← All decks
General Surgery
Liver Surgical Anatomy
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
14 sections · 185 slides
Overview
- Scope of this topic
Development of the liver
- Timeline of early hepatic development
- Three inductive processes in hepatic differentiation
- Origin of the hepatic parenchyma
- Fate of the vitelline and umbilical veins
- Intrahepatic bile ducts and fetal haemopoiesis
- Change in relative lobe size from fetus to adult
- Arterial consequences of the shift in liver mass
Congenital anomalies of the liver
- Sites of the major hepatic anomalies
- Segmental and lobar agenesis
- Transposition of the liver
- Riedel's lobe
- Anomalous lobe on the left side of the liver
- Supradiaphragmatic liver
- Accessory and ectopic hepatic tissue
- Mesenchymal hamartoma
- Intrahepatic biliary atresia
- Congenital cysts, hepatic fibrosis and vascular malformations
Physical characteristics and topography
- Weight of the liver
- Shape and dimensions
- Location and extent
- Projection of the liver on the anterior body wall
- Surface projections of the liver on the thoracic wall
- Sites for percutaneous liver biopsy
- Fixation and mobility of the liver
- Individual variation in hepatic position
Surfaces and peritoneal attachments
- Diaphragmatic surface of the liver
- Inferior border of the liver
- Anterior view of the peritoneal attachments
- Posterior aspect and the divergence of the falciform leaves
- Peritoneal attachments on the posterior aspect
- Posterior view of the liver and its cut peritoneal edges
- Hepatic falciform ligament artery
- Contents of the left triangular ligament
- Visceral surface and its impressions
- The H configuration of the porta hepatis
- Ventral mesogastrium and the origin of the hepatic attachments
- Peritoneal reflections at the gastro-oesophageal junction
- Peritoneal attachments on the inferior surface of the diaphragm
- Correcting the coronary and triangular terminology
- Lesser omentum and the dorsal mesogastrium
Perihepatic spaces
- Supracolic compartment and the bare area
- Right suprahepatic and subhepatic spaces
- Left suprahepatic and subhepatic spaces
- Abscess in the anterior right suprahepatic space
- Abscess in the posterior right suprahepatic space
- Abscess in the anterior left suprahepatic space
- Abscess in the posterior left suprahepatic space
- Right infrahepatic space and the quadrangular space
- Abscess in the right infrahepatic space
- Abscess in the left infrahepatic space
- Extraperitoneal perihepatic spaces
- Extraperitoneal drainage of anterior collections
- Extraperitoneal drainage of posterior collections
- Transperitoneal drainage of subphrenic and subhepatic abscesses
Lobes, segments and fissures
- Apparent versus actual division of the liver
- Ger's true lobar and segmental divisions
- Concepts of the liver lobule and schemes of hepatic segmentation
- Cantlie's line and the exploded segmental plan
- Anatomic versus surgical nomenclature
- Morphology of the liver in anterior and inferior view
- Quadrate and caudate lobes
- Position of the caudate lobe on the undersurface
- Portal supply and venous drainage of the caudate lobe
- Segments, hemilivers and the surgical anatomy of segment 4 and 8
- Reading the nomenclature table
- Anatomic Segments of the Liver and Corresponding Nomenclature
- What the Bismuth system actually is
- Bismuth's functional anatomy of the liver
- Functional division and segmentation in vivo
- The right fissure
- The middle and left fissures
- Obliquity of the middle and right portal fissures
- Ger's four fissures
- Left fissure versus portoumbilical fissure
- Reading the resection tables
- Anatomical Classification of Major Hepatic Resections
- Rise and demise of segment IX
- Interlobar anastomoses
- Intersegmental course of the hepatic veins
- Orientation of the hepatic lobes in sectional imaging
- Identifying segments on transverse sections
- Identifying segments on sagittal sections
- Relations of Resections to Vascular and Ductal Structures
- Relations of Resections to Vascular and Ductal Structures (continued)
- Relations of Resections to Vascular and Ductal Structures (continued)
Intrahepatic architecture and histology
- Blood flow through the hepatic lobule
- The hepatocyte and its relation to the sinusoid
- The perisinusoidal space and the Ito cell
- Bile secretion and the direction of flow
- Transition from canaliculi to bile ducts
- The classic lobule and the hepatic triad
- Hepatic regeneration
- Reading the hepatic function table
- Hepatic Functions
- Hepatic Functions (continued)
- Hepatic Functions (continued)
Hepatic vasculature
- Dual blood supply of the liver
- Terminology of intrahepatic branching
- Proper and right hepatic arteries
- Intrahepatic distribution of the hepatic artery
- Usual and anomalous segmental hepatic arteries
- Variations in branching of the left hepatic artery
- Caudate arteries and the end-artery question
- Consequences of hepatic artery ligation
- Right and left portal veins
- Intrahepatic distribution of the portal vein
- The three hepatic veins and their territories
- Patterns of ramification of the middle and left hepatic veins
- Exposure and vulnerability of the hepatic veins
- Direct hepatic vein anastomosis in hepatectomy
- Relations of the inferior vena cava to the liver
Intrahepatic biliary system
- Assembly of the intrahepatic biliary tree
- Intrahepatic distribution of the bile ducts
- Variations of the right hepatic duct
- Variations of the left hepatic duct
- Variations of the hepatic duct confluence
- Variations of the intrahepatic ductal system
- Caudate ducts and the segment VII-VIII pitfall
Lymphatic drainage and innervation
- Origin of hepatic lymph
- Superficial lymphatic drainage of the liver
- Deep lymphatic drainage of the liver
- The Phrenic Lymph Nodes
- Nerve supply to the liver
- Distribution of the vagus nerve in thorax and upper abdomen
- Function and extent of the intrahepatic nerves
The glissonian sheaths
- What a glissonian sheath is
- Design of the Alexandria dissection study
- Posterior surface of the hilar plate
- Right and left main sheaths on the inferior surface
- Contents of the main sheaths and the sector sheaths
- Sheaths of segment I
- The three sheaths of segment I in a stillborn liver
- Sheaths of segments II, III and lower IV
- Course and contents of the left main sheath
- Arteries and ducts of segments II, III and lower IV
- Arteries of the sheaths of segments II, III and lower IV
- Sheaths of segment IV
- Sheaths of segments V, VIII and upper IV
- Components of the segment VIII and upper IV sheaths
- Portal branches of segments V, VIII, VI and VII
- Two patterns of the right posterior sector sheath
- First pattern of the right posterior sector sheath
- First pattern in an adult liver
- Second pattern of the right posterior sector sheath
- Surgical implications of the sheath anatomy
Historical milestones
- How to use the historical table
- Anatomic and Surgical History of the Liver
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
- Anatomic and Surgical History of the Liver (continued)
Summary
- Anatomical points that govern hepatic surgery
- Variations that cause operative injury
- Spaces, drainage and the pitfalls of surface anatomy
- Sources cited in the text and figures
- Sources cited in the text and figures (continued)
- Sources cited in the text and figures (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
- Join our WhatsApp groups