Lecture on the Liver and Pancreas

Orientation and Anatomy of the Liver

• Importance of knowing right vs left lobe
  • Right lobe: Bigger than the left lobe
  • Left lobe: Smaller
• Identifying anterior vs posterior
  • Anterior: Gallbladder peeks out
  • Posterior: Inferior vena cava (IVC) visible

Key Ligaments

• Right Coronary Ligament: Transitions into the Right Triangular Ligament
• Left Coronary Ligament: Transitions into the Left Triangular Ligament
• Falsiform Ligament: Separates right and left lobes; falls down the liver

Bare Area

• Identified by a change in coloration (brighter red)
• Only spot on the liver not covered by peritoneum
• Close proximity to the thoracic diaphragm

Lobes of the Liver (Posterior View)

• Caudate Lobe: Posterior, near the IVC
• Quadrate Lobe: Square-shaped

Portal Triad

• Hepatic Portal Vein: Delivers blood from the GI tract to the liver for cleansing
• Hepatic Artery Proper: Provides oxygenated blood to the liver
• Common Bile Duct: Transports bile

Hepatic Circulation

• Hepatic Veins: Drain blood from the liver to the IVC
  • Right and Left hepatic veins correspond to their respective lobes

Fetal Remnant Structures

• Round Ligament of the Liver / Ligamentum Teres: Fetal name is left umbilical vein
• Ligamentum Venosum: Fetal name is ductus venosus

Function and Pathways of Bile

• Bile Production and Pathway
  • Right and left hepatic ducts → Common hepatic duct
  • Common bile duct → Pancreas
  • Cystic duct → Gallbladder (for storage)
• Bile Storage and Release
  • CCK hormone stimulates gallbladder contraction
  • Bile travels back up the cystic duct → Common bile duct

Anatomy and Functions of the Pancreas

• Exocrine Functions: Secretion of pancreatic enzymes and sodium bicarbonate
• Endocrine Functions: Insulin and glucagon secretion

Structures of the Pancreas

• Head: Lies in the crook of the duodenum
• Body: Middle segment
• Tail: Near the spleen
• Pancreatic Ducts
  • Main Pancreatic Duct: Dumps into major duodenal papilla
  • Accessory Pancreatic Duct: Dumps into minor duodenal papilla
  • Hepatopancreatic Ampulla (Ampulla of Vater): Mixing point for bile and pancreatic enzymes

Biliary Tree and Hepatopancreatic Ampulla

• Hepatopancreatic Ampulla: Mixing point; links main pancreatic duct and common bile duct
• Common Bile Duct: Transports bile to the ampulla

Blood Flow and Vessels

• Celiac Trunk: First branch off the abdominal aorta
  • Left Gastric Artery: Supplies the lesser curvature of the stomach
  • Splenic Artery: Supplies the spleen
  • Common Hepatic Artery: Bifurcates into hepatic proper artery and gastroduodenal artery
• Veins
  • Portal Vein: Part of the portal triad; final collection point
  • Splenic Vein: Drains into the portal vein
  • Superior Mesenteric Vein: Drains into the portal vein
  • Inferior Mesenteric Vein: Drains into the splenic vein, then the portal vein