Podcast
Questions and Answers
What is the clinical significance of vascular segments in the spleen regarding surgical procedures?
What is the clinical significance of vascular segments in the spleen regarding surgical procedures?
- They dictate the spleen's role in hematopoiesis after birth.
- They define areas of immune surveillance within the spleen.
- They determine the extent of splenic mobility during palpation.
- They enable subtotal splenectomy due to relatively avascular planes. (correct)
What embryological characteristic explains the spleen's function in the body?
What embryological characteristic explains the spleen's function in the body?
- Its development from the mesoderm of the dorsal mesentery.
- Its separation from the kidneys by a weak fascial septum.
- Its hematopoietic function prenatally transitioning to immune functions postnatally. (correct)
- Its close association with the pancreas and the tail of the pancreas.
Which structural feature of the spleen contributes to its ability to expel blood into circulation?
Which structural feature of the spleen contributes to its ability to expel blood into circulation?
- The thin fibrous capsule covered by visceral peritoneum.
- The gastrosplenic ligament connecting it to the stomach.
- The diaphragmatic surface fitting the adjacent ribs.
- The smooth muscle in its capsule and trabeculae. (correct)
How does the thin fibrous capsule of the spleen contribute to its clinical vulnerability?
How does the thin fibrous capsule of the spleen contribute to its clinical vulnerability?
In the context of rib fractures, why is the spleen's proximity to the ribs potentially detrimental, despite the protective function?
In the context of rib fractures, why is the spleen's proximity to the ribs potentially detrimental, despite the protective function?
Which anatomical relationship explains why palpating the notched border of the spleen can be diagnostically useful?
Which anatomical relationship explains why palpating the notched border of the spleen can be diagnostically useful?
A surgeon is planning a splenectomy. Understanding the splenic blood supply, what should the surgeon know about the arterial supply to the spleen before the procedure?
A surgeon is planning a splenectomy. Understanding the splenic blood supply, what should the surgeon know about the arterial supply to the spleen before the procedure?
Which of the following describes the venous drainage of the spleen and its significance?
Which of the following describes the venous drainage of the spleen and its significance?
Which anatomical structure directly relates to the posterior surface and superior border of the pancreas?
Which anatomical structure directly relates to the posterior surface and superior border of the pancreas?
Given its lymphatic drainage pathways, where would a clinician expect to find metastases from a splenic tumor?
Given its lymphatic drainage pathways, where would a clinician expect to find metastases from a splenic tumor?
Considering the autonomic innervation of the spleen, what physiological effect do the post synaptic sympathetic fibers have on its function?
Considering the autonomic innervation of the spleen, what physiological effect do the post synaptic sympathetic fibers have on its function?
A patient presents with referred pain due to gallbladder inflammation. Which nerve, if irritated, could be responsible for this pain referral?
A patient presents with referred pain due to gallbladder inflammation. Which nerve, if irritated, could be responsible for this pain referral?
During a cholecystectomy, a surgeon identifies Calot's triangle. What anatomical structures define the boundaries of this triangle?
During a cholecystectomy, a surgeon identifies Calot's triangle. What anatomical structures define the boundaries of this triangle?
After a cholecystectomy, a patient develops bile leakage. Which anatomical variation might explain this complication?
After a cholecystectomy, a patient develops bile leakage. Which anatomical variation might explain this complication?
How does the structure of the cystic duct contribute to the regulation of bile flow?
How does the structure of the cystic duct contribute to the regulation of bile flow?
A patient is diagnosed with cholecystitis due to a gallstone blocking the cystic duct. What is the most likely physiological consequence of this blockage?
A patient is diagnosed with cholecystitis due to a gallstone blocking the cystic duct. What is the most likely physiological consequence of this blockage?
A patient undergoes a liver biopsy. Knowing the organ's anatomy, through which intercostal space and line is the needle typically inserted, and why is this location preferred?
A patient undergoes a liver biopsy. Knowing the organ's anatomy, through which intercostal space and line is the needle typically inserted, and why is this location preferred?
A surgeon is planning a hepatic lobectomy. What underlying anatomical principle allows for the surgical resection of liver segments?
A surgeon is planning a hepatic lobectomy. What underlying anatomical principle allows for the surgical resection of liver segments?
What explains why the liver is a common site for metastatic carcinoma?
What explains why the liver is a common site for metastatic carcinoma?
