2nd stage / Anatomy / 2021-2022 ‫ فرع التشريح‬/‫ كلية الطب‬/‫جامعة الموصل‬ Lecture 7

Anatomy
The Abdomen
Liver and gall bladder
The objectives:

1. To get knowledge about the normal anatomy of the liver and gall bladder.
2. To get knowledge about the blood supply, nerve supply, lymphatics of the liver
and gall bladder.
3. Understanding the normal location of structures and their anatomical
relationships is necessary in practicing surgery.
4. Knowing the anatomical basis is very important in solving the clinical problems.

Liver :
It is the largest gland in the body (about 2% of body weight in adult). it occupies
the right upper quadrant of the abdomen, below diaphragm.

 Surface anatomy of the liver:

The liver has 3 borders. Sup., inf. and right borders (i.e. triangle).
The sup. border starts at the point behind the 5th rib in the right midclavicular line,
then passes behind xiphisternal junction in the midline. It ends behind a point just
below the apex of the heart.

The inf. border starts behind a point just below the apex of the heart, then it passes
behind: the junction of the 7th and 8th left costal cartilages, the midway between
xiphoid and umbilicus (in the midline), the tip of right 9th costal cartilage, and lowest
point of right costal margin.
The right border is between lowest point of right costal margin and the point
behind the 5th rib in the right midclavicular line.

Thus normally the liver is just palpable through the abd. wall.

 Surfaces of the liver:

1. Diaphragmatic surface: is dome shaped and conforms to the concavity of the
diaphragm. It is divided into superior, anterior, right and posterior.
 Superior surface: is in relation through the diaphragm with the base of the

Dr.Ahmed Hisham. 5/4/2022

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2nd stage / Anatomy / 2021-2022 ‫ فرع التشريح‬/‫ كلية الطب‬/‫جامعة الموصل‬ Lecture 7

right lung, the pericardium of the heart and with the left lung.
 Anterior surface: lies against the diaphragm, the costal margin, the xiphoid
process and the abdominal wall.
 Right and posterior surfaces: they are related to the diaphragm and the ribs.
2. Visceral surface: It is directed downward, backward and to the left. It is
separated from the diaphragmatic surface by the inferior border which is sharp
anteriorly but blunt and rounded posterioly. The inferior border is notched
anteriorly by ligamentum teres just to the right of the midline.
The visceral surface of the liver is in relation with stomach, duodenum, right
colic flexure, right kidney and right suprarenal gland. The visceral surface lodges
the gallbladder anteriorly and it is deeply indented by the inferior vena cava
posterioly.
At the middle (center) of the visceral surface of the liver we have the
Porta hepatis of the liver which is the region of entrance of hepatic artery,
portal vein as well as autonomic nerve fibers and the exit of hepatic bile duct and
lymphatics.

From inferior border anteriorly to the Porta hepatis there is a deep fissure for
the ligamentum teres (the obliterated remains of the left umbilical vein).

From Porta hepatis to the inferior border posterioly, there is the deep fissure
for ligamentum venosum (which is the ligamentum remains of the ductus
venosus in the fetus).

 Lobes of the liver:

The Porta hepatis, gallbladder fossa, inferior vena cava fossa and the fissures of
ligamentum teres and ligamentum venosum combine to form [H] shaped figure
which separates the various lobes of the liver.
** To the left of the fissures for ligaments is the left lobe, to the right of the
gallbladder and inferior vena cava fossae we have the right lobe.
- Quadrate lobe: between gallbladder fossa and ligamentum teres fissure.
- Caudate lobe: between ligamentum venosum fissure and inferior vena cava
fossa.

Anatomically Quadrate and Caudate lobes are part of right lobe, while functionally

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2nd stage / Anatomy / 2021-2022 ‫ فرع التشريح‬/‫ كلية الطب‬/‫جامعة الموصل‬ Lecture 7

they are part of the left lobe.

** Caudate process: it is a part of caudate lobe that forms a ridge between Porta
hepatis and the fossa of inferior vena cava.

