Anatomy Of Liver And Biliary System Pdf

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The liver normally weighs between 1. It is the second-largest organ in the body, and is located on the right side of the abdomen.

Hepatic Surgery. That every surgeon will experience complications is a certainty. Indeed, it has been said that if one has no complications, one does not do enough surgery. Yet, major surgical complications are often avoidable and frequently the result of three tragic surgical errors.

Anatomy of the Liver and Biliary System

An intimate knowledge of the morphological, functional, and real anatomy is a prerequisite for obtaining optimal results in the complex surgery of extra and intrahepatic cholangiocarcinoma.

A complete presentation of the surgical anatomy of the bile ducts includes study of the liver, hepatic surface, margins, and scissures. The frequent variations from the normal anatomy are described and an overview of the blood supply and lymphatics of the biliary tract is presented. The anatomy of the bile duct follows that of the portal system and segmentation of the liver. A bile duct is part of the portal triad, which enters the liver through invagination of Glisson's capsule at the hilum.

According to the vascular anatomy, the right and left hemiliver are drained by a right and a left hepatic duct, respectively. Segment 1 is drained by several ducts joining both the right and left ducts close to the biliary confluence at the hilum. This anatomical knowledge is essential for hilar cholangiocarcinoma surgery. The left hepatic duct drains segments 2, 3, and 4 of the left hemiliver.

The segment 3 duct follows the left horn of the Rex recessus and joins the segment 2 duct above the segment 2 portal branch at the level of the curve of the hilar part in the posterior-anterior portion of the portal branch. This duct is 2. Being extrahepatic in this portion, it runs transversely in the hilum, from left to right. Running first above and behind the left portal branch, it crosses the superior edge and joins the right hepatic duct to form the biliary confluence.

The right hepatic duct drains all segments of the right hemiliver segments 5, 6, 7, and 8. The ducts of segments 6 and 7 form the posterior right hepatic duct, and those of segments 5 and 8 form the anterior right hepatic duct. The anterior hepatic duct lies vertical, located to the left of the anterior branch of the portal vein. The normal right duct is short and vertical and 1 cm in length. The main biliary confluence is formed outside the liver parenchyma, before becoming distal to the common hepatic duct.

It runs along and anterior to the origin of the right branch of the portal vein 1 , 3 , 4. The duct is displaced superiorly and medially to the left of the main portal vein. During a right hepatectomy, the anatomical situation of the main biliary confluence explains the risk of ligating the confluence or the left duct.

In the event of biliary abnormality, it is necessary to take into account not only the type of confluence, but also its height in relation to the portal vein. At the level of the hilum, Glisson's capsule is both thicker and denser, forming the connective tissue of the hilar plate.

The biliary ducts are enclosed within this tissue. Adhesions between this capsule and arterial and portal branches are less important. It is therefore easy to dissect the portal branches at the hilum, but more difficult for the arterial branches and almost impossible to separate the bile duct of the hilar plate Figure 2. In the case of hilar cholangiocarcinoma, the proximity of the portal triad explains the frequent tumor invasion of portal branches. Owing to the absence of vascular interposition at the anterior part of the hilar plate, it is also possible to separate the hilar plate and hepatic parenchyma of segment 4.

The number of portal branches of segment 1 varies from 1 to 6 average 3 6. Segment 1 has its own biliary drainage 3. The left hepatic duct receives one or more duct of segment 4 and one or two ducts of segment 1. The right duct receives one duct of segment 1. The segment 1 ducts are posterior, running above the portal branch and joining the corresponding bile duct on its posterior margin.

In the event of hilar bile duct cancer, which may spread along the bile duct, especially into the dorsal ducts, caudate lobectomy and segmentectomy 4 are routinely necessary for resecting the corresponding bile duct and for complete extirpation of the tumor.

The common hepatic duct receives the cystic duct and then forms distally to the choledochus. This distinction is arbitrary, because the cystic duct joins at a variable site, which must be carefully considered during gallbladder operation. It is better to call it the main bile duct, in general below the biliary confluence. The main bile duct courses downwards and anterior to the portal vein, joining its left margin in the middle part of the hepatic pedicle.

The hepatic artery, which runs upwards, is usually located to the left. The right branch of the hepatic artery crosses the common hepatic duct posteriorly and the portal vein anteriorly, although it can exit anterior to the superior part of the hepatic pedicle. The common hepatic duct constitutes the left border of the triangle of Calot with the inferior surface of the right lobe as the upper border and the cystic duct below.

