Video: Posterior view of the liver

Hello, everyone! This is Joao from Kenhub, and welcome to another anatomy tutorial where, this time, we're going to be talking about the posterior view of the liver. So, what we’re going to be doing on this tutorial is looking at this view of the liver and exploring the different structure that you can see from here. In other words, we’re looking at the back of your liver. And, as you know, the liver is the largest visceral organ in the body and is a very important multifunctional organ of the gastrointestinal tract that is located in the upper right quadrant of the abdomen extending into the upper left quadrant as well. It carries out several vital functions including detoxification, protein synthesis, biochemical production and also nutrient storage. It is also the largest gland of your body. This essential multifunctional organ that you have is made up of four anatomical lobes. For the purpose of this tutorial, we will be looking at the structures of the liver as well as structures related to the liver seen from the posterior view, but we will see other views as well so you can understand how some of these structures look from different perspectives.

Here’s a quick list of the structures we will be exploring in this tutorial. We’re going to look at the parts of the liver, example, the lobes; the ligaments as well, some of the vessels that you see here – arteries, veins and also ducts – and other related structures. If you would like to learn more about the liver from different perspectives, I suggest you look at other tutorials we have here on Kenhub where we talk about the liver as well.

We’re going to start off with the different parts of the liver. First one I’m going to be highlighting here is known as the visceral surface of the left lobe of the liver. We’re going to look at the lobes of the liver from the classical anatomical perspective. In surgery textbooks, you may find another classification which looks at the lobes of the liver from a functional point of view, which then divides the liver into 8 parts but we’re going to be discussing on a separate tutorial. In this tutorial, however, we will focus on describing the liver using the traditional morphological aspect. Now, from this perspective, the liver is divided into 4 lobes and here we see the left lobe of the liver, to be more specific, the visceral surface of the left lobe of the liver which is located in the left hypochondriac and epigastric regions of the body.

In our illustration, you can see the visceral surface of this lobe which basically means the surface that faces the viscera or, in other words, the organs. Now, this surface is clearly seen from the posterior view, specifically, this part of the liver faces the stomach and the esophagus. For that reason, two impressions can be seen on the visceral surface of the left lobe created by adjacent viscera. So, the gastric impression produced by the stomach and you’re going to also find an esophageal impression, which is a bit closer to here where the esophagus will be then in close location.

The next lobe that we’re going to also see here from the same posterior aspect is the right lobe which is then, to be more specific, the visceral surface of the right lobe of the liver, and this one is the largest lobe of the liver, the right one. So, just remember this – the right lobe of the liver is the largest lobe of the liver. In our illustration, we see here highlighted the visceral surface of the right lobe so the part of this lobe that is then facing the organs.

Now, the right lobe of the liver is located in the upper right quadrant of the abdomen. As a result, impressions made by the adjacent organs that you see here – so three impressions caused by different organs. So, here on the far left, you see what is known as the duodenal impression caused by then the duodenum. In the middle, you see the colic impression caused by then the colon and, on the far right, we see the renal impression caused then by the right kidney.

Next, we’re going to be highlighting this structure here which is known as the caudate lobe. So another one of the four lobes of the liver that can be seen from the posterior aspect is the caudate lobe. Though I mentioned that it is one of the four lobes of the liver, the caudate lobe is considered to be part of the anatomical right lobe and it should be noted that, functionally, the caudate lobe is separated from both the right and left lobes of the liver. Now, the caudate lobe is located between the fissure for the ligamentum venosum, the groove for the inferior vena cava, and the hilum of the liver. It has a papillary process that projects caudally and a caudate process which we will look at next. So, the next image we’re going to be highlighting is the caudate process, which is a parenchymal elevation connection situated cranial to the hilum of the liver connecting the caudate lobe and the right lobe of the liver.

The next structure we’re going to be highlighting here is then the quadrate lobe. This is the final lobe of the liver we’re going to look at and named so for its long shape. The quadrate lobe is located between the round ligament of the liver, the gallbladder which you also see here – notice the gallbladder – and here the hilum of the liver. The quadrate lobe is considered to be part of the anatomical right lobe of the liver but, functionally, it is considered part of the left lobe of the liver. We also see here from the posterior view this groove which is the groove of the vena cava. So, as the name indicates, this is the groove for the inferior vena cava. This deep, vertical groove lodges the very important vein, the inferior vena cava, which among its other functions, will be assisting to keep the liver in its place due to its firm attachment inside the groove.

Next on our list, we’re going to be highlighting this part which looks like an empty place here and it’s called the bare area. The bare area of the liver is named as such due to the fact that this is the portion of this organ that is not covered by peritoneum. Now, this part of the liver is found mainly on the diaphragmatic surface of the liver but can also be seen from the posterior aspect as you can see from our illustration highlighting only the posterior part of the bare area. It is attached to the diaphragm by areolar tissue which forms some of the ligaments of the liver.

