THE LIVER AND BILLARY APPARATUS

• Extends between the right hypochondrium and epigastric regions.
  
  
• Pyramidal in shape, with its base on the right side.
  
  
• it has only two surfaces, diaphragmatic and visceral.

Visceral relations of the liver

• Visceral surface faces downwards, posteriorly and to the left.
  
  
• This surface is related to:
  
  (+) Anterior wall of the stomach
  (+) Pyloric part;
  (+) Superior part of the duodenum;
  (+) Right colic flexure,
  (+) Upper pole of the right kidney and
  (+) Right suprarenal.
  (+) Oesophagus
  (+) Gall bladder

• The most obvious structure on the visceral surface of the liver is the portal hepatis .

This contains/transmits;

• Hepatic artery
• Portal veins
• Common hepatic duct
• Lymphatics, lymph nodes
• Autonomic nerve plexus

The diaphragmatic relations

The diaphragmatic relations surface is moulded to the undersurface of the diaphragm separating it from:

• Pericardium and heart
• Right Lung and pleura
• Right costodiaphragmatic recess.

Peritoneal relations

• Two layers of the falciform ligament connect the diaphragm and upper anterior abdominal wall to the diaphragmatic surface, just to the right of the median plane.
  
  
• The falciform ligament contains ligamentum teres and the paraumbilical veins.
  
  
• At the reflection onto the liver, the layers of the falciform ligament separate.
  
  
• To the right it forms the upper leaf of the right triangular ligament (coronary ligament) on the left, it continues as the left triangular ligament.
  
  

• The liver is in direct contact with the diaphragm between the leaves of the right triangular ligament.
  
  
• This part of the liver is called the bare area of the liver.
  
  
• It is a peritoneum-free triangular area, between the two layers of the coronary ligament, and is loosely attached to the diaphragm.

note:  RCL: Right coronary ligament

         RTL: Right triangular ligament

         BA: Bare area,