1. Accessory Organs
Liver
Pancreas
spleen
Gall bladder

2. The Liver The largest gland in the body Weighs about 1.5kg
Location – under the diaphragm on the right
Found in the upper abdominal cavity: extends from right upper quadrant to left upper quadrant of the abdomen
Attached to diaphragm by
Falciform and coronary ligaments
Left and right triangular ligaments
Functions:
Bile production and secretion
Detoxification
Storage of glycogen
Protein synthesis
Production of heparin and bile pigments
Erythropoiesis (in fetus)

3. The Liver
Anatomically has four lobes – right, left, caudate, and quadrate
The falciform ligament:
Separates the right and left lobes
Separate the subphrenic recess made by the peritoneum
Suspends the liver from the diaphragm and anterior abdominal wall
The ligamentum teres:
Is a remnant of the fetal umbilical vein
Round ligament in the inferior surface
Runs along the free edge of the falciform ligament
Ligamentum venosum inferior surface remnant of fetal ductus venosus

4. Functional lobes
Rt and Lt lobes
Portal lobes are two equal lobes (sagittal plan)
Further divided in 8 segments based on principal branches of Hepatic art. Vien, and bile duct
Divided into 4 anatomical lobes
Left
Right
Caudate Post
Quadrate nt

5. Surfaces of the Liver
Figure 24.19b, c

6. 1.Diaphragmatic surface

7. Posterior surface

9. The Liver Superior surface
FG25_20C.JPG
Title: Anatomy of the Liver
Notes: (a) Horizontal section through the upper abdomen. (b)Horizontal section through upper abdomen; cadaver. (c)Anatomical landmarks; anterior liver surface. (d)Posterior surface of liver.
Keywords: liver, horizontal, stomach, falciform ligament, caudate, lobe, inferior vena cava, aorta, spleen, sternum, kidney, right lobe, gallbladder, round ligament, left lobe, hepatic vein, hepatic portal vein, hepatic artery, quadrate lobe, common bile duct, porta hepatis

10. 2. Visceral surface
Covered by visceral peritoneum except porta hepatis and gall bladder bed.
The visceral surface is related to:
Right side of the stomach i.e. gastric and pyloric areas
Superior part of the duodenum i.e. duodenal area
Lesser omentum
Gall bladder
Right colic flexor
and right transverse area ; colic area
Right kidney
and suprarenal gland; Renal area

12. The Liver Inferior surface
The round ligament(ligamentum teres) – obliterated umbilical vein
The ligamentum venosum – fibrous remnant of fetal ductus vein
The Porta hepatis (hepatic potal; portal fissure) - transverse fissure on the visceral surface of the liver.
It gives passage to the:
Portal vein
Hepatic artery
Hepatic nerve plexus
Hepatic ducts
Lymphatic vessels
FG25_20D.JPG
Title: Anatomy of the Liver
Notes: (a) Horizontal section through the upper abdomen. (b)Horizontal section through upper abdomen; cadaver. (c)Anatomical landmarks; anterior liver surface. (d)Posterior surface of liver.
Keywords: liver, horizontal, stomach, falciform ligament, caudate, lobe, inferior vena cava, aorta, spleen, sternum, kidney, right lobe, gallbladder, round ligament, left lobe, hepatic vein, hepatic portal vein, hepatic artery, quadrate lobe, common bile duct, porta hepatis

13. Peritoneal relations of the Liver
The Lesser omentum
Encloses the portal triad (bile duct, hepatic artery and portal vein )
Passes from the liver to lesser curvature of the stomach + 2 cm of duodenum
Thick free edge -- hepatoduodenal ligament
Sheet like remainder – hepatogastric ligament

14. Microscopic Anatomy of the Liver
Hexagonal-shaped liver lobules are the structural and functional units of the liver
Composed of hepatocyte (liver cell) plates radiating outward from a central vein
Portal triads are found at each of the six corners of each liver lobule
Portal triads consist of a bile duct and
Hepatic artery – supplies oxygen-rich blood to the liver
Hepatic portal vein – carries venous blood with nutrients from digestive viscera

