 Good day everybody. Dr. Sanjay Sanyal, Professor of Department Chair. So this is going to be a demonstration of the spaces around the liver and the peritoneal ligaments. This is the right time to show you because after this we will remove the liver. So we have removed every structure from the abdominal cavity and we can see the liver here. First, let's start with this ligament that we can see here. This is Fatsiform ligament. The word Fatsiform means sickle shaped. Therefore, it is a triangular shaped peritoneal fold. One edge of the triangle is attached to the liver here and this is the one which demarcates the liver into an anatomical right lobe and an anatomical left lobe. The other end of the Fatsiform ligament is attached to the under surface of the antriabdominal wall and that is we can see it here. And the third margin of the Fatsiform ligament is free and running in the free margin of the Fatsiform ligament is this additional embryonic structure. This is called the round ligament of liver. The round ligament of liver is the remnant of the umbilical vein, the obliterated umbilical vein which in fetal life carried oxygen from the placenta to the fetus. The next structure that we can see here is this is the lesser momentum. More specifically, the hepatogestric part of the lesser momentum which came from the lesser curvature of the stomach and gets attached to the fissure for the ligament and venosum. We have just kept it here. Now let's take a look at the liver itself and for that I have lifted up the right costal margin to show you the liver and we can see this is the anatomical right lobe and this is the anatomical left lobe. I am putting my finger under the diaphragm and the anatomical right lobe and this place. This place adds similarly this space. These two spaces are referred to as the sub-phrenic recess meaning under the diaphragm. This sub-phrenic recess communicates with the general periodontal cavity. However, as I mentioned just a little while back, this is the falciform ligament and this falciform ligament separates the sub-phrenic recess into two parts, the right part and the left part. The next space that I want to draw your attention to is this space on the visceral surface of the liver. This is called the sub-hepatic space. This is the one which communicates again with the general periodontal cavity and we can see clearly the sub-phrenic recess also communicates with the sub-hepatic. If I were to put my finger further deep inside from the sub-hepatic space and it's going in right now and I'm lifting it up here to show you that space. This is known as the hepatorenal recess also called the Morrison punch. This is present on the right side between the right anatomical lobe of the liver and the right kidney. This hepatorenal recess if I were to put putting my pushing my finger at one point my finger does not go any further. So therefore the posterior limit of this hepatorenal recess is the posterior layer of the coronary ligament. Just like the posterior limit of the sub-phrenic recess is the anterior layer of the coronary ligament. Hepatorenal recess is one of the two most dependent parts of the abdominal cavity when the patient is lying down. So therefore if there's any abnormal fluid collection it tends to gravitate in the hepatorenal recess. The other most dependent part of the abdominal cavity is the pelvis which we can see here and we can already see liquid fat collected there. Just to reiterate these sub-phrenic recess, the sub-hepatic space and the hepatorenal recess they all communicate with each other and with the general period of the cavity. Now I'll draw your attention to this ligament structure here. This is the left triangular ligament. It is formed by the fusion of the anterior leaf of the coronary ligament and the posterior layer of the coronary ligament which we cannot see here. Anterior layer of the coronary ligament is formed by the splitting of the phalseiform ligament. We are supposed to see a right coronary ligament which is faintly visible on the right side here. That is also formed by the fusion of the anterior layer of the coronary ligament and the posterior layer of the coronary ligament. But we cannot see the posterior layer of the coronary ligament. Now let's take a look at the visceral surface of the liver. We can see this is the fissure for the ligamentum venosum and the round ligamentum liver. So this is the one which has demarcated the liver into a left anatomical lobe and a right anatomical lobe. On the visceral surface we can see this is the gallbladder. So this is the gallbladder fissure. When we look further we can see these three structures here. One here, one here and one here. These are the structures of the extra hepatic portal triad which were enclosed in the two leaves of the hepatodeodontal ligament and they are all entering the liver in this region here and this is referred as the portahepatus. So what are these three structures? This is hepatic artery proper. The hepatic artery proper is the continuation of the common hepatic artery. Common hepatic artery makes an upward curve and at the point of the curve it gives up this branch. This is the gastrododontal artery and after that it becomes known as the hepatic artery proper. This enters the portahepatus. The next structure that we see here, this is the portal vein which is formed by the union of the superior mesentric vein and the spleenic vein and the third structure that we see here, this is the common bile duct which is formed by the union of the cystic duct made from the gallbladder and the common hepatic duct. So these are the three structures which enter the portahepatus and the margin of the portahepatus, we can see remnant of this structure here. This is the peritoneum of the hepatodeodontal ligament which is attached to the margins of the portahepatus. My instrument has got under the extra hepatic portal triad and if the extra hepatic portal triad had been enclosed in the hepatodeodontal ligament this case would have been known as the epiploid forabinum, Winslow and my instrument now has reached the place which was the lesser side or the omental bursa and similarly the omental bursa has got also a superior recess where my finger is gone in and that superior recess is also demarcated by the posterior leaf of the coronary ligament. Omental bursa also communicates through the omental foremen with the hepatorenal recess. We can see this portion of the liver here between the fossa for the gallbladder and the fissure for the round ligament of liver. This portion of the liver is referred to as the quadrate lobe of the liver because it is roughly quadrangular shaped. Quadrate lobe of the liver forms part of hepatic surgical segment 4. So this is what we can see in this particular view. After this we were going to remove the liver and before I conclude I would like to draw your attention to the consistency of the liver as we can see it here. Here if you look the liver is firm in consistency and this is the inferior margin of the liver which is also quite firm. But if I were to look at the visceral surface of the liver you would find that the liver has got abnormal texture and it is soft in consistency and my finger is dipping in very easily and here also it is dipping in very easily. So obviously there is some pathology in this portion of the liver which we shall determine once we have got open the liver. These are the points which I want to demonstrate to you coordinating to the structures around the liver including the spaces and the ligaments. Thanks for watching Dr. Sanjay Sanyal signing out. David over the camera person if you have any questions or comments please put them in the comment section below. Have a nice day.