Arteries
|
| Artery |
Source |
Branches |
Supply |
Notes |
| aberrant hepatic (N305, TG5-25) |
left - l. gastric a.; right- SMA |
|
liver |
|
| celiac trunk |
abdominal aorta at level of T12-L1 intervertebral disc |
left gastric, splenic, common hepatic |
stomach, lower esophagus, liver, upper duodenum, pancreas, spleen |
(Greek, celiac = belly; the celiac artery supplies the principal organs of the belly) |
| cystic (TG5-24, TG5-25) |
right hepatic a. (or superior mesenteric a., proper hepatic a., left hepatic a., gastroduodenal a.) |
no named branches |
gall bladder |
cystic a. arises from the right hepatic a. in ~72% of cases; other possible origins are noted at left and are clinically relevant during gall bladder surgery (Greek, cystic/kystis = bladder or pouch) |
| hepatic, common (TG5-27) |
celiac trunk |
gastroduodenal & proper hepatic |
liver & parts of duodenum, pancreas & stomach |
|
| hepatic, proper (TG5-27) |
common hepatic |
right gastric, right & left hepatic |
liver, lesser curvature of stomach |
|
| hepatic, left (TG5-25) |
proper hepatic |
|
left & quadrate lobes of liver, part of caudate lobe |
left hepatic a. supports liver parenchyma and stroma |
| hepatic, right (TG5-25) |
proper hepatic |
cystic |
right lobe of liver, part of caudate lobe |
right hepatic a. supports liver parenchyma and stroma |
Veins
|
| Vein |
Tributaries |
Drains Into |
Region Drained |
Notes |
| esophageal (TG4-40) |
|
azygos and hemiazygos vv. |
esophagus |
connect with esophageal brs. of left gastric, forming potential portal-caval anastomosis (esophageal varices when enlarged) |
| portal (TG5-22, TG5-26) |
formed by union of superior mesenteric & splenic vv.; tributaries: posterior superior pancreaticoduodenal v., right & left gastric vv. |
right & left branches of portal v., into liver sinusoids |
|
connects with caval drainage at 1) esophagus, 2) rectum, 3) umbilicus, 4) retroperitoneal gut structures |
| hepatic, left (TG5-25) |
segmental vv. |
inferior vena cava |
lateral segment & superior portion of medial segment of left lobe of liver |
|
| hepatic, middle (TG5-25) |
segmental vv. |
inferior vena cava |
inferior portion of medial segment of left lobe of liver, & inferior part of anterior segment of right lobe |
|
| hepatic, right (TG5-25) |
segmental vv. |
inferior vena cava |
posterior segment & superior portion of anterior segment of right lobe of liver |
|
| gastric, left (TG5-28) |
esophageal vv. |
portal v. |
lesser curvature of stomach, lower esophagus |
connects with esophageal vv., forming portal-caval venous anastomosis (esophageal varices when enlarged); also known as: coronary v. |
| gastric, right (TG5-28) |
|
portal v. |
lesser curvature of stomach |
also known as: coronary v. |
| mesenteric, superior (TG5-26, TG5-27) |
pancreticoduodenal, jejunal, right and middle colic |
portal v. |
gut |
|
| paraumbilical (TG5-02) |
|
umbilical part of left branch of portal vein |
falciform ligament, round ligament of liver |
potential site of portal-caval anastomosis; blood may pass retrogradely into body wall veins near umbilicus, creating caput medusa sign |
| splenic (TG5-20) |
pancreatic brs. |
unites with SMV to form portal v. |
spleen |
|
| mesenteric, inferior (TG5-28) |
superior rectal, sigmoid, left colic vv. |
splenic v. (or superior mesenteric v.) |
gut from splenic flexure distally |
courses lateral to 4th part of duodenum |
Viscera
|
| Organ |
Location/Description |
Notes |
| greater duodenal papilla (TG5-26) |
an eminence on the posteromedial wall of the descending duodenum |
location of the opening of the hepatopancreatic duct (Latin, papilla = a nipple) |
| lesser duodenal papilla (TG5-26) |
located just superior to the greater duod. papilla |
location of the opening of the accessory pancreatic duct (Latin, papilla = a nipple) |
| pancreatic duct, main (TG5-26) |
drains tail, body & lower head of pancreas |
unites with the bile duct at hepatopancreatic ampulla |
| liver (TG5-21A, TG5-21C, TG5-21D) |
consists of 4 anatomical lobes: left, right, quadrate & caudate |
lies inferior to the diaphragm as high as 5th rib on right |
| bare area of liver (TG5-21A, TG5-21D) |
lies between anterior & posterior laminae of coronary lig. |
in contact with diaphragm |
| porta hepatis (TG5-21) |
region of undersurface of liver where hepatic ducts, hepatic aa. & portal v. enter/leave |
|
| quadrate lobe (TG5-23) |
part of liver between bed of gall bladder & round ligament of liver |
functionally part of left lobe (Latin, quadrate = square) |
| ligamentum venosum (TG5-21) |
lies in attachment of hepatogastric lig. to liver, between caudate & left lobe |
remnant of obliterated ductus venosus |
| gallbladder (TG5-24A, TG5-24B) |
hangs below liver between right & quadrate lobes of liver |
connected to the bile duct via cystic duct |
| gallbladder, body of (TG5-24) |
lies in bed of gallbladder between right & quadrate lobes of liver |
|
| gallbladder, fundus of (TG5-24) |
expanded lower part; located near inner surface of anterior abdominal wall at junction of right 9th costal cartilage & right semilunar line |
|
| gallbladder, neck of (TG5-24) |
constricted upper part of gallbladder |
