(ANA 2I2)

GROSS ANATOMY OF THE

THORAX AND ABDOMEN

TOPIC:
LIVER, PANCREAS AND SPLEEN

Dr. ELIJAH, S. O.
THE LIVER
• The largest gland and single organ (except skin) in
the body with wide variety of functions

• Weight proximately 1/50 of body weight in adult &

1/20 of body weight in infant

• Both exocrine(bile) & endocrine organ(Albumen ,

prothrombin & fibrinogen)

• Function of the liver:

– Secretion of bile & bile salt
– Metabolism of carbohydrate, fat and protein
– Formation of heparin & anticoagulant substances
– Detoxication
– Storage of glycogen and vitamins
 LOCATION AND SURFACE MARKING
• Occupies right
hypochondrium +
epigastrium and
extends to left
hypochondrium

• The greater part of the

liver is situated under
cover of the right costal
margin

• Diaphragm separates it
from the pleura, lungs,
pericardium, and heart.
 SURFACES OF LIVER, THEIR RELATIONS and
IMPRESSIONS

• Anterior surface Relations of the liver

Anteriorly
• Posterior surface • Diaphragm

• Right surface • Rt & Lt pleura and lung

• Postero - inferior surface= • Costal cartilage

visceral surface

• Superior surface = • Xiphoid process

Diaphragmatic surface
• Ant. abdominal wall
 Posterior relation of the liver
• Diaphragm

• Rt. Kidney

• Supra renal gland

• T. colon (hepatic flexure)

• Duodenum

• Gall bladder

• I.V.C

• Esophagus
Postero- infero surface= visceral surface
Relations
• I.V.C esophagus

• Stomach duodenum

• right colic flexure right kidney

• Right Suprarenal gland gallbladder.

• Tubular omentum Ligamentum teres

• Porta hepatic( bile duct, Hepatic artery and Vein)

• Fissure for ligamentum Venosum & lesser omentum

 Superior Surface of the liver
• Right and left lobes
• Cut edge of Falciform ligament
• Cut edges of the superior and inferior parts of the
coronary ligament
• The left triangular ligament
• The right triangular ligament
• Bare area of the liver (no peritoneum covering liver)
• Groove for the inferior vena cava and the hepatic veins
• Caudate lobe of the liver (wrapping around groove of
IVC)
• Fundus of gall bladder
RELATIONS
• Diaphragm

• Pleura & lung

• Pericardium &
heart
 Lobes of the liver
Four: Right Lobe, Left lobe, Quadrate lobe and Caudate lobe
Separation of the four lobes of the
liver:
• Right sagittal fossa - groove for
inferior vena cava and gall bladder

• left sagittal fissure - contains the

Ligamentum Venosum and round
ligament of liver

• Transverse fissure (also porta

hepatis) - bile ducts, portal vein,
hepatic arteries.
 Right Lobe
• Largest lobe

• Occupies the right

hypochondrium

• Divided into anterior

and posterior sections
by the right hepatic vein

• Reidel’s Lobe extend as

far caudally as the iliac
crest
 Left Lobe
• Varied in size
– Lies in the epigastric and left
hypochondriac regions
– Divided into lateral and
medial segments by the left
hepatic vein

Rt. & Lt lobe separated by

• Falciform ligament
• Ligamentum Venosum
• Ligamentum teres
 Caudate Lobe
present in the posterior
surface from the Rt.
Lobe
Two processes
1- c- process
2- papillary process
Relations of caudate lobe
- Inf.  the porta hepatis
- The right  the fossa for
the inferior vena cava
- The left the fossa for
the ligamentum venosum.
Present on the inferior
surface from the Rt. Lobe

Relation
- Ant. anterior margin of
the liver
- Sup. porta hepatis
- Rt. fossa for the
gallbladder
- Lt by the fossa for
ligamentum teres
 PORTA HEPATIS
• Is the hilum of the liver
• Found on the posteroinferior
surface
• Lies between the caudate and
quadrate lobes
• Lesser omentum attach to its
margin