The hepatic artery supplies the liver with arterial blood through branches that run close to the portal branch and bile duct portal triad. Embryologically, there are three hepatic arteries: a left hepatic artery that arises from the left gastric artery, a middle hepatic artery from the celiac axis, and a right hepatic artery from the superior mesenteric artery.

Usually, the left and right branches disappear and the middle artery remains as the future proper hepatic artery. The middle artery divides into two right and left branches at the lower part of the hepatic pedicle. The left branch is taken away from the main bile duct. Multiple combinations of the embryologic arteries have been described Figure 4.

One arterial variation is important for the surgery of cholangiocarcinoma: if a right hepatic artery is in place, it is then possible to perform an extended left hepatic hepatectomy to segment 1 or to segments 1, 5, and 8 without dissecting the hilum. Arising from the superior mesenteric artery, this right hepatic artery runs in every case at the posterior side of the portal trunk and joins the right margin edge at a variable height.

The portal vein carries the splanchnic blood to the liver. At the hilum, the main portal trunk divides into right and left branches. The right branch is short and lies to the anterior part of the caudate process and immediately enters the liver through the hilar plate then divides into anterior and posterior branches. The left branch is longer 4 cm and lies anterior to the caudate lobe before running on the left side within the hilar plate in a sagittal direction to reach the umbilical fissure.

There it turns sharply. At its end, it is prolonged by the round ligament. Abnormalities are frequent, more often to the right than to the left portal branches. For realization of a hepatectomy, two gliding of the right antero-medial portal vein towards the left are important Figure 5 : a trifurcation of the portal trunk without true right portal branch and an origin from the left branch of this sector branch.

The arteries of the supraduodenal bile duct arise from the retroduodenal artery, gastroduodenal artery, right branch of the hepatic artery, and cystic artery. There is an average of eight small arteries, each measuring approximately 0. The most important of these vessels runs along the lateral borders of the duct.

The hilar duct receives a copious supply of arterial blood from its surroundings, forming a rich arterial plexus on the surface of the duct in continuity with the vessels around the supraduodenal duct. A communicating arcade between the right and left arterial system is located within the hilar plate, and originated from the segment 4 artery and the right branch of the middle hepatic artery 7. The veins draining the bile duct usually exist parallel to corresponding arteries along the border of the common bile duct.

Veins draining the gallbladder terminate in the right portal branch and in the hepatic parenchyma in the branch of the right portal vein or the middle hepatic vein. In patients with portal hypertension, these veins can be large and a source of unexpected hemorrhage. In portal thrombosis, the large collateral venous channel into the hepatic pedicle comes from hypertrophied veins of this system, particularly in the bile wall.

The lymphatic drainage distributes into two pathways: one superiorly with lymph nodes along the cystic duct, hepatic artery, and celiac axis; one inferiorly with lymph nodes along the cystic duct, the anterolateral aspect of the portal vein, the posterior pancreas, and between the aorta and vena cava. National Center for Biotechnology Information , U.

HPB Oxford. Denis Castaing. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Feb 4. This article has been cited by other articles in PMC.

Abstract An intimate knowledge of the morphological, functional, and real anatomy is a prerequisite for obtaining optimal results in the complex surgery of extra and intrahepatic cholangiocarcinoma.

Keywords: Anatomy, cholangiocarcinoma. Introduction The anatomy of the bile duct follows that of the portal system and segmentation of the liver.

Intrahepatic bile duct anatomy Figure 1. Open in a separate window. Figure 1. Biliary confluence Figure 1 The main biliary confluence is formed outside the liver parenchyma, before becoming distal to the common hepatic duct. Figure 2. Main bile duct Figure 3. Figure 3. Anterior aspect of the biliary anatomy in the hepatic pedicle.

Blood supply The hepatic artery supplies the liver with arterial blood through branches that run close to the portal branch and bile duct portal triad. Figure 4. Figure 5. Lymphatic drainage The lymphatic drainage distributes into two pathways: one superiorly with lymph nodes along the cystic duct, hepatic artery, and celiac axis; one inferiorly with lymph nodes along the cystic duct, the anterolateral aspect of the portal vein, the posterior pancreas, and between the aorta and vena cava.

References 1. Hribernik M, et al. Variations of intrahepatic and proximal extrahepatic bile ducts. The topography of the intrahepatic duct system. Acta Anat Basel ; 11 — Anatomy of the bile duct within the human liver. Arch Surg. Couinaud C.

Le foie. Etudes anatomiques et chirurgicales.

Biliary tract

The hepatic A. Lobes of the Liver:. The cystic duct:. Open navigation menu. Close suggestions Search Search.

