Surface Anatomy of Liver Quiz and Flashcards: Upper Border and More

Location: occupies the whole right hypochondrium, a part of epigastrium, and a part of left hypochondrium
Weight: 1/50 of body weight in adults (1500gm) and 1/20 of body weight in infants
Functions:
- Exocrine (bile) and endocrine (albumin, prothrombin, and fibrinogen) gland
- Secretion of bile and bile salts
- Metabolism of carbohydrates, fats, and proteins
- Formation of heparin and anticoagulant substances
- Detoxification
- Storage of glycogen and vitamins
- Activation of vitamin D

Upper border: presented by a line joining the following points:
- Left 5th intercostal space below the left nipple at the left midclavicular line
- Point at the xiphisternal junction
- Right 5th costal cartilage at the midclavicular line
- Right 7th rib at the midaxillary line
Right border: convex line joining two points:
- Point at the 7th rib at the midaxillary line
- Point at the 11th rib at the midaxillary line
Lower border: presented by a line joining the following points:
- Left 5th intercostal space below the left nipple at the left midclavicular line
- Left costal margin at the tip of the left 8th costal cartilage
- Point on the midline at the transpyloric plane
- Right 11th rib at the midaxillary line
Shape: wedge shape with its base to the right
Surfaces: five surfaces, including the base or right, superior, anterior, posterior, and inferior or visceral surfaces
Borders: ill-defined except for the inferior border

Anterior surface relations:
- Diaphragm separating it from the right and left pleura and lung
- Right costal cartilage
- Xiphoid process
- Anterior abdominal wall
Superior surface relations:
- Diaphragm separating it from the pericardium and heart (in the middle) and pleurae and lungs (on each side)
Right lateral surface (base) relations:
- Diaphragm separating it from the right lung and pleura and ribs from 7-11 of the right side
Posterior surface relations:
- Bare area: triangular area related to the diaphragm (devoid of peritoneum)
- Groove for the IVC
- Caudate lobe: related to the diaphragm, projecting downwards to form the quadrate process separating the IVC from the porta hepatis
- Fissure for the ligamentum venosum (obliterated ductus venosus in embryology)
- Esophageal notch

Anatomical division:
- The liver is divided into a smaller left and a larger right lobe by:
  - Falciform ligament: anteriorly
  - Fissure for the ligamentum venosum: posteriorly
  - Fissure for the ligamental teres: inferiorly
The right lobe contains two additional lobes: the caudate and quadrate lobes
Functional division:
- Caudate lobe:
  - Located in the posterior surface of the right lobe
  - Relations: inferior to the porta hepatis, right to the fossa for the inferior vena cava, and left to the fossa for the ligamentum venosum
- Quadrate lobe:
  - Located on the inferior surface of the right lobe
  - Relations: anterior to the inferior margin of the liver, superior to the porta hepatis, right to the fossa for the gallbladder, and left to the fissure for the ligamentum teres

It is the hilum of the liver
Located on the postero-inferior surface of the liver
Lies between the caudate and quadrate lobes
Structures passing through it:
- DAV (from before backwards): right and left hepatic ducts, right and left branches of the hepatic artery, and portal vein
- Lymphatics, lymph nodes, and autonomic fibers

The liver is covered by peritoneum (intraperitoneal organ) except at the bare area
Inferior surface covered with peritoneum of the greater sac except for the porta hepatis, gallbladder, and ligamentum teres fissure
Right lateral surface covered with peritoneum, related to the diaphragm, which separates it from the right pleura, lung, and ribs from 7-11

Parts:
- Fundus: projects below the inferior margin of the liver, lies opposite the tip of the right 9th costal cartilage, related anteriorly to the anterior abdominal wall and posteriorly to the transverse colon
- Body: related anteriorly to the liver and posteriorly to the 1st part of the duodenum
- Neck: continuous with the cystic duct, has the same relation as the body
Peritoneal covering:
- Fundus: completely covered by peritoneum
- Body and neck: only covered posteriorly
Function: stores and concentrates bile
Artery: cystic branch of the right hepatic artery
Vein: cystic vein that drains into the right branch of the portal vein
Lymph drainage: cystic lymph nodes, then to hepatic and finally to celiac lymph nodes
Nerves: sympathetic from the celiac nerve plexus (T7-9), parasympathetic through the vagus nerves, and pain through the right phrenic nerve with referral to the stomach, inferior angle of the right scapula, and right shoulder

Right and left hepatic ducts:
- Emerge from the porta hepatis
- Drain bile from the right and left lobes of the liver
- Unite to form the common hepatic duct
Common hepatic duct:
- One and a half inches in length
- Formed by the union of the two hepatic ducts
- Unites with the cystic duct to form the common bile duct
Common bile duct:
- Formation: formed below the porta hepatis by the union of the cystic and common hepatic ducts
- Descends in the free edge of the lesser omentum and divides into three parts:
  - Supra duodenal part
  - Retroduodenal part
  - Infra duodenal part