And now that we have covered the anatomical and functional parts of the liver seen from a posterior view, let’s move on to look at the ligaments of the liver starting with the coronary ligament that you see here highlighted in green, this is the coronary ligament of the liver. The coronary ligament is one of the ligaments that attaches the liver to the inferior surface of the diaphragm and I can also show you here this image of the anterior view of the liver where you now see the coronary ligament of the liver highlighted in green and attached to this muscle here cut – which is cut – this is then the diaphragm. This ligament of which only a small part is seen from the posterior view – as we saw on the previous image – and has two portions, an anterior part and a posterior part. And between these two portions of the coronary ligament, we find the bare area which we have already seen on the previous slide. Now, the anterior and posterior portions of the coronary ligament come together laterally and form the triangular ligaments.

As for the next slide, we’re going to be highlighting this structure here and back to the posterior view of the liver, this is the right triangular ligament. As I mentioned previously, the right ligament of the liver is formed by the convergence of the anterior and posterior layers of the coronary ligament. It is found at the right extremity of the bare area and connects the liver to the diaphragm. We also see here a left one, so, this is the left triangular ligament of the liver which is seen highlighted, also connects the upper surface of the liver on the left side, specifically, the left lobe to the diaphragm.

The next ligament we’re going to be highlighting here is known as the ligamentum teres hepatis – if you want it to say in Latin – but it’s the round ligament of the liver. This is a degenerative string of connective tissue that represents the remnants of the fetal umbilical vein. It inserts around the umbilicus on the inner surface of the anterior abdominal wall. We can also see here the round ligament of the liver highlighted in green from this image here – notice the ligament here – but now we’re looking at an anterior view of the abdomen but we just retracted here using a tool, the liver. So you can see how its, how its round ligament is then connected to all these structures. Notice here a very important organ, the pancreas, and also see here the large intestine, the spleen, a few structures and, here a very important one, the gallbladder.

Next, we’re going to highlight again here on this structure, you see a magnification showing a highlighted structure which is then the venous ligament. The venous ligament of the liver is located between the caudate lobe and the left lobe of the liver and is innervated by the peritoneal folds of the lesser omentum. Now, this ligament represents the fibers’ remnant of the fetal ductus venosus.

The last ligament of the liver that we will cover in this tutorial is known as the fibrous appendix of the liver. It is a connective tissue band located at the upper end of the left lobe of the liver and passes along with the left triangular ligament of the liver to attach to the diaphragm. Please note that this structure may not always be present.

The next topic we’re going to be talking about are just a few arteries that we see here starting off with this one that we highlighted here in green – notice this artery here – which is known as the proper hepatic artery, also known as the hepatic artery proper. Now, this artery is one of the two terminal branches of the common hepatic artery and, if I show you here on this image, again from an anterior view but with a retracted liver, you can see here highlighted in green, the proper hepatic artery. Now, it runs alongside the hepatic portal vein and the common bile duct as they enter the liver at the hilum. These three structures running together form what is known to as the portal triad – so, don’t forget that. The portal triad is then comprised of the hepatic artery proper or the proper hepatic artery, the hepatic portal vein, and the common bile duct. The common bile duct was removed here on this image as we cut here but we see here then the, the hepatic portal vein. The proper hepatic artery will then split into these two arteries which are known as the left and right hepatic arteries. We can also see here back to the image of the posterior view, notice the highlight here which shows the left branch of the proper hepatic artery or simply the left hepatic artery. And, as we’ve seen on the previous slide, this artery is coming from this bifurcation of the hepatic artery proper. Now, it supplies the left lobe of the liver and a variation in this artery may occur when it arises instead from the left gastric artery.

Next to it, we’re going to then find the right hepatic artery seen now highlighted in green on the image. In the same way, this right branch of the hepatic artery proper arises from the bifurcation of the hepatic artery proper and it passes to the right side of the hilum of the liver to then supply the right side of this organ. A variation may also occur in this branch of the hepatic artery proper where it rises instead from the superior mesenteric artery.

And continuing on with covering the different vessels of the liver that we find here on this view – on the posterior view - we’re going to talk about the veins that we see here. And let’s start with this large vein seen here highlighted in green which is known as the hepatic portal vein. This blood vessel carries nutrient-rich blood from the gastrointestinal tract and the spleen to the liver. One very important thing that you have to remember is that the hepatic portal vein is not a true vein. Now, this is a shocker, as it conducts blood to the liver and not directly to your heart. Now, blood from the gastrointestinal tract containing both nutrients and toxins from food will arrive through the hepatic portal vein to the liver which is responsible for filtering your blood. Now, the hepatic portal vein divides into the left and right portal veins just before entering the liver but you cannot clearly see here from this view. These branches of the left and right hepatic portal vein that I mentioned are not to be confused with the left and right hepatic veins which drain into the inferior vena cava and will be discussed later on on this tutorial.