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The biliary system consisted of right and left hepatic ducts, common hepatic duct, cystic duct and common bile duct. The present study concluded.


Biliary System Anatomy and Functions

An intimate knowledge of the morphological, functional, and real anatomy is a prerequisite for obtaining optimal results in the complex surgery of extra and intrahepatic cholangiocarcinoma. A complete presentation of the surgical anatomy of the bile ducts includes study of the liver, hepatic surface, margins, and scissures. The frequent variations from the normal anatomy are described and an overview of the blood supply and lymphatics of the biliary tract is presented. The anatomy of the bile duct follows that of the portal system and segmentation of the liver.

Liver Cancer pp Cite as. The liver is the largest abdominal viscus, weighing between 1. It occupies a fixed position in the right upper quadrant of the peritoneal cavity with its left lateral portion extending across the abdominal midline into the medial left upper quadrant.

Essential Functional Hepatic and Biliary Anatomy for the Surgeon

Cholescintigraphy pp Cite as. The liver is the largest organ in the body weighing in the adult of — g comprising one fiftieth of the total body weight. It is located in the upper part of the abdomen where it occupies the right hypochondriac and the greater part of the epigastric region.

Surgical Anatomy of the Liver and Biliary Tree

ГЛАВА 70 Дэвид Беккер почувствовал, что у него подкашиваются ноги. Он смотрел на девушку, понимая, что его поиски подошли к концу. Она вымыла голову и переоделась - быть может, считая, что так легче будет продать кольцо, - но в Нью-Йорк не улетела. Беккер с трудом сдерживал волнение. Его безумная поездка вот-вот закончится. Он посмотрел на ее пальцы, но не увидел никакого кольца и перевел взгляд на сумку. Вот где кольцо! - подумал .

ГЛАВА 42 Вернувшись в комнату, Сьюзан, не находя себе места, нервно ходила из угла в угол, терзаясь мыслью о том, что так и не выбрала момент, чтобы разоблачить Хейла. А тот спокойно сидел за своим терминалом. - Стресс - это убийца, Сью. Что тебя тревожит.

Не будучи религиозной, она не рассчитывала услышать ответ на свою молитву, но вдруг почувствовала внезапную вибрацию на груди и испуганно подскочила, однако тут же поняла: вибрация вовсе не была рукой Божьей - она исходила из кармана стратморовского пиджака. На своем Скайпейджере он установил режим вибрации без звонка, значит, кто-то прислал коммандеру сообщение. Шестью этажами ниже Стратмор стоял возле рубильника. В служебных помещениях ТРАНСТЕКСТА было черно как глубокой ночью. Минуту он наслаждался полной темнотой. Сверху хлестала вода, прямо как во время полночного шторма. Стратмор откинул голову назад, словно давая каплям возможность смыть с него вину.


PDF | The objective of this paper is to develop an understanding of the diseases related with gallbladder, liver, and biliary tract. The study.


The Liver and Biliary Tract. Anatomical and Physiological Considerations

Он запаникует и в конце концов, столкнувшись с группой вооруженных людей, ничего не сможет поделать. После минутного упорства ему придется уступить. Но если я вызову агентов безопасности, весь мой план рухнет, - подумал. Хейл сдавил горло Сьюзан немного сильнее, и она вскрикнула от боли. - Ну что, вы решили.

Как только он оказался там, его сразу же увлек за собой поток молодых людей. - А ну с дороги, пидор! - Некое существо с прической, больше всего напоминающей подушечку для иголок, прошествовало мимо, толкнув Беккера в бок. - Хорошенький! - крикнул еще один, сильно дернув его за галстук.

Она открыла глаза, не в состоянии даже протянуть руку. Простыня на его половине кровати была холодной.

 Что же тогда случилось? - спросил Фонтейн.  - Я думал, это вирус. Джабба глубоко вздохнул и понизил голос.

Директорские апартаменты. В этот субботний вечер в Коридоре красного дерева было пусто, все служащие давно разошлись по домам, чтобы предаться излюбленным развлечениям влиятельных людей. Хотя Бринкерхофф всегда мечтал о настоящей карьере в агентстве, он вынужден был довольствоваться положением личного помощника - бюрократическим тупиком, в который его загнала политическая крысиная возня. Тот факт, что он работал рядом с самым влиятельным человеком во всем американском разведывательном сообществе, служил ему малым утешением.

И тут же забилась, задыхаясь от удушья.

1 Response
  1. Abner V.

    The biliary tract , biliary tree or biliary system refers to the liver , gall bladder and bile ducts , and how they work together to make, store and secrete bile.

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