Contents
• Gallbladder  ant.
• Hepatic artery + nerve +
lymphatic node  middle.
• Portal vein  post.
 Peritoneum of the liver
• The liver is covered by peritoneum except at bare
area (its origin from septum transversum)

• Inferior surface covered with peritoneum of greater

sac except porta hepatis, G.B & Ligamentum teres
fissure

• Rt. Lateral surface covered by peritoneum, related

to diaphragm which separate it from Right Pleura ,
lung and the Right Ribs (6-11).
 The ligaments of the liver
1- The Falciform ligament of liver
2- The Ligamentum teres hepatis
3- The coronary ligament
4- The right triangular ligament
5- The left triangular ligament
6- The Hepatogastric ligament
7- The hepatoduonedenal ligament
8- The Ligamentum Venosum
 Falciform ligament of liver
• Consists of double
peritoneal layer
• Sickle shape

• Extends from anterior

abdominal wall
(umbilicus) to liver

• Free border of the

ligament contains
Ligamentum teres
(obliterated umbilical
vein)
Coronary ligament
• The area between upper
and lower layer of the
coronary ligament is the
bare area of liver which
contract with the
diaphragm;

Left and right triangular

ligaments
• Formed by left and right
extremity of coronary
ligament
Hepatogastric ligament
• Extends between the
groove for the ligamentum
venosum and the lesser
curvature of the stomach.

Hepatoduodenal ligament
• Thick, free edge of the
lesser omentum
• Extends between the
porta hepatis and the
duodenum
• Encloses the structures
that pass through the
porta hepatis.
 The Ligamentum Venosum
• Fibrous band that is the
remains of the ductus
venosus

• Attached to the left

branch of the portal vein

• Ascends in a fissure on
the visceral surface of the
liver to be attached
above to the inferior vena
cava.
 Segmental Anatomy of the Liver
• Anatomically Rt. & Lt. lobes no morphological significance.

• Separation by ligaments (Falciform, lig. Venosum & Lig.

teres)

• Morphological and physiological division by a line extending

from fossa of GD to fossa of I.V.C each has its own arterial
blood supply, venous drainage and biliary drainage

• No anastomosis between divisions

• 3 major hepatic veins  Right, Left & central

• 8 segments based on hepatic and portal venous segments.

Segments are based on the portal and hepatic venous segments
 Blood supply of the liver
Portal Systemic Anastomoses
• Proper hepatic
artery  The right
and left hepatic
arteries enter the
porta hepatis.

• The right hepatic

artery usually gives
off the cystic artery,
which runs to the
neck of the
gallbladder.
• The blood vessels conveying blood
to the liver are the hepatic artery
(30%) and portal vein (70%).

• The hepatic artery brings

oxygenated blood to the liver, and
the portal vein brings venous blood
rich in the products of digestion,
which have been absorbed from the
gastrointestinal tract.

• The arterial and venous blood is

conducted to the central vein of
each liver lobule by the liver
sinusoids.

• The central veins drain into the right

and left hepatic veins, which passes
through the posterior surface of the
liver and open directly into the IVC.
 Vein drainage of the liver
• The portal vein divides
into right and left
terminal branches that
enter the porta hepatis
behind the arteries.

• The hepatic veins

(three or more) emerge
from the posterior
surface of the liver and
drain into the IVC.
 Lymphatic drainage of the liver
• Liver produce 1/3 of total body lymph received by
thoracic duct.

• Most of the lymph is formed in the perisinusoidal

spaces (of Disse) and drains to the deep lymphatics
in the surrounding intralobular portal triads.

• Lymph leave the liver and enters several lymph nod

in porta hepatis efferent vessels pass to celiac nods

• A few vessels pass from the bare area of the liver

through the diaphragm to the posterior Mediastinal
lymph nodes.
 Nerve supply
• Derived from hepatic plexus

• Derivative of the celiac plexus.

Consists of:
– sympathetic fibers from the celiac plexus
– Parasympathetic fibers from anterior and
posterior vagal trunks.