15. Figure 23.14d

16. Microscopic Anatomy of the Liver
Liver sinusoids – enlarged, leaky capillaries located between hepatic plates
Kupffer cells – hepatic macrophages found in liver sinusoids
Hepatocytes’ functions include:
Production of bile
Processing bloodborne nutrients
Storage of fat-soluble vitamins
Detoxification
Secreted bile flows between hepatocytes toward the bile ducts in the portal triads

18. Figure 23.14b

19. Figure 23.14c

20. Blood Supply of Liver Hepatic artery provides oxygenated blood
Hepatic portal vein provides deoxygenated blood
Nutrients, drugs, toxins, microbes
Hepatic artery and vein carry blood to sinusoids
Substances exchanged by hepatocytes
Blood drains to central vein and eventually hepatic vein
Portal triad
Hepatic portal vein
Hepatic artery
Bile duct

21. Histology and Blood Supply of the Liver
FG25_21A.JPG
Title: Liver Histology
Notes: (a) Diagrammatic view of lobular organization. (b)Light micrograph; liver lobule. (c)Light micrograph; detail of portal area.
Keywords: liver, lobular organization, connective tissue, hepatic artery, bile duct, hepatocytes, hepatic portal vein, interlobular septum, portal area, bile ductules, central vein, vile canaliculi, sinusoid

22. Fig

23. Liver: Associated Structures
The lesser omentum anchors the liver to the stomach
The hepatic blood vessels enter the liver at the porta hepatis
The gallbladder rests in a recess on the inferior surface of the right lobe
Bile leaves the liver via
Bile ducts which fuse into the common hepatic duct
The common hepatic duct fuses with the cystic duct
These two ducts form the bile duct

24. Bile Duct System Bile secreted by hepatocytes Bile canaliculi
Right and left hepatic ducts
Common hepatic duct
Common bile duct
Gallbladder for temporary storage of bile
Cystic duct

25. Figure 23.13a

27. Figure 23.13c

28. The cystic duct is about 2. 5 cm in length
The cystic duct is about 2.5 cm in length. Internal projections of circular muscle fibers account for the spiral valve of Heister, which makes the passage of calculi difficult.
The common hepatic duct is usually less than 2.5 cm long, and is formed by the union of the right and left hepatic ducts.
The common bile duct, about 7.5 cm long, is formed by the junction of the cystic and the common hepatic ducts.
The Gallbladder
Location – underside of the right lobe of the liver
Connected to the liver by the hepatic duct
Connected to the duodenum by the common bile duct
The functions of the gallbladder is to concentrate and store bile
Gallstones

30. The anatomical subdivisions are, a fundus, a body, and a neck which terminates in the narrow infundibulum.
The angulated distal part of the neck forms a pouch, called Hartmann’s pouch, a common site for a solitary gall-stone  to lodge.
The muscle fibers in the wall of the gall-bladder are arranged in a criss-cross manner, being particularly well developed in the neck.
The mucous membrane contains indentations of the mucosa that sink into the muscle coat - these are the crypts of Luschka.

31. The wall of the gallbladder is composed of three layers: mucosa ; muscularis and serosa. There is no muscularis mucosae or submucosa.
There are different sized branching folds lined by single layer of columnar cells with a pale cytoplasm and basally located nuclei.
The lamina propria is composed of loose connective tissue, blood vessels, nerves and some plasma cells.
The muscle layer is composed of haphazardly distributed bundles of smooth muscle fibers.

33. Pancreas Mixed endocrine and exocrine gland
Exocrine  compound acinar gland, similar in structure to parotid gland.
Distinction between 2 glands can be made based on absence of striated ducts and presence of islets of Langerhans.
Initial portions of intercalated ducts penetrate lumens of acini.
Centroacinar cells constitude interacinar portion of intercalated duct.