 Peritoneal reflection of the liver:

- Liver is completely peritonized except at the bare area. The bare area is an area
that lies on the posterosperior part of the diaphragmatic surface of the liver. It has
no peritoneal covering (liver is in direct contact with diaphragm) and it lies between
the right triangular ligament and inferior vena cava (or between the anterior and
posterior coronary ligaments).
- Anterior (superior) and posterior (inferior) coronary ligaments: reflection of
peritoneum from liver to diaphragm.
- Right and left triangular ligaments: the right and left extremities of ant. coronary lig.
- Falciform ligament: (peritoneal fold) extends from the umbilicus (ant. abd.wall) to
the liver at the notch for the ligamentum teres. It contains the ligamentum teres.
Gall bladder:
It is a pear shaped organ, measuring 7.5×2.5 cm, it stores and concentrates the
bile. It lies in the gall bladder fossa (gall bladder bed) on visceral surface of liver. It is
divided into fundus, body, neck and cystic duct.
- The fundus makes contact with anterior abdominal wall at the tip of right 9th
costal cartilage. It rests on transverse colon.
- The body and tapered neck are related to the duodenum. The neck is directed
toward porta hepatis and become continuous with the cystic duct.
- The cystic duct is 2-4 cm long directed backward downward and to the left to
join the common hepatic duct close to porta hepatis forming the common bile
duct. Com. bile duct is 8 cm long. it descends in the free margin of lesser
omentum to the Rt of proper hepatic artery, ant. to the portal vein. Then
com.bile duct passes post. to 1st part of duodenum to the Rt of gastroduod.
artery then post. to head of pancreas. It opens in the 2nd part of the duodenum
(as mentioned before) at greater duod. papilla.
 Arteries of liver and gallbladder:
 Proper hepatic arteryRight hepatic arteryCystic Artery
Left hepatic artery

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2nd stage / Anatomy / 2021-2022 ‫ فرع التشريح‬/‫ كلية الطب‬/‫جامعة الموصل‬ Lecture 7

 Cystic artery may arise from common hepatic artery, it supplies gallbladder.
 Arteries of the common bile duct:
 Cystic artery.
 Right hepatic artery.
 Gastroduodenal artery.
 Posterior superior pancreaticoduodenal artery.
 Veins of the liver:
 Left hepatic vein.
 Middle hepatic vein.
 Right hepatic vein.
All join the inferior vena cava.
 Veins of the gallbladder:

*Gallbladder drained by cystic vein to portal vein directly.

* Veins of gallbladder and bile ducts may drain directly into the liver.
 Lymphatics of liver:
Liver produces about 1/2 of all body lymph. The lymphatic vessels pass to porta
hepatis lymph nodes then to celiac lymph nodes. A small number of lymphatics pass
from the bare area of liver through the diaphragm to the post. mediastinal L.N.
** Lymphatics of the gallbladder and bile ducts pass to cystic nodes (on cystic
duct) and nodes in the porta hepatis then to celiac lymph nodes.

 Nerves of liver:
Nerve supply of liver is from:
1. Hepatic plexus: from celiac plexus which gives sympathetic and parasympathetic
innervations.
2. Ant. vagal trunk: gives hepatic branch which will pass directly to the liver.

 Gall bladder takes innervations from celiac plexus (sympathetic, parasympathetic),

right phrenic nerve (sensory).

Dr.Ahmed Hisham. 5/4/2022

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2nd stage / Anatomy / 2021-2022 ‫ فرع التشريح‬/‫ كلية الطب‬/‫جامعة الموصل‬ Lecture 7

Summary

Liver :
Surface anatomy of the liver: triangular in shape.
Surfaces of the liver: diaphramatic and visceral surfaces .
Lobes of the liver: right and left lobes.
Peritoneal reflection of the liver: peritonized except bare area.
Gall bladder:
Arteries of liver and gallbladder: righr and left hepatic arteries.
Arteries of the common bile duct:more than 2 arteries
Veins of the liver: hepatic veins.
Veins of the gallbladder: cyctic vein
Lymphatics of liver: cyctic lymph nodes.
Nerves of liver & Gall bladder : autonomic.

MCQs
1. The common bile duct receives arterial supply from all following arteries except
a. cystic
b. right hepatic
c. gastroduodenal
d. anterior superior pancreaticoduodenal
e. posterior superior pancreaticoduodenal

1. Following statements concerning liver are true except

a. it is the largest gland in the body
b. it has 4 lobes
c. its visceral surface is in relation with stomach, duodenum, right colic flexure and right kidney
d. it has a caudate process between the porta hepatis and the fossa of inferior vena cava
e. the right hepatic bile duct drains the quadrate lobe

References:

1- Snell`s clinical Anatomy by Regions. Tenth edition. Chapter 12.

2- Cunningham`s Manual of Practical Anatomy. Thorax and Abdomen, 16th Edition- Vol. 2.

3- Atlas of Humanl Anatomy by FH Netter.

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