continuous with cystic duct |
| hepatic duct, common (N294, TG5-22A, TG5-24C) |
formed by union of right & left hepatic ducts |
unites with cystic duct to form bile duct |
| hepatic duct, left (N294, TG5-22A, TG5-24C) |
drains left lobe, quadrate lobe & part of caudate lobe of the liver |
unites with right hepatic duct to form common hepatic duct |
| hepatic duct, right (N294, TG5-22A, TG5-24C) |
drains right lobe & part of caudate lobe of the liver |
unites with left hepatic duct to form common hepatic duct |
| bile duct (N294, TG5-22A, TG5-24C) |
union of cystic & common hepatic ducts |
drains to hepatopancreatic ampulla & greater duodenal papilla with main pancreatic duct |
| cystic duct (N294, TG5-22A, TG5-24C) |
duct of the gallbladder; unites with common hepatic duct to form the bile duct |
both drains and fills gallbladder (Greek, cystic/kystis = bladder or pouch) |
Peritoneal Specializations and Associated Structures
|
| Specialization |
Location/Description |
Notes |
| hepatoduodenal ligament (TG5-18, TG5-19) |
part of lesser omentum connecting liver with 1st part of duodenum |
contains bile duct, proper hepatic a. & portal v. |
| hepatogastric ligament (TG5-18) |
part of lesser omentum connecting liver with lesser curvature of stomach |
|
| falciform ligament (N269 ,N287, TG5-21) |
sickle-shaped fold of peritoneum connecting liver to umbilicus |
contains round ligament of liver (ligament teres hepatis) (Latin and English combo, falciform = shaped like a scythe or sickle) |
| coronary ligament (N287, TG5-21) |
peritoneum connecting liver to undersurface of diaphragm |
area between anterior & posterior laminae is bare area of liver |
| round ligament of the liver (TG5-21) |
|
also known as: ligamentum teres hepatis |
| triangular ligaments (TG5-21) |
left and right extremes of the coronary ligament |
formed by the fusion of anterior & posterior laminae of the coronary ligament |
| ligamentum teres hepatis (TG5-21) |
lies within falciform lig.; connects liver to umbilicus; remnant of umbilical v. |
also known as: round ligament of liver (Latin, teres = round) |
Clinical Terms
|
| Term |
Definition |
| portocaval anastomosis |
a common method for reducing portal hypertension by diverting blood
from the portal venous system to the systemic venous system by creating
a communication between the portal vein and the IVC. This usually leads
to hepatic encephalopathy as the toxins from the GI tract bypass the liver and
its processing of them. |
| pancreatitis |
acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic and which is due to autodigestion of pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis or uremia. |
| gallstones |
a concretion in the gall bladder or a bile duct, composed chiefly of cholesterol crystals. |
| jaundice |
yellowing of the skin (and whites of eyes) by bilirubin, a bile pigment. Frequently because of a liver problem. (Latin, jaundice/jaune = yellow) |
| cholecystectomy |
the surgical removal of the gallbladder. This type of surgery may be performed with the traditional open incision or via a flexible fiberoptic scope (laparoscopic cholecystectomy). |
| cirrhosis |
liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. (Greek, kirrhos = yellow liver + -osis = condition) |
| portal hypertension |
any increase in the portal vein pressure due to anatomic or functional obstruction (for example alcoholic cirrhosis) to blood flow in the portal venous system. Indicators of portal hypertension are: esophageal varices, hemorrhoids, enlarged veins on the anterior abdominal wall (caput Medusae) and ascites (fluid within the abdominal cavity). |
| ascites |
an effusion and accumulation of serous fluid in the abdominal cavity. (Greek, askos = a bag) |
| cholecystojejunostomy |
surgical establishment of a communication between the gall bladder and the jejunum. |
| bilirubin |
pigment found in bile; mainly formed during heme catabolism - the breakdown of old red blood cells within the liver(Latin, bilis = bile + ruber = red) |
| hepatomegaly |
enlargement of the liver |
| diuretics |
agents that promote the excretion of urine through their effects on the function of the kidney |
| endoscopic retrograde cholangiopancreatography |
fiberoptic endoscopy for duodenal observation and cannulation of the hepatopancreatic ampulla in order to visualize the pancreatic and biliary duct system by retrograde (against the usual direction of flow) injection of contrast media |
| caput medusae |
varicose veins radiating from the umbilicus. Ordinarily seen as a sign of cirrhosis of the liver and caused by portal hypertension. (Latin, caput medusae = medusa head) |
| cholecystitis |
acute or chronic inflammation of the gall bladder |
| laparoscopic cholecystectomy |
surgery to remove a diseased gallbladder through a fiberoptic scope that is inserted into a small incision near the navel. The patient is usually home 24 hours after the surgery. |
| Pringle maneuver |
manually stopping the inflow to the liver by compressing the portal vein and
proper hepatic artery. This is utilized in cases when the liver is bleeding and the
bleeding must be stopped immediately (such as in trauma or surgical exploration) |
