Projection of borders onto the anterior abdominal wall
Topographically, the upper and lower borders of the organ are distinguished. The upper border is relatively constant, whereas the lower border can vary significantly.
- Upper border: begins at the 5th intercostal space along the left midclavicular line. Moving to the right, it is projected onto the cartilage of the 5th rib (along the right parasternal line), reaches the 4th intercostal space (along the right midclavicular line), descends to the 8th rib (along the right midaxillary line), and ends at the level of the 11th rib near the vertebral column.
- Lower border: normally on the right along the midaxillary line corresponds to the 10th intercostal space. Then the inferior margin emerges from under the costal margin, running obliquely to the left and upward. At the median plane of the body, the inferior margin is projected exactly in the middle of the distance between the umbilicus and the base of the xiphoid process. It crosses the left costal margin approximately at the level of the 6th rib cartilage.
External structure and surfaces
The liver is wedge-shaped with smoothed margins. Its massive base faces to the right, while the organ thins toward the left. The inferior margin is sharp, featuring two characteristic notches: the gallbladder fossa and the notch for the round ligament. The posterior margin is rounded and lies against the posterior abdominal wall.
The organ has two main surfaces:
- Diaphragmatic surface (facies diaphragmatica): smooth and convex, completely conforming to the shape of the diaphragmatic dome.
- Visceral surface (facies visceralis): inferior, uneven surface. It bears impressions from adjacent organs to which the liver is apposed. The relief of this surface is formed by fissures that together resemble the letter "H".
Fissures and division into lobes
Anatomically, the liver is divided into a larger right lobe and a smaller left lobe. On the diaphragmatic surface, the falciform ligament serves as the boundary between them, while on the visceral surface, it is the left longitudinal fissure.
System of fissures on the visceral surface (H-shaped complex):
- Transverse fissure: this is the porta hepatis (porta hepatis). Anteriorly, it is bounded by the quadrate lobe, posteriorly by the caudate lobe, and laterally by the right and left lobes.
- Right longitudinal fissure: its anterior part contains the fossa for the gallbladder, and its posterior part contains the groove for the inferior vena cava.
- Left longitudinal fissure: anteriorly represented by the fissure for the round ligament (contains the remnant of the umbilical vein), and posteriorly by the fissure for the ligamentum venosum (contains the remnant of the ductus venosus).
These fissures further demarcate the quadrate lobe (between the anterior parts of the longitudinal fissures) and the caudate lobe (between their posterior parts) on the visceral surface.
Ligamentous apparatus and hepatic triad
The liver is fixed in place by several ligaments. The falciform ligament (lig. falciforme) is stretched sagittally and posteriorly splits to become the frontal coronary ligament (lig. coronarium). The leaves of the latter form the extraperitoneal area (area nuda) and merge at the margins to form the triangular ligaments. The round ligament of the liver (lig. teres hepatis) runs in the fissure from the umbilicus to the porta hepatis, merging anteriorly with the falciform ligament.
The lesser omentum ligaments connect the liver to the stomach and duodenum. The hepatoduodenal ligament (lig. hepatoduodenale) occupies the rightmost position. It transmits vital structures (the hepatic triad):
- On the left: proper hepatic artery (a. hepatica propria).
- On the right: common bile duct (ductus choledochus).
- Between them and posteriorly: portal vein (v. portae).
This ligament also contains gastric vessels, lymph nodes, and hepatic nerve plexuses.
Rule of arrangement of elements in the hepatoduodenal ligament (from right to left): bile duct on the right, portal vein between them and posteriorly, proper hepatic artery on the left.
Class and exam questions
The organ parenchyma itself is very fragile and easily lacerated. Sutures can hold only thanks to the strength of the connective tissue vascular sheaths (perivascular fibrous capsule of Glisson).
The organ parenchyma itself is very fragile and easily lacerated. Sutures can hold only thanks to the strength of the connective tissue vascular sheaths (perivascular fibrous capsule of Glisson).
The vessels running within the hepatoduodenal ligament can be compressed. To do this, the surgeon inserts a finger into the omental foramen and compresses the ligament between the margin of the foramen and the thumb.
The vessels running within the hepatoduodenal ligament can be compressed. To do this, the surgeon inserts a finger into the omental foramen and compresses the ligament between the margin of the foramen and the thumb.
This is an area on the posterior part of the diaphragmatic surface of the liver devoid of peritoneal covering. At this site, the organ fuses directly with the diaphragm.
This is an area on the posterior part of the diaphragmatic surface of the liver devoid of peritoneal covering. At this site, the organ fuses directly with the diaphragm.
What else to study on this topic
- Exact dimensions and surgical anatomy of the porta hepatis
- Structure of the fibrous tunic and Glisson's capsule
- Topography of vessels and nerve plexuses of the lesser omentum
- Transition of the fibrous tunic to the adventitia of the inferior vena cava
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Other topics in the section "Topographic Anatomy of the Abdomen"
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