RAD 325
The Digestive System II
DR. C. C. OHAGWU
Department of Radiography and
Radiological Sciences, Nnamdi Azikiwe
University
11 July 2023 1
Liver
The liver is the largest gland in the body and, after the skin, the
largest single organ.
It weighs approximately 1500 g and accounts for approximately
2.5% of adult body weight.
In a mature fetus—when it serves as a hematopoietic organ—it
is proportionately twice as large (5% of body weight).
Except for fat, all nutrients absorbed from the digestive tract
are initially conveyed to the liver by the portal venous system.
In addition to its many metabolic activities, the liver stores
glycogen and secretes bile, a yellow-brown or green fluid that
aids in the emulsification of fat.
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Surface anatomy, surfaces, peritoneal
reflections, and relationships of liver
It lies in the RUQ of the abdominal cavity and
much of the epigastrum
The liver has a convex diaphragmatic surface (anterior,
superior, and some posterior) and a relatively flat or
even concave visceral surface (posteroinferior).
The diaphragmatic surface is smooth and dome
shaped - related to the concavity of the inferior
surface of the diaphragm, which separates it from
the pleurae, lungs, pericardium, and heart
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Surface anatomy, surfaces, peritoneal
reflections, and relationships of liver
The visceral surface is separated anteriorly by its sharp inferior border
that follows the right costal margin
The visceral surface of the liver is covered with peritoneum
except at the fossa for the gallbladder and the porta hepatis
The porta hepatis is a transverse fissure where the vessels (hepatic
portal vein, hepatic artery, and lymphatic vessels), the hepatic nerve
plexus, and hepatic ducts that supply and drain the liver enter and
leave it.
In contrast to the smooth diaphragmatic surface, the visceral
surface bears multiple fissures and impressions from contact with
other organs – gallbladder, IVC, round ligament, ligamentum
venosum
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Surface anatomy, surfaces, peritoneal
reflections, and relationships of liver
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Photography of the liver isolated
from neighbouring organs
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Hepatic vasculature
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Hepatic vasculature
• The liver is unique in having a dual blood supply
• 75% originate from the portal venous system
• 25% arising from the hepatic artery.
• The hepatic veins are responsible for drainage of
filtered blood from the liver into the IVC
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Hepatic lobes, segments, and
subsegments
The liver is divided into three functional lobes: the R lobe, the L lobe, and the caudate
lobe.
The R and L lobes are further divided into 2 segments each:
• The anterior and posterior segments of the right lobe
• The medial and lateral segments of the left lobe
These 4 segments are further divided into 8 subsegments:
• The superior anterior and superior posterior subsegments of the right lobe
• The inferior anterior and inferior posterior subsegments of the right lobe
• The superior medial and superior lateral subsegments of the left lobe
• The inferior medial and inferior lateral subsegments of the left lobe
The caudate lobe is positioned posteriorly and is separated from the remainder of the
liver by the fissure for the ligamentum venosum.
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Segmental anatomy of the liver
Couinaud's numbering system:
1. Caudate lobe
[Link] Superior Lateral subsegment
[Link] Inferior Lateral subsegment
4.(a) Left Superior Medial subsegment
5.(b) Left Inferior Medial subsegment
[Link] Inferior Anterior subsegment
[Link] Inferior Posterior subsegment
[Link] Superior Posterior subsegment
[Link] Superior Anterior subsegment
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Biliary System
The Gb functions as a reservoir for bile produced by the liver. It is 7-10 cm long, 3
cm wide at its broadest measure, and has a capacity of 30-50 ml.
The gallbladder is divided into three regions as shown in the image on the right:
fundus, body, and neck.
The fundus usually extends anteriorly, inferiorly, and to the right, extending
beyond the inferior border of the liver to contact the anterior abdominal wall
behind the ninth right costal cartilage.
Bile produced by the left and right portions of the liver travel through the right and
left hepatic ducts (1-2 mm in diameter). These two ducts join to form the common
hepatic duct.
The CHD lies anterior to the portal vein and to the right of the hepatic artery.
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Biliary System
The CHD descends roughly 3cm before the CD (3-4cm
long) from the gallbladder joins it from the right.
The CD may have from five to twelve crescentic folds,
similar to those found in the Gb.
These folds give the cystic duct the appearance of a spiral
valve, which allow the duct to dilate when distended.
The union of the CHD and CD forms the common bile
duct (CBD).
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Biliary System
The CBD is usually 7-8 cm long and up to 6 mm in diameter.
Ductal diameter increases 0.5-1 mm per decade.
The CBD passes posterior to the first portion of the duodenum.
It then descends via a groove on the superolateral portion of
the posterior head of the pancreas, sometimes traveling
through the pancreas head.
At the head of the pancreas, the CBD meets the pancreatic duct,
and they exit into the second part of the duodenum, forming
the hepatopancreatic ampulla (or ampulla of Vater).
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Illustration of the biliary
system
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Illustration of the opening of the CBD &
the pancreatic duct into the duodenum
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Pancreas
The pancreas develops from dorsal and ventral
diverticula that buds from the primitive
foregut. These two buds fuse after the rotation of the
duodenum adjoins the two structures.
The ventral bud develops from the hepatic duct, and
forms the uncinate process and the
posterior/inferior head of the pancreas.
The dorsal bud develops directly from the foregut,
forming the anterior head, body and tail of the
pancreas.
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Pancreas
The distal duct system of the dorsal bud joins with that of the ventral
bud to form the main pancreatic duct (of Wirsung), which joins with
the common bile duct at the level of the ampulla of Vater.
The distal duct system of the dorsal bud may persist as the accessory
pancreatic duct (of Santorini), and empties into the duodenum at the
minor duodenal papilla.
The "normal" short axis measurement of the pancreas is 2.5 cm at
the head, and 1.5 cm at the tail; there are normal variations. In
general, the pancreas decreases with size with age.
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Pancreas
The pancreas produces:
an exocrine secretion (pancreatic juice from the
acinar cells) that enters the duodenum through
the main and accessory pancreatic ducts.
endocrine secretions (glucagon and insulin from
the pancreatic islets [of Langerhans]) that enter
the blood
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Illustration of the development
of the pancreas
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Labeled pancreatic anatomy
Keys
A: Right hepatic duct
B: Left hepatic duct
C: Main hepatic duct
D: Main pancreatic duct (of
Wirsung)
E: Pancreatic tail
F: Body of pancreas
G: Ligament of Treitz
H: Third part of duodenum
I: Major duodenal papilla/sphincter
of Oddi
J: Head of pancreas
K: Accessory pancreatic duct (of
Santorini)
L: common bile duct
M: Cystic duct
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End
Thank you for listening
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