How do the anterior and posterior surfaces of the liver differ in terms of peritoneal covering, and what is the clinical significance of this difference?
How do the anterior and posterior surfaces of the liver differ in terms of peritoneal covering, and what is the clinical significance of this difference?
What is the clinical consequence of portal hypertension, and what anatomical feature contributes to its development?
What is the clinical consequence of portal hypertension, and what anatomical feature contributes to its development?
Why is the hepatic portal system clinically significant?
Why is the hepatic portal system clinically significant?
A patient presents with jaundice and abdominal pain. An obstruction of the hepatopancreatic ampulla is suspected. Which anatomical structure is directly affected by this condition?
A patient presents with jaundice and abdominal pain. An obstruction of the hepatopancreatic ampulla is suspected. Which anatomical structure is directly affected by this condition?
A patient is suspected of having a blockage in either their bile duct or pancreatic duct. Which procedure would be most useful in determining the location of the blockage?
A patient is suspected of having a blockage in either their bile duct or pancreatic duct. Which procedure would be most useful in determining the location of the blockage?
Select the statement that is most accurate regarding the spleen anatomy and function:
Select the statement that is most accurate regarding the spleen anatomy and function:
What is the significance of the ligamentum teres hepatis?
What is the significance of the ligamentum teres hepatis?
What is NOT a surface that forms the visceral surface of the liver?
What is NOT a surface that forms the visceral surface of the liver?
In the context of liver anatomy, what is unique about the Quadrate and Caudate lobes?
In the context of liver anatomy, what is unique about the Quadrate and Caudate lobes?
What is the significance of the porta hepatis?
What is the significance of the porta hepatis?
Choose the statement that best describes the relationship between the Inferior Vena Cava (IVC) to Hepatic Veins and Liver:
Choose the statement that best describes the relationship between the Inferior Vena Cava (IVC) to Hepatic Veins and Liver:
What is cholecystokinin (CCK) and what role does it serve in the body?
What is cholecystokinin (CCK) and what role does it serve in the body?
What is the key lymphatic vessel for the cystic duct and liver?
What is the key lymphatic vessel for the cystic duct and liver?
Which arteries supply the bile duct?
Which arteries supply the bile duct?
Which statement best describes a gallstone?
Which statement best describes a gallstone?
If a gallstone blocks the cystic duct causing inflammation in the gallbladder causing it to enlarge, can this lead to:
If a gallstone blocks the cystic duct causing inflammation in the gallbladder causing it to enlarge, can this lead to:
During a cholecystectomy, which key liver anatomical location is most crucial to identify arteries and hepatic:
During a cholecystectomy, which key liver anatomical location is most crucial to identify arteries and hepatic:
During the surgical exploration of the spleen, a surgeon encounters significant bleeding originating from a deep laceration. Assuming standard splenic arterial segmentation, which of the locations would least likely offer an avascular plane for clamping to control hemorrhage?
During the surgical exploration of the spleen, a surgeon encounters significant bleeding originating from a deep laceration. Assuming standard splenic arterial segmentation, which of the locations would least likely offer an avascular plane for clamping to control hemorrhage?
Considering the spleen's location in the left upper quadrant and its relationship to the adjacent ribs, what is the most likely consequence of a severe, penetrating trauma to the lower thoracic region?
Considering the spleen's location in the left upper quadrant and its relationship to the adjacent ribs, what is the most likely consequence of a severe, penetrating trauma to the lower thoracic region?
How would significant enlargement of the spleen (splenomegaly) alter the anatomical relationship between the spleen and the left kidney?
How would significant enlargement of the spleen (splenomegaly) alter the anatomical relationship between the spleen and the left kidney?
Following a traumatic injury, a patient exhibits signs of splenic rupture. Given the spleen's structure, where would intraperitoneal hemorrhage most likely accumulate first when the patient is in a supine position?
Following a traumatic injury, a patient exhibits signs of splenic rupture. Given the spleen's structure, where would intraperitoneal hemorrhage most likely accumulate first when the patient is in a supine position?
During a splenectomy, the surgeon must carefully identify the ligaments connected to the spleen to avoid injury to adjacent structures. Which ligament directly connects the spleen to the greater curvature of the stomach?
During a splenectomy, the surgeon must carefully identify the ligaments connected to the spleen to avoid injury to adjacent structures. Which ligament directly connects the spleen to the greater curvature of the stomach?
