Supracolic compartment , Biliary tree and spleen

19-3-2018 Dr. Firas Mohammed Ghazi Liver

 Right hypochondrium  Covered by rib cage  Extends to the left Gross appearance

1. Diaphragmatic surface 2. Visceral surface 3. Inferior border • Right and Left lobes • Quadrate and Caudate

C R L L R

Qr Diaphragmatic surface of liver

1. Falciform (teres ligament?) 2. 3. Triangular (right and left) Visceral surface of liver

1. Ligamentum teres/ Ligamentum venosum 2. Gall bladder/ Inferior vena cava 3. / Lesser omentum Porta hepatis

1. Hepatic ducts 2. Hepatic artery 3. Portal vein 4. Autonomic nerve fibers 5. Hepatic lymph nodes Falciform and teres ligaments

Extensions and attachment Coronary and triangular ligaments

Extensions and attachment Bare area of the liver

Boundaries and clinical importance Lig. venosum & lesser omentum

Fissure for ligamentum venosum Lesser omentum attachment? Hepatic circulation Blood supply

1. Hepatic artery  A branch of celiac trunk

2. Portal vein  Run behind the arteries

Both lie within the free edge of lesser omentum Venous drainage

Hepatic veins (three or more) Drain into______Anatomical vs Functional lobes

• The functional and anatomical lobes of liver are different

C L

R

Qr Pop quiz

• What forms the functional left lobe of the liver?

C L

R

Qr Biliary system of ducts

A. Intra-hepatic

B. Extrahepatic

1. Rt & Lt hepatic ducts 2. 3. 4. Opening into dudenum 1. Ampulla of vatter 2. Major duodenal papilla Biliary system Pop quiz

 Bile secreted from quadrate lobe of the liver is drained by which hepatic duct? Gall bladder

• Location? • Parts ? • Surface markings of fundus? • Blood Supply: • cystic artery: a branch of______• Cystic vein: drains into ______Function of the gall bladder

• No digestion: Store and concentrate bile • Digestion: Delivers bile to duodenum Course of bile duct

 First part: (Free margin of lesser omentum)  In front of portal V.  On the right of hepatic A.

Second part  (Behind 1st part of duodenum)

Third part  (Posterior surface of the head of ) Termination of bile duct Hepatopancreatic ampulla within the wall of 2nd part of dudenum

Sphincter of Oddi Circular muscle surrounds the hepatopancreatic ampulla

Major duodenal papilla Bile stones Locations and effects

B

A C D Surgical notes on gall bladder

 Completely surrounded by  Hepatocystic triangle Sub-phrenic spaces

 Right and left  Potential spaces  Location? Sub-hepatic space

Between the liver, right kidney, and right hepatic flexure of transverse colon

Deepest space in supine position Gas or fluid?

 Gas or fluid may accumulate in these spaces  Air under diaphragm: Perforation of a viscous  Liver is divided into segments.  bile ducts, hepatic arteries, and portal vein going to a segment can be ligated to allows the surgeon to remove large portions of the liver What prevent mobilization of the liver during surgery

1. Attachment of the hepatic veins to IVC (main) 2. Peritoneal ligaments (minor) 3. Tone of abdominal muscles (minor) Spleen

 Intraperitoneal  Gastrosplenic & splenicorenal ligs.  Splenic vessels reach through ______ Location and risk of rupture Splenic enlargement  Phrenicocolic lig. & direction of enlargement  Splenic notch and palpation  Splenectomy and Tale of pancreas………