• Primary function - vasoconstriction

 GALLBLADDER
Location:
• Epigastric - Right hypochondrium region Capacity 40 - 60
cc

• Green muscular organ Pear-shaped, hollow structure

• On inferior surface of liver Between quadrate and right

lobes

• Has a short mesentery At the tip of the 9th Rt . C.C

Fundus
-Ant: Anterior
abdominal wall
- Post.inf: transvers-
colon
Body
sup: liver
post.inf: Transvers-colon.
Doudenum
Neck
- Form the cystic duct, 4cm
 The biliary ducts
• Convey bile from the liver to the duodenum.

• Hepatocytes secrete bile into the bile

canaliculi formed between them.

• Canaliculi drain into the small interlobular

biliary ducts and then into large collecting
bile ducts of the intrahepatic portal triad,
which merges to form the right and left
hepatic ducts.
• The right and left hepatic ducts drain the
right and left (parts of the) liver, respectively.

• After leaving the porta hepatis,

– the right and left hepatic ducts unite to form the
common hepatic duct
– joined on the right side by the cystic duct to
form the bile duct
– conveys the bile to the duodenum.

• Measures from 5 to 15 cm.

• The ducts unite to form
the hepatopancreatic
ampulla.

• The ampulla opens into

the duodenum through
the major duodenal
papilla.

• Circular muscle around

the distal end of the
bile duct thickens to
form its sphincter.
 Arterial Supply to the Gallbladder
The arteries supplying the bile duct include:
• Cystic artery: supplying the proximal part of the
duct.

• Right hepatic artery: supplying the middle part of

the duct.

• Posterior superior pancreaticoduodenal artery and

gastroduodenal artery: supplying the
retroduodenal part of the duct.
• The veins from the proximal part of the bile duct
and the hepatic ducts usually enter the liver directly.

• The posterior superior pancreaticoduodenal vein

drains the distal part of the bile duct and empties
into the portal vein or one of its tributaries.

NERVES
• Sympathetic and parasympathetic from celiac plexus
• Parasympathetic - vagous nerve
 Lymphatic of the bile
The lymphatic vessels from
the bile duct pass to
• the cystic lymph nodes
near the neck of the
gallbladder,
• the node of the omental
foramen, and
• the hepatic lymph nodes.

• Efferent lymphatic vessels

from the bile duct pass to
the celiac lymph nodes.
 WHAT’S BILE ?
• Composed of water, ions, bile acids,
organic molecules (cholesterol,
phospholipids, bilirubin)

• Gallstones are mostly cholesterol.

• Acids and salts emulsify fats for

absorption across wall of small
intestines into lacteal lymph
capillaries.

• Contains waste products from RBC

breakdown and other metabolic
processing (color of feces from
bilirubin in bile).

• Ions buffer chyme from stomach.

 APPLIED ANATOMY OF THE LIVER
Rupture of the Liver
• Fractured rib that perforates the diaphragm tears the
liver.

• Because of the liver's great vascularity and friability,

liver lacerations often cause considerable hemorrhage
and right upper quadrant pain.

In such cases,
• Removal of foreign material, the contaminated or
devitalized tissue by dissectio
Hepatomegaly
• The IVC and hepatic veins lack valves.

• Rise in central venous pressure is directly

transmitted to the liver, which enlarges as it
becomes engorged with blood.

• Congestive heart failure, bacterial and viral diseases

such as hepatitis cause liver enlargement.

• Tumors also enlarge the liver.

Gallbladder Diseases
1- Cholelithiasis & Cholecystitis
Cholecystitis = inflammation of GB
Cholelithiasis = Stone(s) in GB
2- Obstructive jaundice: liver patterns
3- Gangrene of gall bladder - rare
4- Congenital defects
THE PANCREAS
• An elongated, accessory digestive gland
• Lies retroperitoneally and transversely across
the posterior abdominal wall
Location:
• Posterior to the stomach
• Between the duodenum on the right and the
spleen on the left
Surface Anatomical position
- Epigastric
- left upper hypochondrium region
• An exocrine secretion (pancreatic juice from the
acinar cells) that enters the duodenum through the
main and accessory pancreatic ducts.
• Endocrine secretions (glucagon and insulin from the
pancreatic islets [of Langerhans]) that enter the
blood.
 Common relation
Anterior
-Transverse colon and
mesocolon
-Lesser sac of Stomach