The hepatic portal vein also forms important anastomosis or connections with the esophageal veins, the rectal venous plexus, and the superficial veins of the skin of the abdomen. This hepatic portal vein certainly has very, very important clinical significance and now we’re looking at it from an anterior view. You can even see how it divides as it enters the liver. When blood pressure increases in the hepatic portal vein due to obstruction in blood flow through the liver, for example, in cirrhosis, then blood tries to bypass the portal system via the anastomosis that we mentioned before. Now, this causes several symptoms such as varices or enlarged veins in the esophagus, stomach, anus, and around the umbilicus. This clinical condition is known as portal hypertension.

The next structures we’re going to be highlighting here, the next structure is known as the right hepatic vein – notice here the highlight in green. Now, the hepatic veins are short, intrahepatic veins that drained blood from the liver to the inferior vena cava. Now, the right hepatic vein – seen here highlighted – drains blood from the right lobe of your liver.

Next, we’re going to be highlighting right to the left side, we’re going to be then highlighting what is known to be as the left and middle hepatic veins, which drain blood from the left lobe of the liver and the caudate lobe of the liver respectively, into the inferior vena cava. You should note, however, that neither the right, left nor middle hepatic veins contain valves, so, no valves.

Next on our image, we’re going to zoom in to show you here this highlighted structure – so we just highlighted in a different green – this is known as the right hepatic duct. So, so far we have looked at the arteries and veins of the live. Now, let’s move on and take a look at different channels that collect bile from the hepatic parenchyma and transport it to the duodenum.

Firstly, we’re going to look at this one, the right hepatic duct which we see here highlighted. Now, the right hepatic duct arises from the right lobe of the liver and it drains bile from the right functional lobe. The right hepatic duct is comprised of several smaller segmental bile ducts and finally it joins the left hepatic duct to form the common hepatic duct. On this image here, you can even see a magnified view of the right hepatic duct seen now from an inferior view of the liver. And still using this inferior view but now a bit more zoomed in, you can see this structure which is the left hepatic duct. This one arises from the left lobe of the liver and drains bile from the left functional lobe of the liver. This duct is also composed of several smaller segmental bile ducts and it joins with the right hepatic duct to form then the common hepatic duct, and you can see here a bit how they join – the two ducts – to then form the common hepatic duct.

Next, we’re going to be highlighting this structure here, the gallbladder – you can see here in a different green, the gallbladder. Since, we have covered all the parts, ligaments and vessels of the liver, it’s time to look at other very important structures – like this one here – that are closely connected to the liver. Now, the gallbladder is a pear-shaped organ that acts as a reservoir of bile produced in the liver before it is released in the small intestine. It measures about 8-12 centimeters in length and is located beneath the right lobe of the liver in the fossa for the gallbladder.

The next structure we’re going to be highlighting here is then the cystic duct – notice here this structure that is highlighted in a different green. Now, this is a small biliary vessel seen here that drains bile from the gallbladder and that is the, that is known as the cystic duct. Now, the cystic duct contains specialized valves known as the spiral valves of Heister. These valves do not provide much resistance for flow of bile and, as a result, bile can flow bidirectionally – meaning that bile can flow in both directions and it can be stored in the gallbladder between meals. Now, the cystic duct joins with the common hepatic duct to form the common bile duct.

Next, we’re going to be looking at this structure here that you see highlighted – notice here – this is then the common bile duct. And as I mentioned before, it is formed by the union of the cystic duct and the common hepatic duct, and this duct passes into the greater duodenal papilla joined by the pancreatic duct forming the ampulla of Vater that is surrounded by the sphincter of Oddi which helps regulate the release of bile from the gallbladder into the duodenum.

Follow that, we’re going to move on to this highlighted structure here – this really thin, highlighted structure – which is known as the cystic artery. Now, the cystic artery – as you can see here – passes to the anterior and posterior surfaces of the gallbladder supplying then oxygenated blood to both the gallbladder and the cystic duct. Now, this small artery arises from the right hepatic artery which is a branch of the hepatic artery proper – notice here – this is the right hepatic artery.

Now that you just completed this video tutorial, then it’s time for you to continue your learning experience by testing and also applying your knowledge. There are three ways you can do so here at Kenhub. The first one is by clicking on our “start training” button, the second one is by browsing through our related articles library, and the third one is by checking out our atlas.

Now, good luck everyone, and I will see you next time.