Podcast
Questions and Answers
Which ligament separates the left and caudate lobes of the liver?
Which ligament separates the left and caudate lobes of the liver?
What structure is found within the Falciform Ligament?
What structure is found within the Falciform Ligament?
Which fissure separates the right lobe into anterior and posterior segments?
Which fissure separates the right lobe into anterior and posterior segments?
Which lobe of the liver is the largest?
Which lobe of the liver is the largest?
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What is the function of the Glisson capsule?
What is the function of the Glisson capsule?
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Which structure connects the lesser curvature of the stomach to the liver?
Which structure connects the lesser curvature of the stomach to the liver?
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Which of the following is a remnant of the ductus venosum from fetal life?
Which of the following is a remnant of the ductus venosum from fetal life?
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What is the name of the space that the main lobar fissure passes through?
What is the name of the space that the main lobar fissure passes through?
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Which of the following statements about hepatic veins is true?
Which of the following statements about hepatic veins is true?
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What percentage of the liver's blood supply comes from the hepatic artery?
What percentage of the liver's blood supply comes from the hepatic artery?
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In portal venous hypertension, what pressure measurement indicates it is hemodynamically significant?
In portal venous hypertension, what pressure measurement indicates it is hemodynamically significant?
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Which structure is responsible for 70% of the liver's blood supply?
Which structure is responsible for 70% of the liver's blood supply?
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What is a secondary cause of portal vein thrombosis?
What is a secondary cause of portal vein thrombosis?
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Which space is located anterior to the right kidney and lateral to the right lobe of the liver?
Which space is located anterior to the right kidney and lateral to the right lobe of the liver?
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What is the primary function of the portal veins with respect to blood circulation in the liver?
What is the primary function of the portal veins with respect to blood circulation in the liver?
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Which segment of the liver is known as the caudate lobe?
Which segment of the liver is known as the caudate lobe?
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Which structure separates the anterior segment of the right lobe from the medial segment of the left lobe?
Which structure separates the anterior segment of the right lobe from the medial segment of the left lobe?
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What is the appearance of the liver structures described as echogenic or hyperechoic indicative of?
What is the appearance of the liver structures described as echogenic or hyperechoic indicative of?
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Which ligament is known to form the most caudal division of the left lobe of the liver?
Which ligament is known to form the most caudal division of the left lobe of the liver?
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Which of the following statements about the hepatic arteries is correct?
Which of the following statements about the hepatic arteries is correct?
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Which of the following spaces is located between the superior border of the liver and the diaphragm?
Which of the following spaces is located between the superior border of the liver and the diaphragm?
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What is the primary purpose of a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
What is the primary purpose of a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
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Which type of liver abscess is most likely associated with travel abroad and ingesting contaminated water?
Which type of liver abscess is most likely associated with travel abroad and ingesting contaminated water?
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What appearance is characteristic of a candidiasis infection in the liver?
What appearance is characteristic of a candidiasis infection in the liver?
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Which type of hepatitis is primarily spread by the fecal-oral route?
Which type of hepatitis is primarily spread by the fecal-oral route?
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What is a common risk factor for fatty infiltration of the liver?
What is a common risk factor for fatty infiltration of the liver?
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Which imaging appearance is associated with chronic hepatitis?
Which imaging appearance is associated with chronic hepatitis?
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What term describes the inflammatory and infectious disease of the liver, encompassing several types?
What term describes the inflammatory and infectious disease of the liver, encompassing several types?
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What ultrasound finding may suggest cirrhosis?
What ultrasound finding may suggest cirrhosis?
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Which benign liver condition is described as a tumor of the glandular epithelium that is more common in women?
Which benign liver condition is described as a tumor of the glandular epithelium that is more common in women?
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What symptom is common among patients with schistosomiasis affecting the liver?
What symptom is common among patients with schistosomiasis affecting the liver?
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In the context of liver pathology, what does the term 'micronodular cirrhosis' denote?
In the context of liver pathology, what does the term 'micronodular cirrhosis' denote?
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Which of the following is NOT a likely cause of pyogenic liver abscess?
Which of the following is NOT a likely cause of pyogenic liver abscess?
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What is the echogenicity pattern often seen in a hepatic adenoma?
What is the echogenicity pattern often seen in a hepatic adenoma?
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Which parasitic infection is particularly linked to traveling to underdeveloped countries and presents with distinctive cystic masses?
Which parasitic infection is particularly linked to traveling to underdeveloped countries and presents with distinctive cystic masses?