-Posterior
-Bile duct -Portal vein
-Splenic vein -IVC
-Aorta
Pancreas
-Origin of Sup. mesentric.art.
-Lt. Psoas muscle
-Lt. Suprarenal gland
-Left kidney
• Parts of the Pancreas
• Head
• Neck
• Body
• Tail
The head
-Disc shaped
- lies within the concavity of
the duodenum
- A part extends behind the
superior mesenteric vessels
and is called the Uncinate
process.
The neck
• Is the constricted portion of the
pancreas

• Connects the head to the body.

• Lies in front of the beginning of the

portal vein
The body
• Runs upward and to the left across the midline

• It is somewhat triangular in cross section.

• Has three surfaces: anterior, posterior, and inferior.

• Three borders: anterior, superior, and inferior

The anterior surface

- Covered by peritoneum of posterior Wall of lesser sac
- Tuber omental : where the anterior surface of pancreas
join the neck
 The anterior border
• Separates the anterior surface from the
inferior surface

Along this border,

• the two layers of the transverse mesocolon
diverge from one another;
• one passing upward over the anterior surface
• the other backward over the inferior surface.
The posterior surface
• Is devoid of peritoneum
• In contact with the aorta, superior mesenteric artery,
left suprarenal gland, left kidney and renal vessels.

The superior border

- Blunt and flat to the right;
- Narrow and sharp to the left near the tail
• It commences on the right in the omental tuberosity
In relation with
1- The celiac artery
2- Hepatic artery
3- The splenic artery
The inferior surface
• Narrow on the right but broader on the left
• Covered by peritoneum of greater omentum
• Lies upon the duodenojejunal flexure
• Some coils of the jejunum
• Its left extremity rests on the left colic flexure

The inferior border

• Separates the posterior from the inferior surface
• The superior mesenteric vessels emerge under its
right extremity.
The tail
• Lies anterior to the left kidney

• Closely related to the splenic hilum and the left colic

flexure.

• The tail is relatively mobile

• Passes between the layers of the splenorenal ligament with

the splenic vessels.

• The tip of the tail is usually blunted and turned superiorly.

 PANCREATIC DUCTS
The main duct
• Begins in the tail and runs the length of the gland
• Receiving numerous tributaries on its way.
• Opens into the second part of the duodenum at about its middle
with the bile duct on the major duodenal papilla

Accessory duct
• When present, drains the upper part of the head
• Opens into the duodenum a short distance above the main duct on the minor
duodenal papilla .
- Frequently communicates with the main duct
 Blood Supply of pancreas
Arteries
• The splenic artery
• The superior
pancreaticoduodenal
artery
• Inferior
pancreaticoduodenal
arteries artery

Veins
• Corresponding veins
drain into the portal
system.
 Lymphatic drainage of pancreas
• Lymph nodes are
situated along the
arteries that
supply the gland.

• The efferent
vessels ultimately
drain into the
celiac and superior
mesenteric lymph
nodes.
 Nerve supply
• Sympathetic and parasympathetic

• Parasympathetic = vagus nerve

• Sympathetic fibers pass to blood vessels.

• Sympathetic and Parasympathetic fibers are

distributed to pancreatic acinar cells and islets.

• The parasympathetic fibers are secretomotor

• Pancreatic secretion is
mediated by secretin and
cholecystokinin

• Hormones formed by the

epithelial cells of the
duodenum and upper
intestinal mucosa under
stimulus of acid contents
from the stomach.
 APLLIED ANATOMY OF PANCREAS
• Annular Pancreas - pancreas encircles duodenum
(rare)

• Ectopic Pancreas - Outside the gastrointestinal tract

(very common)

• Cancer head of pancreas  Obstruction jaundices

• Cancer body of pancreas  pressure I.V.C & portal vein

• Acute pancreatitis = inflammation of pancreas

THE SPLEEN
• Reddish & oval shaped
• Largest single mass of lymphoid tissue in the body.
• Has a notched anterior border.
• Site of lymphocyte proliferation, immune surveillance and
response

Location:
• Left hypochondrium

• Lies just beneath the left half of the diaphragm

• Under the 9th, 10th, and 11th ribs.

