 Dr. Sanjo Sanyal, Professor Department Chair. Today we are going to demonstrate the liver. So this is the right anatomical lobe and this is the left anatomical lobe of the liver. The right anatomical lobe is larger and it is under the right dome of the diaphragm. And that is the reason why the right dome of the diaphragm is one intercostal space higher than the left dome. This is the falciform ligament. Cut portion of the falciform ligament. One portion is attached to the anti-abdominal wall. That is the abdominal part. The other margin is attached to the liver at the junction between the anatomical right lobe and the anatomical left lobe. And this is what separates the right lobe from the left lobe and the free margin is this one. This also goes up to here. This contains two structures inside it and we can feel them and see them. This cord-like structure inside this is the round ligament of liver which actually is a remnant of the umbilical vein which carries nutrient-rich blood from the placenta to the fetus. And we can see that the round ligament of liver gets attached to a fissure here which we shall mention later. The second structure which is present in the free margin are we can see some of those here. They are the para-umbilical veins. These para-umbilical veins on one end they connect to the umbilicus. In adult life from where they connect to the superficial epigastric vein. And the other end they connect to the left branch of the portal vein. So therefore they constitute what is known as the side of porta-systemic anastomosis. The falciform ligament splits to form an anterior layer of the corneary ligament which attaches the superior surface of the liver to the under surface of the diaphragm. The diaphragmatic surface of the liver is known as the anterior superior surface and the visceral surface of the liver is known as the postural inferior surface. And separating the two of them is the inferior margin of liver. And we can see peeping out from the inferior margin of the liver is the fundus of the gallbladder. The gallbladder is located in the gallbladder fossa of the liver. Now let's take a look at the spaces. This space that we see here is called the sub-phrenic space and the sub-phrenic space is divided into two parts by this passive omeligament into a right half and a left half. Sub-phrenic space communicates with the general peritoneal cavity. This space under the liver, this is called the sub-hypatic space and if we were to go where my finger is going, the extension of the sub-hypatic space goes between the right lobe of the liver and the right kidney and that is known as the hepatorenal recess or the moriscence pouch. And looking at the depth of it, we can make out that this is one of the most dependent parts of the peritoneal cavity where fluid can collect. Just to continue with these spaces, this is the lesser momentum which has been cut and this is the structure of the portal triad which formed the right free margin of the lesser momentum. My finger has gone through the epiploid foramina vislo into the lesser sac. If I were to lift this up and put my hand up, my finger goes up to a certain distance. So that is known as the superior recess of the omental bursa and the superior recess of the omental bursa is stopped after a certain distance. Similarly, the hepatorenal recess also stops after a certain distance and it is stopped by the posterior layer of the coronary ligament. So the coronary ligament is a quadrangular shaped ligament which has got an anterior margin which is reflected onto the diaphragm on both the sides and it has got a posterior margin which also gets reflected onto the diaphragm. The hepatorenal recess and the superior recess of omental bursa are limited by the posterior layer of coronary ligament while the sub-phrenic recess is limited by the anterior layer of the coronary ligament. When the patient is lying supine, the fluid from the superior recess of omental bursa communicates through the omental foramen of Winslow epipoic foramen and it communicates with the hepatorenal recess. And when the patient sits up, the fluid then tracks and the paracolic gutter and it goes down to the pouch of Douglas or the pelvis. So therefore, the hepatorenal recess and the pelvic cavity are the two most dependent spaces when the patient is lying down for collection of abnormal fluid in the bentoneal cavity. Now let's take a look at some of the important relations of the liver with the abnormal portion of the isophagus here. We have the stomach here and we have the pylorus here. So to continue further, we have the diodenum also related. Then we have the right supranial gland and we have the right kidney. So these are all the structures which are related to the visceral surface of the liver. And what has been removed from here is the transverse colon. The transverse colon is related along the inferior margin of the liver, the so-called colic area of the liver. Now let's turn the liver. We see certain structures. First of all, let's take a look at this depression here where I told you was attached to the gallbladder. This is the gallbladder fossa. This is one groove. The other groove is if I were to trace the inferior vena keva. The inferior givina keva also forms a groove in the so-called bare area of the liver. The bare area of the liver is the space between the anterior layer of the coronary ligament and the posterior layer of the coronary ligament. And in the bare area of the liver is directly in contact with the diaphragm. Going through the bare area of the liver is the groove for the inferior vena keva. So therefore this gallbladder fossa and the groove for the inferior vena keva, they together constitute what is known as the right sagittal fissure. On the superior surface, the line will be from here like this. And this imaginary line is known as the cantile line. Right sagittal fissure is also the main portal fissure and inside that is located the middle hepatic vein. Now again let's take a look at the liver on the inferior surface. We see two further grooves on the left side. This is the groove for the round ligament of the liver and we can see the round ligament is attached here. And this is the groove for the ligamentum venosum which is the remnant of the ductus venosus which connects the umbilical vein directly to the inferior vena keva. This groove is called the left sagittal fissure. In the surgical segments this left sagittal fissure becomes known as the left portal fissure also called the umbilical fissure. And inside that is located the left hepatic vein. And finally to the right of the cantile line there is an imaginary line further to the right. And that is imaginary line is the right portal fissure which contains the right hepatic vein. Now let's take a look at one more structure and that is this portion of the liver. This portion of the liver is the portahepatus. The portahepatus is one portion where it is not covered by the peritoneum and we see three structures either entering or leaving the liver. One of them is the pylduct, hepatic artery, portal vein. So these three structures constitute the structures inside the portahepatus. What are the structures in the portal triad? I have lifted up the structures of the portal triad here. This portion of the portal triad is referred to as the extra hepatic portal triad because they are outside the liver. And these were covered by the hepatodeodontal ligament which is the right ligamentous portion of the lesser momentum. And we have already seen that this constitutes the anterior margin of this foramen here which is known as the epidroic foramen of will slow and it leads into the mental person. Going from right to left, we have this, this is the common bile duct. Then we have the proper hepatic artery and posteriorly we have portal vein. So these are the three structures which constitutes the extra hepatic portal triad and these structures will then go inside through the portahepatus and they will divide and form interfacial inter lobular portal triad. So these are the bare essentials that I wanted to show you of the liver. Thank you very much for watching. If you have any questions or comments put them in the comment section below. Have a nice day. Dr. Sanjay Sanyal signing out.