LiverReview - Liver Review Vic Vernenkar, D.O. St. Barnabas...

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Liver Review Vic Vernenkar, D.O. St. Barnabas Hospital Bronx, NY
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Major Structures and Landmarks Glisson’s capsule : the peritoneal lining that surrounds the liver. Bare area : posterior surface of the liver not covered. Coronary ligaments : reflections of peritoneum on the posterior surface.
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Major Structures and Landmarks Triangular ligaments : lateral extensions of the coronary ligaments. Falciform : from umbilicus to diaphragm, contains obliterated umbilical vein. Ligamentum teres , extends from falciform on undersurface of liver.
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Anatomy Eight segments, based on arterial and portal venous inflow. Segment 1 is the caudate lobe of the liver. Segments 2-4 are segments of the left lobe resected during left hepatic lobectomy. Segments 5-8 are segments of the right lobe resected during right hepatic lobectomy.
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Segments
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Anatomy Falciform ligament does not divide right and left lobes of liver, the portal fissure or Cantlies line is a plane passing from the left side of the gallbladder fossa to the left side of the IVC. It defines the physiologic division between left and right lobes of liver. It does separate medial and lateral segments of left lobe
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Anatomy A right trisegmentectomy includes a resection of the right lobe plus segment 4. A left lateral segmentectomy includes resection of segments 2 and 3 to the left of the falciform. Resection of 80% of parenchyma is compatible with life.
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Anatomy Portal vein is a valveless vein formed by SMV and splenic vein behind head of pancreas. Passes posteriorly to the bile duct and hepatic artery in the hepatoduodenal ligament . 75% of liver’s blood supply.
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Anatomy Portal vein drains blood from the small and large intestines, stomach, spleen, pancreas,and gallbladder. The portal trunk divides in to 2 lobar veins , the right drains the cystic vein, the left receives umbilical and paraumbilical veins that enlarge to form the caput medusae . The coronary vein drains the distal esophagus, which also enlarge in PHTN.
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Anatomy Common hepatic artery arises from the celiac artery and becomes the proper hepatic artery after the GD branches. Passes medial to the bile duct and anterior to portal vein. Bifurcates into right and left hepatics in liver parenchyma. Can come off SMA (right) or Left gastric (left). Pringle maneuver.
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Pyogenic liver abscesses (80% of all liver abscesses). Routes of infection are portal, ascending biliary tree, bacteremia via hepatic artery, direct extension (appendicitis), primary infection post trauma. Intra-abdominal infection most common identifiable source (biliary, colonic). ABX plus drainage, look for source.
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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LiverReview - Liver Review Vic Vernenkar, D.O. St. Barnabas...

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