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Study Notes
Liver Anatomy
- The liver is the largest solid organ in the body
- It weighs 1600g in males and 1400g in females
- Covered by Glisson capsule
- 3 lobes (left, right, and caudate)
- Ligaments, fissures, and spaces
- Vascular (hepatic arteries, hepatic veins, portal veins)
- Biliary Tract
Lobes of the Liver
- Left lobe is divided into medial and lateral segments by the left hepatic vein and ligamentum teres
- Separated from the caudate lobe by the ligamentum venosum
- Separated from the right lobe by the middle hepatic vein superiorly and the main lobar fissure inferiorly
- Right lobe is divided into anterior and posterior segments by the right hepatic vein
- 6x's larger than the left lobe
- Three posterior fossae (gallbladder, porta hepatis, IVC)
- Caudate lobe is the smallest lobe of the liver
- Separated from the left lobe by the ligamentum venosum
Ligaments of the Liver
- The liver is attached to the diaphragm, anterior abdominal wall, stomach and retroperitoneum by ligaments
- Coronary ligament connects the liver to the body wall (upper and lower layers)
- Falciform ligament connects the liver to the anterior abdominal wall and extends from the diaphragm to the umbilics. Separates the right and left subphrenic spaces
- Gastrohepatic ligament attaches the lesser curvature of the stomach to the liver
- Hepatoduodenal ligament connects the liver to the proximal duodenum
- Ligamentum Teres (round ligament) lies within the falciform ligament
- Previous fetal umbilical vein
- Triangular ligament is the most lateral portion of the coronary ligament and connects the liver to the body wall
- Ligamentum Venosum separates the left lobe from the caudate lobe and is the obliterated ductus venosum (fetal life)
- Lesser omentum attaches to the ligamentum venosum
Fissures of the Liver
- Main lobar fissure separates the right lobe from the left lobe of the liver and passes through the gallbladder fossa to the inferior vena cava.
- Right intersegmental fissure divides the right lobe of the liver into anterior and posterior segments.
- Left intersegmental fissure divides the left lobe into medial and lateral segments.
Liver Spaces
- Morison pouch (Hepatorenal pouch) is lateral to the right lobe of the liver, anterior to the right kidney, and communicates with the right paracolic space
- Subhepatic space is inferior to the right lobe of the liver and anterior to the right kidney
- Subphrenic space is between the superior border of the liver and diaphragm
Vascular Supply
- Hepatic venous system: portal veins carry blood from the bowel to the liver, hepatic veins drain blood from the liver to inferior vena cava (IVC)
- Hepatic arteries carry oxygenated blood to the liver
- Bile ducts transport bile to the duodenum
Hepatic Veins
- Right middle and left hepatic veins course interlobar and drain directly into the IVC
- Minimum amount of collagen in the walls
- Straight and longitudinal course
- Increase in size closer to the diaphragm
- Hepatic vein velocity waveform reflects the hemodynamics of the right atrium
- Triphasic pattern with two large antegrade diastolic and systolic waves, and a small retrograde wave that corresponds to the atrial kick
Hepatic Arteries
- Proper hepatic artery enters the liver at the porta hepatis, dividing into right, middle, and left hepatic arteries
- 30% of the liver's blood supply comes through the hepatic artery
Portal Venous System
- Main right and left portal veins enter at the porta hepatis.
- Bifurcate into right and left branches
- 70% of the liver's blood supply
- Nutrient-rich blood from the digestive tract
- Walls contain fibrin
- Normal diameter <13mm
Right Portal Vein
- Larger of the two portal vein branches
- Requires a more posterior and more caudal transducer approach.
- Divides into anterior and posterior divisions
Primary Liver Functions
- Hepatic metabolic functions: converts sugars into glucose, converts glucose to glycogen and stores it, metabolizes fats into lipoproteins
- Role in digestion: secretes bile for digestion of fats, breaks down red blood cells into bilirubin
- Storage function: stores iron and vitamins, detoxifies many drugs and poisons, and waste products of the body's metabolic processes
Indications for Sonographic Evaluation
- Abnormal liver function tests (LFTs)
- Hepatocellular disease
- Biliary disease
- Abdominal pain
- Post-prandial pain
- Gallbladder disease
- Palpable liver or spleen (PV HTN)
- Pancreatitis
Liver Segments
- Key segments include: Segment I (Caudate lobe), Segments II and III (Left superior and inferior lateral segments), Segments IVa and IVb, Segments V and VI (Medial segments of the left lobe, caudal to the transverse plane), Segments VII and VIII (Cephalad to the transverse plane). These segments are determined relative to the hepatic veins (right, middle, and left).
Liver Anomalies
- Developmental anomalies (agenesis, hypertrophy, anomalies of position – such as Riedel lobe, situs inversus, heterotaxy, and congenital diaphragmatic hernia (CDH).)
- Inflammation/infections (abscesses, candidiasis, echinococcal cyst, hepatitis, schistosomiasis)
- Malignant neoplasms (hepatoblastoma, hepatocellular carcinoma, metastases)
- Vascular-related anomalies (Budd-Chiari syndrome, portal hypertension, portal vein thrombosis)
Benign Hepatic Conditions
- Fatty infiltration, cirrhosis, focal nodular hypoplasia, adenoma, cavernous hemangioma, glycogen storage disease, hemochromatosis
Liver Trauma
- The liver is the third most commonly injured abdominal organ after the spleen and kidney.
- Laceration, hematoma severity determines need for surgery. Right lobe is affected more often than the left.
Liver Transplant
- Living or deceased donor transplants
- Section (40-70%) of right lobe of donor liver is transplanted for living donors
- Orthotopic transplant removes all native liver prior to transplant for deceased donors
- Check anastomotic sites, and signs of rejection (based on LFTs and biopsy).
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Description
Explore the intricate anatomy of the liver, the largest solid organ in the human body. This quiz covers its structure, including the liver lobes, ligaments, and vascular system, providing insights into its functional significance. Test your knowledge on the liver's anatomy and its various components.
