Anatomy of the Liver

The liver is the largest gland in the body. It weighs

approximately 1500 g and accounts for approximately 2.5%
or adult body weight.
Location
- The liver lies mainly in the right upper quadrant (RUQ)
where it is protected by the rib cage and the diaphragm.
- The liver lies deep to ribs 7-11 on the right side and cross
the midline toward the left nipple.
- The liver occupies most of the right hypochondrium and
upper epigastrium and extends into the left
hypochondrium.
- The liver moves with the excursions of the diaphragm
and is located more inferiorly when one is erect because
of gravity.

Surfaces
Diaphragmatic surface (anterior, superior, and some posterior)
- The surface that is related to the diaphragm. It is smooth and dome-shaped where it
follows the concavity of the inferior surface of the diaphragm.
- The diaphragmatic surface of the liver is covered with visceral peritoneum, except
posterior in the bare are of the liver, where it lies in direct contact with the diaphragm.
- The bare area is demarcated by the reflection of the peritoneum from the diaphragm to it
as the anterior (upper) and posterior (lower) layers of the coronary ligament.
- Theses layers meet on the right to form the right triangular ligament, and diverge to the
left to enclose the triangular bare area.
- The anterior layer of the coronary ligament is continuous on the left with the right layer of
the falciform ligament, and the posterior layer continuous with the right layer of the
lesser omentum.
- Near the apex of the liver, the anterior and posterior layers of the left part of the coronary
ligament meet to form the left triangular ligament.
- The IVC traverses a deep groove for the vena cava within the bare area of the liver.

Visceral surface (postero-inferior)

This surface is relatively flat or even concave. It is separated anteriorly by its sharp
inferior border that follows the right costal margin.
- The visceral surface is also covered with visceral peritoneum, except in the fossa for the
gallbladder and the porta hepatis (a trasverse fissure where hepatic portal vein, hepatic
artery, lymphatic vessels, the hepatic nerve plexus, and hepatic ducts that supply and
drain the liver enter and leave it.
- The visceral surface bears multiple fissures, they are two sagittally oriented fissures:
a. Right Sagittal Fissure: continuous groove formed anteriorly by the fossa for the
gallbladder and posteriorly by the groove for the vena cava. It is linked centrally to the
right sagittal fissure by the transverse porta hepatis, forming the letter H on the
surface.
b. Umbilical (left sagittal) Fissure: continuous groove formed anteriorly by the fissure for
the round ligament/ligamentum teres hepatis (fibrous remnant of the umbilical vein;
now it, along with small para-umbilical veins course in the free edge of the falciform
ligament) and posteriorly by the fissure for the ligamentum venosum (fibrous remnant
of the fetal ductus venosus).
- In addition, there are impressions on (areas of) the visceral surface that reflect the livers
relationship to the structures that surround it:
-

a.
b.
c.
d.
e.
f.

Gastric and Pyloric areas: right side of the anterior aspect of the stomach
Duodenal area: superior part of the duodenum
Lesser omentum (extends into the fissure for the ligamentum venosum)
Fossa for gallbladder
Colic are: right colic flexure and right transverse colon
Renal and Suprarenal areas: right kidney and suprarenal gland

 The lesser omentum encloses the portal triad (bile duct, hepatic artery, and hepatic portal
vein) passes from the liver to the lesser curvature of the stomach and the first 2 cm of the
superior part of the duodenum. It has two parts:
- The hepatoduodenal ligament: the thick, free edge of the lesser omentum that extends
between the porta hepatis and the duodenum and encloses the structures that pass
through the porta hepatis
- The hepatogastric ligament: the sheet-like remainder of the lesser omentum that extends
between the groove for the ligamentum venosum and the lesser curvature of the
stomach.

Pertioneal Recesses (potential spaces)

Subphrenic recesses
They are superior extensions of the greater sac and are located between diaphragm and
the anterior and superior aspects of the diaphragmatic surface of the liver. The subphrenic
recesses are separated by the falciform ligament into right and left recesses.

Subhepatic Space
The portion of the supracolic compartment of the peritoneal cavity immediately inferior to
the liver.

Hepatorenal Recess (hepatorenal pouch; Morison pouch)

It is the posterosuperior extension of the subhepatic space. It lies between the right part of
the visceral surface and the right kidney and suprarenal gland. This recess is gravitydependent part of the peritoneal cavity in the supine position. Fluid draining from the
omental bursa flows into this recess. It communicates anteriorly with the right subphrenic
recess.

 Anatomical Lobes
Externally, the liver is divided into two anatomical lobes and two accessory lobes by the
reflections of peritoneum from, the fissures formed, and vessels serving the liver and
gallbladder. These superficial lobes are not true lobes. The two anatomical lobes are the larger
right lobe and the much smaller left lobe, these two are separated by the attachment of the
falciform ligament and the left sagittal fissure.
On the visceral surface, the right and left sagittal fissures course on each side of two
accessory lobes (parts of the anatomic right lobe): the quadrate lobe anteriorly and inferiorly,
and the caudate lobe posteriorly and superiorly. The caudate lobe was so-named because it
often gives rise to a tail in the form of an elongated papillary process. A caudate process
extends to the right, between the IVC and the porta hepatis, connecting the caudate and right
lobes.