A clinician suspects a splenic infarction due to the splenic artery's unique branching. Which statement best describes the pattern that contributes to increased vulnerability to infarction?
A clinician suspects a splenic infarction due to the splenic artery's unique branching. Which statement best describes the pattern that contributes to increased vulnerability to infarction?
A patient presents with pancreatitis. Considering the anatomical relationship between the pancreas and spleen, which complication is most likely to occur due to inflammation-induced compression?
A patient presents with pancreatitis. Considering the anatomical relationship between the pancreas and spleen, which complication is most likely to occur due to inflammation-induced compression?
Following a motor vehicle accident, imaging reveals damage to the tail of the pancreas where it comes into close proximity with the splenic hilum. Which vascular structure is most at risk?
Following a motor vehicle accident, imaging reveals damage to the tail of the pancreas where it comes into close proximity with the splenic hilum. Which vascular structure is most at risk?
A patient undergoing evaluation for pancreatic cancer is found to have a tumor in the neck of the pancreas. Considering the anatomical relationships, which vascular structure is most immediately at risk?
A patient undergoing evaluation for pancreatic cancer is found to have a tumor in the neck of the pancreas. Considering the anatomical relationships, which vascular structure is most immediately at risk?
During a surgical procedure involving the pancreas, a surgeon must consider the arrangement of the pancreatic ducts. In a scenario where the main pancreatic duct is obstructed, what compensatory mechanism might maintain exocrine function?
During a surgical procedure involving the pancreas, a surgeon must consider the arrangement of the pancreatic ducts. In a scenario where the main pancreatic duct is obstructed, what compensatory mechanism might maintain exocrine function?
A surgeon is planning a Whipple procedure (pancreaticoduodenectomy). Which anatomical relationship requires careful attention to prevent complications related to vascular supply?
A surgeon is planning a Whipple procedure (pancreaticoduodenectomy). Which anatomical relationship requires careful attention to prevent complications related to vascular supply?
A patient undergoes a liver biopsy. Post-procedure, the patient develops significant hemoperitoneum. Which anatomical characteristic of the liver contributes most significantly to this complication?
A patient undergoes a liver biopsy. Post-procedure, the patient develops significant hemoperitoneum. Which anatomical characteristic of the liver contributes most significantly to this complication?
A patient diagnosed with liver cirrhosis develops ascites. What is the underlying anatomical basis for this condition?
A patient diagnosed with liver cirrhosis develops ascites. What is the underlying anatomical basis for this condition?
A surgeon performing a cholecystectomy identifies Calot's triangle. What complication is most likely if the surgeon fails to appreciate variations within this anatomical space?
A surgeon performing a cholecystectomy identifies Calot's triangle. What complication is most likely if the surgeon fails to appreciate variations within this anatomical space?
During an ERCP (endoscopic retrograde cholangiopancreatography) procedure, the endoscope is advanced through the duodenum to visualize the biliary and pancreatic ducts. What anatomical landmark signals the location of the hepatopancreatic ampulla where cannulation is required?
During an ERCP (endoscopic retrograde cholangiopancreatography) procedure, the endoscope is advanced through the duodenum to visualize the biliary and pancreatic ducts. What anatomical landmark signals the location of the hepatopancreatic ampulla where cannulation is required?
Flashcards
Large Intestine (Orad)
Large Intestine (Orad)
Large intestine part proximal to the left colic flexure.
Sympathetic Fibers
Sympathetic Fibers
Fibers that are conveyed to the large intestine.
Spleen Location
Spleen Location
Organ located in the left upper quadrant (LUQ).