34. Pancreas –all flesh

35. Introduction…
Soft, lobulated elongated gland with both exocrine and endocrine functions
Exocrine –pancreatic juice
Endocrine-insulin
Location….
epigastric & left hypochondriac
regions
behind the stomach in the lesser sac
Transversely across the posterior abdominal wall at the level of the L2 & L3

36. Size and shape… Parts … J shaped or retort shaped. Length-15-20 cm
Thickness- cm
Breadth cm
Wt-90 gm
Size and shape…
Parts …

37. Head …
Enlarged part C shaped, lying within the concavity of duodenum, consist of
3 borders-superior ,inferior & right lateral
2 surfaces-anterior & posterior
uncinate process
Posterior surface relation:
IVC
Right Renal veins
Right crus of diaphragm
Bile duct

38. Stomach
Lesser omentum

39. Head … Superior border- -1st part of duodenum
-Sup. pancreaticodudenal A.
Inferior border-
-3rd part of duodenum
-Inf. pancreaticodudenal A.
Rt. lateral border-
-2nd part of duodenum
-Terminal part of bile duct
-Anastomosis betn 2 arteries.

40. Uncinate process…
Triangular projection which arises from lower and left part off the body.
Relations:
Anterior:
-Superior mesenteric vessels.
Posterior
-Aorta
Above
-Left renal vein

41. Neck… Relations: Anterior surface Peritoneum covering lesser sac
Pylorus
Posterior surface
is related to
superior mesenteric vein
portal vein

42. Body… Elongated part. Extends from neck to the tail.
Passes toward the left with slight upward and backward inclination
Triangular in cross section
3 borders-
-Anterior
-superior
-Inferior
Tuber omentale -small projection on superior border little to the left of the neck

43. Body-Relations… Borders:
Anterior attach to root of the tranverse mesocolon .
Superior related to coeliac trunk, hepatic artery & splenic artery
Inferior is related to superior mesenteric artery.
Surfaces:
Anterior is convex covered by the peritoneum related to the lesser sac & stomach.
Inferior surface covered by the peritoneum related the DJ flexure coils of jejunum & Lt. colic flexure.

44. Body –relations… Posterior surface -Aorta -Left crus of the diaphragm
-Left kidney
-Left Suprarenal gland
-Left renal vessels
-Splenic vein

45. Tail … Left end of the pancreas
Lies in the lienorenal ligament ,together with the splenic vessels
Related to the lower part of the spleen (gastric surface.

46. Ducts system… Exocrine part of pancreas is drained by the 2 ducts Main
Lies near posterior surface ,3 mm in diam.white in colour
Begins at the tail, runs throughout the body ,bends at the neck to run downwards backwards in the head.
Herring bone pattern
Accessory.

47. The accessory duct
Begins in the lower part of head, crosses the main duct with which it communicates
Opens as minor duodenal papilla in the 2nd part of duodenum (6-8 cm distal to pylorus)
In the head of the pancreas, it is related to the bile duct(on rt. side)
Two ducts open in the wall of the 2nd part of the duodenum and join to form hepatopancreatic ampulla of vater which open as major duodenal papilla,8-10 cm distal to pylorus.

48. Arterial supply…
-Splenic A. -Superior pancreatico-duodenal artery (from coeliac trunk) -Inferior pancreatico-duodenal A.(from superior mesenteric A)

49. Nerve supply…
Parasympathetic by the vagus nerve controlling secretion .
Sympathetic from coeliac & superior mesenteric plx.
Secretion is also controlled by
harmone secretin-pancreozymine.

50. Lymphatic drainage…
Head & neck –ventral & dorsal pancreaticodudenal grp LN.
Body &tail by pancreatico-splenic LN.
Efferents to Coeliac & sup.mesenteric LN

53. Pancreas
Figure 24.26a