Functional Subdivisions
Although not distinctly demarcated, internally, the liver has functionally independent right
and left livers (parts or portal lobes) that are much more equal in size than the anatomical
lobes. Each part receives its own primary branch of the hepatic artery and hepatic portal vein
and is drained by its own hepatic duct. The caudate lobe may in fact be considered a third
liver as its vascularization is independent of the bifurcation of the portal triad and is drained
by one or two small hepatic veins which enter directly into the IVC. The liver can be further
subdivided into four divisions and then into eight surgically resectable hepatic segments, each
served independently by a secondary (2) or tertiary (3) branch of the portal triad
respectively.
Segmentation of the Liver
The liver is divided into right and left based on the primary division of the portal triad into
right and left branches. The plane between the right and left livers is the main portal fissure,
in which middle hepatic vein lies. On the visceral surface, this plane is the demarcated by the
right sagittal fissure ; on the diaphragmatic surface this plane is extrapolated using an
imaginary linethe Cantlie line from the notch for the fundus of the gallbladder to the
IVC).
The right and left livers are subdivided vertically into medial and lateral divisions by the
right portal and umbilical fissures, in which the right and left hepatic veins lie. The right
portal fissure has no external demarcation. Each of the four divisions receives a secondary
branch of the portal triad.
A transverse hepatic plane at the level of the horizontal parts of the right and left
branches of the portal triad subdivides three of the four divisions creating six hepatic
segments, each receiving tertiary branches of the triad. The left medial division is also
counted as a hepatic segment, so that the main part of the liver has seven segments, which
have also been given a descriptive name. The caudate lobe is segment I and is supplied by
branches of both divisions and is drained by its own minor hepatic veins.

 Vascularization
Vein
The hepatic portal vein brings 7580% of the blood to the liver. Portal blood contains about
40% more oxygen than blood returning to the heart from the systemic circuit, and thus
sustains the liver parenchyma (liver cells or hepatocytes). The hepatic portal vein carries
virtually all of the nutrients absorbed by the alimentary tract to the sinusoids of the liver,
except lipids which bypass the liver via the lymph.
Between the hepatic divisions are the intersegmental veins that drain parts of adjacent
segments. They are the right, intermediate (middle), and left hepatic veins. The central
veins drain the sinusoids of the hepatic parenchyma, they in turn, drain to the collecting
veins that unite to form the hepatic veins. The hepatic veins open into the IVC just
inferior to the diaphragm. The attachments of these veins to the IVC helps hold the liver
in position.
The hepatic portal vein, a short, wide vein, is formed by the superior mesenteric and
splenic veins posterior to the neck of the pancreas. It ascends anterior to the IVC as part
of the portal triad in the hepatoduodenal ligament. It will eventually enter the sinusoids
and drain into the central vein.

Artery
Arterial blood from the hepatic artery
accounts for only 2025% of blood
received by the liver. The arterial blood is
distributed initially to nonparenchymal
structures, particularly the intrahepatic
bile ducts.
The hepatic artery is a branch of the
celiac trunk and may be divided into the
common hepatic artery (the segment
from the celiac trunk to the origin of the
gastroduodenal artery) and the hepatic
artery proper (from the origin of the
gastroduodenal artery to the bifurcation
of the hepatic artery).
At or close to the porta hepatis, the
hepatic artery and hepatic portal vein

divides into right and left branches. These primary branches supply the right and left livers.
Within the livers, the primary branches divide again to form secondary branching that supply
the medial and lateral divisions of the right and left liver. Three of the four secondary
branches then further divides into tertiary branching to supply independently seven of the
eight hepatic segments.

Lymph
The liver is a major lymph-producing organ. Between and of the lymph entering the
thoracic duct comes from the liver. The lymphatic vessels of the liver occur as superficial
lymphatics in the subperitoneal fibrous capsule of the liver (Glisson capsule) and as deep
lymphatics in the connective tissue. Most lymph is formed in the perisinusoidal spaces of
Disse and drain to the deep lymphatics in the surrounding intralobular portal triads.
Superficial and Deep Lymphatics
- Anterior Aspect
These lymphatics of the diaphragmatic and visceral surfaces along with deep lymphatic
vessels accompanying the portal triads converge toward the porta hepatis. They drain to
the hepatic lymph nodes scattered along the hepatic vessels and ducts in the lesser
omentum. Efferent lymphatic vessels from the hepatic nodes drain into celiac lymph
nodes which in turn drain into the cisterna chili.
- Posterior Aspect
These lymphatics of the diaphragmatic and visceral surfaces drain toward the bare area
of the liver. Here they drain into phrenic lymph nodes, or join deep lymphatics that have
accompanied the hepatic veins converging on the IVC, and pass with this large vein
through the diaphragm to drain into the posterior mediastinal lymph nodes. Efferent
vessels from these nodes join the right lymphatic and thoracic ducts.

Other Routes
From the posterior surface of the left lobe to the esophageal hiatus of the diaphragm to
end in the left gastric lymph nodes.
- From the anterior central diaphragmatic surface along the falciform ligament to the
parasternal lymph nodes.
- Along the round ligament to the umbilicus and lymphatics of the anterior abdominal wall.
-

Innervation
The nerves are derived from the hepatic plexus, the largest derivative of the celiac plexus.
This plexus consists of symphatetic fibers from the celiac plexus and parasympathetic fibers
from the anterior and posterior vagal trunks. Other than vasoconstriction, their function is
unclear.