cava and the 3 hepatic veins that drain in it. * Cut edge of the Falciform ligament. * Caudate lobe of the liver more or less wrapping around the groove of the inferior vena cava * Fundus of gall bladder * Ligamentum teres → Relations of the superior surface • Diaphragm (the diaphragm is above the liver and is related to the anterior, superior and posterior surfaces of the liver but the visceral surface of the liver doesn’t have relations with the diaphragm). The diaphragm separates the Pleura & lung and the Pericardium & heart from the liver. 1 | P a g e → Relations of the liver anteriorly • Diaphragm • Rt & Lt pleura and lung (separated from the liver by the diaphragm) • Costal cartilage • Xiphoid process • Anterior abdominal wall → Relations of the liver posteriorly • Diaphragm • Rt. Kidney • Supra renal gland • Transverse colon (hepatic flexure) • Duodenum • Gall bladder • I.V.C • Esophagus • Fundus of stomach (pay attention to the impressions in the picture they are important) → lobes of the liver • Right Lobe • Left lobe • Quadrate lobe • Caudate lobe (the quadrate and caudate lobes are similar
    [Show full text]
  • A Novel Approach of Gross Structure of Human Liver
    wjpmr, 2019,5(2), 181-186 SJIF Impact Factor: 4.639 WORLD JOURNAL OF PHARMACEUTICAL Research Article Manoj et al. AND MEDICAL RESEARCH World Journal of Pharmaceutical and Medical ResearchISSN 2455 -3301 www.wjpmr.com WJPMR A NOVEL APPROACH OF GROSS STRUCTURE OF HUMAN LIVER A. Manoj and Annamma Paul Department of Anatomy, School of Medical Education, M.G University (Accredited by NAAC with A-Grade), Kottayam, Kerala, India. *Corresponding Author: A. Manoj Department of Anatomy, Government Medical College, Thrissur- 680596, under Directorate of Medical Education Health and Family Welfare– Government of Kerala, India. Article Received on 05/12/2018 Article Revised on 26/12/2018 Article Accepted on 16/01/2019 ABSTRACT This current exploratory research conducted to design for comprehensive study of human liver inorder to get best knowledge of learning objectives of its Gross structure. Topography of the liver was taken to know the exact position of liver. The weight, length of surfaces and borders were measured. It had two principal anatomical lobes based on attachment of ligaments and two functional lobes due to the distribution of blood and bile. It had five surfaces with one distinct border. Owing to the dichotomous divisions of the hepatic artery, portal vein and bile ducts it has to have eight vascular segments which can be resected without damaging those remaining. Apart from peritoneal covering it had been connected with falciform ligaments, Coronary ligaments, Triangular ligaments, Ligamentum teres, Ligamentum venosum. The nonperitoneal areas were fissures of ligamentum venosum, teres hepatis, Groove of inferior venacava, Fossa for gall bladder and bare area.
    [Show full text]
  • Falciform Ligament
    It is largest gland in body, soft & pliable . Location: RT hypochondrium just beneath diaphragm which separates from the liver from thoracic cavity. Surfaces of liver: Superioanterior surface (diaphragmatic): its a convex upper surface of liver is molded to domes of diaphragm. Posteroinferior (visceral) :its irregular in shape molded to adjacent viscera 1)Large RT lobe & small LT lobe form by attachment of peritoneum of falciform ligament . 2)RT lobe is further subdivided into a quadrate lobe & caudate lobe by presence of gallbladder , ligamentum teres, inferior vena cava & ligamentum venosum . It found on visceral surface & lies between caudate & quadrate lobes . It containes : RT & LT hepatic ducts. RT& LT branches of hepatic artery. Portal vein. Sympathetic & parasympathetic nerve fibers . Hepatic lymph nodes. Peritoneal relation: Falciform Ligament: which is two-layered fold of peritoneum ascends from umbilicus to liver. It contain ligamentum teres ( remains of umbilical vein). Falciform ligament passes on to anterior & then superior surfaces of liver& then splits into two layers. The right upper layer forms coronary ligament. left upper layer of falciform ligament forms left triangular ligament . The right extremity of coronary ligament is known as right triangular ligament. ligamentum venosum ( remains of the ductus venosus) a fibrous band is attached to left branch of portal vein and inferior vena cava. lesser omentum arises from lesser curvature of stomach till edges of porta hepatis. It be noted that the peritoneal layers forming the coronary ligament are widely separated leaving an area of liver devoid of peritoneum. Diaphragm. RT & LT costal margins. RT & LT pleura . Lower margins of both lungs. Xiphoid process.
    [Show full text]
  • Surgical Significance of Variations in Anatomy in the Biliary Region
    International Journal of Research in Medical Sciences Hassan AU et al. Int J Res Med Sci. 2013 Aug;1(3):xx-xx www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: 10.5455/2320-6012.ijrms20130812 Review Article Surgical significance of variations in anatomy in the biliary region Ashfaq Ul Hassan1*, Showqat A. Zargar2, Aijaz Malik3, Pervez Shah4 1Department of Anatomy, SKIMS Medical College, Srinagar, Kashmir, India 2Department of Gastroenterology, SKIMS, Srinagar, Kashmir, India 3Department of Surgery, SKIMS, Srinagar, Kashmir, India 4Department of Medicine, SMHS Hospital, Srinagar, Kashmir, India Received: 8 May 2013 Accepted: 21 May 2013 *Correspondence: Dr. Ashfaq Ul Hassan, E-mail: [email protected] © 2013 Hassan AU et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Variations in the anatomy of the gallbladder, the bile ducts, and the arteries that supply them and the liver are important to the surgeon, because failure to recognize them can cause iatrogenic injury to the biliary tract. A surgeon should be always be careful while operating in this area. In addition these anomalies are associated with a range of other congenital anomalies, including biliary atresia and cardiovascular or other gastrointestinal malformations, biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction etc, so a look out for other anomalies should be carried out simultaneously. Keywords: Gall bladder, Cystic fossa, Calots triangle, Monyhans hump, Extrahepatic, Atresia, Double Gall bladder, Triple Gall bladder, Agenesis, Cystic duct, Carolis disease NORMAL ANATOMY the left from the neck of the gallbladder, and joins the common hepatic duct to form the common bile duct.
    [Show full text]