• Its long axis parallel to the 10th rib

• The spleen is an intraperitoneal organ

Two ligaments
1- the gastrosplenic omentum (ligament)
between the spleen & the greater curvature of
the stomach (carrying the short gastric and left
gastroepiploic vessels)

2- splenicorenal ligament between spleen &

kidney (carrying the splenic vessels and the tail
of the pancreas).
The relations
• Anteriorly - the stomach.

• Posteriorly - the left part

of the diaphragm, which
separates it from the
pleura, lung, and ribs 9 -
11.

• Inferiorly - the left colic

flexure.

• Medially - the left kidney.

Has 2 surfaces
- Diaphragmatic surface
- Visceral surface

Diaphragmatic surface
• Has Posterolateral relation
• Convex
• Smooth
Diaphragm separates it from
- Pleura & lung
- Ribs 9,10 ,11
Has 2- Visceral surface
divided by a ridge into
• An anterior or gastric
• A posterior or renal
portion.

Internal border separates

the diaphragmatic from
the colic surface.

Lower extremity has

• Colic surface
• Pancreatic surface
Gastric surface
• Extends forward, upward,
and medially
• Broad and concave
• Related to stomach

Intermediate margin
separates the renal and
gastric surfaces.

Renal surface
• Directed medially and
downward.
• Somewhat flattened
• Related to Left kidney
The lower extremity or colic
surface
• Is flat
• Triangular in shape
• Rests upon the left flexure of
the colon and the
phrenicocolic ligament, and
• In contact with the tail of the
pancreas (pancreatic
surface)
Hilum of spleen
• Anteriorly: Splenic Artery
• Posteriorly: Splenic vein
• Tail of pancreas
 Borders of spleen
Superior Border Inferior border
• Free, sharp and • More rounded and blunter
thin
• Separates the renal from the
diaphragmatic surface
• Often notched
(sup.notch)
• Corresponds to the lower
border of the eleventh rib
• Separates the
diaphragmatic • Lies between the diaphragm
surface from the and left kidney. The
gastric surface
 BLOOD SUPPLY
• The large splenic artery • The splenic vein leaves
is the largest branch of the hilum
the celiac artery.
• Runs behind the tail
• Runs along the upper and the body of the
border of the pancreas pancreas.

• Divides into about six • Joins the superior

branches, which enter mesenteric vein to form
the spleen at the hilum the portal vein at neck
of the pancreas.
 Lymphatic Drainage of spleen
• Lymph vessels emerge from
the hilum and

• Pass through a few lymph

nodes along the course of
the splenic artery

• Drain into the celiac nodes.

NERVES
• Derived from the celiac
plexus.
 APLIED ANATOMY OF SPLEEN
Splenomegaly
• Diseased spleen may enlarge to 10 or more times its normal size and
average a weight of 100 - 250 g.

• Spleen engorgement sometimes accompanies hypertension (high

blood pressure).

Accessory Spleen(s)
• One or more small accessory spleens may form near the splenic hilum.

• They may be embedded partly or wholly in the tail of the pancreas,

between the layers of the gastrosplenic ligament, in the infracolic
compartment in the mesentery, or in close proximity to the ovary or
testis.
THAT’S
ALL FOR
NOW…
Cirrhosis of the Liver
• Progressive destruction of hepatocytes (parenchymal
liver cells) in hepatic cirrhosis and replacement of them
by fat and fibrous tissue.

• Industrial solvents, such as carbon tetrachloride,

produce cirrhosis,

• The condition develops most frequently in persons

suffering from chronic alcoholism.

• Alcoholic cirrhosis, the most common of many causes of

portal hypertension, is characterized by enlargement of