Function of Spleen
Function of Spleen
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Fibroelastic Capsule
Fibroelastic Capsule
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Splenic Hilum
Splenic Hilum
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Diaphragmatic Surface
Diaphragmatic Surface
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Gastrosplenic Ligament
Gastrosplenic Ligament
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Splenic Artery
Splenic Artery
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Splenic Vein
Splenic Vein
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Pancreaticosplenic Nodes
Pancreaticosplenic Nodes
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Nerves of the Spleen
Nerves of the Spleen
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Pancreatic Juice
Pancreatic Juice
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Endocrine Secretions
Endocrine Secretions
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Head of Pancreas
Head of Pancreas
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Uncinate Process
Uncinate Process
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Neck of Pancreas
Neck of Pancreas
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Sphincter of Bile Duct
Sphincter of Bile Duct
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Pancreatic Arteries
Pancreatic Arteries
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Liver
Liver
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Bile
Bile
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Diaphragmatic Surface
Diaphragmatic Surface
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Hepatorenal Recess
Hepatorenal Recess
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Peritoneal Reflections
Peritoneal Reflections
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Bare Area of Liver
Bare Area of Liver
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Falciform Ligament
Falciform Ligament
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Porta Hepatis
Porta Hepatis
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The Umbilical Fissure
The Umbilical Fissure
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Lesser Omentum
Lesser Omentum
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Visceral Surface
Visceral Surface
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Hepatic Plexus
Hepatic Plexus
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Biliary Ducts
Biliary Ducts
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Liver Lobules
Liver Lobules
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Bile Canaliculi
Bile Canaliculi
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Hepatic Ducts
Hepatic Ducts
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Bile Duct
Bile Duct
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Common hepatic duct
Common hepatic duct
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Cystic Artery
Cystic Artery
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Cystic veins
Cystic veins
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Gallbladder
Gallbladder
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Fundus
Fundus
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Cystic Duct
Cystic Duct
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Cystic Artery
Cystic Artery
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Hepatic Portal Vein (HPV)
Hepatic Portal Vein (HPV)
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Portal-Systemic Anastomoses
Portal-Systemic Anastomoses
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Caput Medusae
Caput Medusae
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Portosystemic Shunts
Portosystemic Shunts
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Study Notes
- The large intestine, suspended by the sigmoid mesocolon, shows significant variability in length and disposition and concludes at the rectosigmoid junction, where the teniae, haustra, and omental appendices end anterior to the third sacral segment.
- The superior mesenteric vessels supply the large intestine proximal to the left colic flexure, while the inferior mesenteric vessels supply most of the large intestine distal to the flexure.
- Cranial and sacral parasympathetic innervation of the alimentary tract divides at the left colic flexure.
- Sympathetic fibers reach the large intestine through abdominopelvic splanchnic nerves and prevertebral ganglia, while the middle of the sigmoid colon marks a sensory innervation divide.
- The spleen is an ovoid, purplish mass, about the size and shape of a fist, located in the left upper quadrant (LUQ) or hypochondrium of the abdomen, it is considered the most vulnerable abdominal organ.
- The spleen is the largest lymphatic organ, functioning in lymphocyte proliferation, immune surveillance, and response as part of the body's defense system.
- Prenatally, the spleen is hematopoietic, but after birth, it identifies, removes, and destroys expended red blood cells and platelets, recycling iron and globin.
- The spleen acts as a blood reservoir, storing RBCs and platelets and aids "self-transfusion" during hemorrhage, but despite its size and functions, it is a non-vital organ.
- The spleen's structure includes a soft, vascular mass with a delicate fibroelastic capsule, covered by visceral peritoneum except at the splenic hilum, along with splenic artery and vein entry/exit points, facilitating expansion and contraction.
- The spleen is mobile and typically rests on the left colic flexure, associated posteriorly with the left 9th–11th ribs, separated by the diaphragm and costodiaphragmatic recess.
- The spleen’s relations include the stomach anteriorly, the diaphragm posteriorly, the left colic flexure inferiorly, and the left kidney medially.
- Spleen size varies, but it averages approximately 12 cm long and 7 cm wide and 1 inch thick, 3 inches wide, and 5 inches long and weighs 7 ounces.
- The diaphragmatic surface is convexly curved, fitting the diaphragm and adjacent ribs; anterior and superior borders are sharp and often notched.
- The posterior end and inferior border are rounded; the spleen typically doesn't extend below the left costal margin unless enlarged or hardened.
- The spleen has a thin fibrous capsule and trabeculae carrying blood vessels, containing a large blood quantity expelled into circulation via smooth muscle action.
- The splenic artery supplies blood, dividing into five or more branches at the hilum, forming vascular segments due to limited anastomosis, aiding subtotal splenectomy.
- The splenic vein drains blood, formed by tributaries from the hilum, joining the IMV and running behind the pancreas, uniting with the SMV to form the hepatic portal vein.
- Splenic lymphatic vessels extend to the pancreaticosplenic lymph nodes and then to the celiac nodes.
- Nerves from the celiac plexus distribute along splenic artery branches, regulating function as vasomotor nerves.
- The pancreas is an elongated accessory digestive gland that produces exocrine (pancreatic juice) and endocrine (glucagon and insulin) secretions.
