Summary: Liver Anatomy - Textbook Page Analysis

This is a two-page spread from an anatomy textbook covering the Liver and Extrahepatic Biliary System. Here is a structured summary of all content:

LEFT PAGE

Anatomical Relations of the Inferior (Visceral) Surface of the Liver

Label	Structure	Impression Produced
(b)	Gall bladder (fossa)	Lies right of quadrate lobe; cystic duct near porta hepatis
(c)	Right colic flexure	Colic impression
(d)	1st/2nd duodenal junction	Duodenal impression
(e)	Right kidney	Renal impression

Porta Hepatis (f)

A horizontal fissure ~5 cm long on the visceral surface, between the quadrate lobe and caudate lobe
Structures entering: right & left branches of the hepatic artery and portal vein
Structures leaving: right & left hepatic ducts
Arrangement (posterior to anterior): V-A-D (Vein, Artery, Duct)
Also contains lymph nodes and nerves

Fissure for Ligamentum Teres (g)

Deep cleft to the left of the quadrate lobe; ligamentum teres lies in its floor

Clinical Correlation - Bare Area of the Liver

Directly contacts the diaphragm via loose connective tissue; separated from the right pleural cavity
Surgically encloses the right extraperitoneal subphrenic space
In amoebic hepatitis: pus collects here forming a subphrenic abscess, which can rupture into the right pleural cavity through the diaphragm
Also a potential site of portacaval anastomosis (active in portal hypertension)

RIGHT PAGE

Clinical Procedures

1. Needle Biopsy of the Liver (Fig. 8.10)

Needle inserted in the midaxillary line through the 9th or 10th intercostal space
Passes through: chest wall → costodiaphragmatic recess of pleura → diaphragm → right anterior intraperitoneal space → liver
Key rule: Needle above the 8th intercostal space will injure the lung

2. Palpation of the Liver

Palm placed flat below the right costal margin; patient takes a deep breath
Liver moves downward (diaphragm descends); if enlarged, it strikes the hand

3. Liver Resection / Hepatectomy

Up to 75% (two-thirds) of liver can be removed safely
Liver has immense regenerative capacity - grows back to near-normal size within 3 months

4. Liver Transplantation

Diseased portion replaced with healthy donor liver tissue
Even end-stage liver disease (whole liver) can be replaced by a donor liver

Blood Supply

Source	Type of Blood	Proportion
Portal vein	Venous (nutrient-rich)	~80%
Hepatic artery	Arterial (oxygenated)	~20%

The liver receives ~1/3 of total cardiac output in a normal resting adult

Sections Partially Visible (Right Margin)

Venous Drainage - large hepatic veins draining into IVC
Lymphatics - superficial and deep lymphatic networks
Nerve Supply - sympathetic and parasympathetic innervation

Diagram Summary (Fig. 8.10)

The diagram shows a cross-section of the thoracoabdominal wall illustrating needle biopsy technique, with structures labeled: ribs 7-10, costodiaphragmatic recess, lung, liver, diaphragm, peritoneum, and the right subphrenic space.

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