- It sits retroperitoneally, transversely crossing the L1 and L2 vertebrae, posterior to the stomach and between the duodenum and spleen.
- The pancreas is divided into four parts: head, neck, body, and tail; main and accessory pancreatic ducts enter the duodenum.
- The head of the pancreas is embraced by the duodenum, with the uncinate process extending posteriorly to the SMA.
- The pancreatic head rests posteriorly on the IVC, renal artery/vein; the bile duct is embedded in its surface.
- The neck of the pancreas, short and overlying the mesenteric vessels, has an anterior surface adjacent to the pylorus and the SMV joining the splenic vein posteriorly to form the hepatic portal vein.
- The body of the pancreas stretches from the neck over the aorta/L2 vertebra, covered with peritoneum, and contacts the aorta, SMA, left suprarenal gland, kidney, and renal vessels posteriorly.
- The tail of the pancreas lies anterior to the left kidney close to the hilum and is mobile, running through the splenorenal ligament with splenic vessels.
- The main pancreatic duct runs the length of the gland and links to the bile duct to create the hepatopancreatic ampulla, which opens into the duodenum.
- Sphincters control digestive secretions and duodenal content, but only the bile duct sphincter significantly regulates bile flow into the duodenum.
- The accessory pancreatic duct opens into the duodenum, usually communicating with the main duct or solely carrying pancreatic juice.
- The pancreas' arterial supply includes multiple pancreatic arteries from the splenic, gastroduodenal, and superior mesenteric arteries, while venous drainage flows via pancreatic veins to parts of the splenic and superior mesenteric vein.
- Lymphatic vessels follow blood vessels to pancreaticosplenic lymph nodes, draining to superior mesenteric or celiac nodes.
- The nerves of the pancreas are vagus and abdominopelvic splanchnic nerves from the celiac and superior mesenteric plexuses, some fibers control pancreatic secretions.
- The liver is the body's largest gland, weighing 1,500 g, composing 2.5% of adult body weight (5% in mature fetus), conveying nutrients via the portal venous system, storing glycogen, and secreting bile for fat emulsification.
- Bile follows the hepatic ducts to the common hepatic duct, uniting with the cystic duct, bile production is continuous, with accumulation and storage in the gallbladder.
- The liver resides mainly in the right upper abdomen, shielded by the thoracic cage/diaphragm, its surface projection extends deep to ribs 7–11.
- The liver comprises of convex diaphragmatic surface (anterior, superior, and some posterior) and a relatively flat or even concave visceral surface which are separated anteriorly by its sharp inferior border, following the right costal margin inferior to the diaphragm.
- The diaphragmatic surface is positioned near the concavity of the diaphragmatic inferior surface to separate it from the pleurae, lungs, peritoneum, and heart.
- Subphrenic recesses occur between the diaphragm and anterior/superior liver aspects; hepatorenal recess (Morison pouch) is a posterosuperior space extension, draining fluid from the omental bursa and connecting to the subphrenic recess.
- Recesses are potential spaces containing enough fluid to lubricate the peritoneal membranes, which divides into right and left recesses by the falciform ligament.
- The visceral surface is covered with visceral peritoneum, with the exclusion of the fossa for the gallbladder and the porta hepatis, it is connected to the stomach by the gastrosplenic ligament and lesser omentum, and to the left kidney by the splenorenal ligament.
- The hilum constitutes the left boundary of the omental bursa and is often in contact with the pancreas tail.
- Right colix flexure and right transverse colon lie along its right side.
- Inferior vena cava, ligamentum venosum, gastric and pyloric areas are marked by fissures.
- Umbilical fissure is split into fissure for the round ligament and fissure for the ligamentum venosum.
- The lesser omentum (hepatogastric ligament) connects the liver to the stomach, while the hepatoduodenal ligament connects the liver to the porta hepatis.
- Externally, it is divided into two anatomical lobes and two accessory lobes marked by peritoneum reflections.
- The midline is defined by the falciform ligament attachment separating the right lobe from the left.
- On the visceral surface the right and left fissures separate the quadrate lobe anteriorly and the caudate lobe posteriorly.
- The liver is functionally divided into the right and left livers which receive its own primary branch with hepatic artery and portal vein and is drained by the hepatic duct.
- For each 8, the caudate lobe's vascularization is independent that is drained by hepatic veins.
- Hepatic Veins (right, intermediate, left) are intersegmental in distribution and function.
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