 This is the demonstration of the liver. The first point is about the location of the liver. So you can see that the liver is located under the right dome of the diaphragm. And it extends partly into the epigastrium, and it spins over into the left hypochondrium. So the main location is right hypochondrium, little bit in the epigastrium, and little bit in the left hypochondrium. In order to understand the parts of the liver, we have to look at this ligament that we are holding up here. This is the falciform ligament. And we can see that the falciform ligament is attached to one area of the liver here. And this is what divides the liver into its component anatomical parts. The portion to the right is called the right anatomical lobe, and this is the left anatomical lobe. This portion, which is in contact with the under surface of the diaphragm, where my finger has gone in, this is known as the diaphragmatic surface. It's also referred to as the anterior superior surface. And this surface, where my finger has gone in, this is the visceral surface because it is related to the visceral of the abdomen. And this also referred to as the posterior inferior surface because my hand is going posterior inferiorly. So these are the essential parts of the liver, right anatomical lobe, left anatomical lobe, anterior superior surface, and posterior inferior surface. And separating them is this sharp margin that we see here. This is the inferior border or the inferior margin of the liver. In a normal person, in whom the liver is not, this is not a normal case, this is a patient with no micro-nodular cirrhosis, but in a normal patient, the inferior margin of the liver is just above the costal margin. So we should not be able to feel the inferior margin of the liver in a normal person. However, if the liver's enlarged, which is called hepatomegaly, then we can feel it when we palpate the liver from below up. In children, the liver inferior margin may be palpable one centimeter below the right costal margin, which is not considered abnormal. There is one portion of the liver on the right side of the right anatomical lobe, which is referred to as the right surface of the liver in some anatomical textbooks. And this is the surface which is used to perform what is known as a liver biopsy through the ninth intercostal space in the mid-axillary line. So these are the parts of the liver. Welcome to the visceral relationships of the liver. In order to understand the visceral relationships, we will reflect the liver up. So this is the visceral surface of the liver or the posterior inferior surface. This is the cut portion of the stomach and this is the location of the esophagus. So let's put the structures in the normal anatomical position. On the left side, going from above down, we have the esophagus, then we have the stomach and then we have the pyloric atrium. And then further to the right, we have the diodenum. This is the diodenum. Then we have the kidney, the right kidney and then we have the right supravenum. So esophagus, stomach, pylorus, diodenum, diodenum, kidney, right supravenum. So these are the six structures which are located to the visceral surface. This was the location of the transverse colon. So the transverse colon is located in relation to the inferior margin of the liver. So these are the visceral relationships of the liver. Let's take a look at the ligament which are attached to the liver. This ligament which is being held up by my assistant here. This is the falciform ligament. The falciform ligament as the term implies is a sickle shaped triangular ligament. So therefore it has got two attached margins and one free margin. This margin that you see here, this is the margin which is attached to the inner surface of the abdominal wall. When it goes to the liver, it gets attached to the fissure between the anatomical right grove and the left grove. This portion is also part of the falciform ligament which then splits to form the coronary ligament. This is the other attached margin. And finally, we see this margin here. This is the free margin of the liver and this contains this structure here. This structure is a combination of two things. One of them is called the round ligament of liver which is a remnant of the umbilical vein. And other structure which is present is the para-umbilical vein and we can see the para-umbilical vein here. The round ligament of the liver carries oxygenated blood in future life from the umbilicus to the fetus. And the para-umbilical veins in adult life communicate the left branch of the portal vein with the veins on the umbilicus and they get engorged in a patient with cirrhosis with portal hypertension. So, these are the structures which are seen on this surface. Let's come back to where we saw the under surface of the diaphragm. Again, to come back, this is part of the falciform ligament and we can see that the falciform ligament is getting attached to the under surface of the diaphragm. So, therefore, this is an important structure which holds up the liver. And going further posteriorly, the falciform ligament splits into this layer here and this layer here. This is the anterior leaf of the coronary ligament. Similarly, we have something called the posterior leaf of the coronary ligament which we cannot see which also holds up the liver against the diaphragm. Now, let's come to the fissures of the liver. For that again, we will turn the liver up. We are looking at the visceral surface, but here we are now not focusing on the visceral organs, but we are focusing on the fissures. Straight away, we can see one fissure here and another fissure here. This is the cystic fissure or the fossa for the gallbladder. And we can see that the gallbladder is attached to the, in this region. This is the region where the liver does not have visceral peytonium because it is covered by the gallbladder. So, this is the gallbladder fossa or the cystic fissure. To the left of that, we see yet another fissure. This is the fissure for the round ligament of liver. And we already mentioned the round ligament of liver is a remnant of the umbilical vein. Further posteriorly, if you trace the fissure for the round ligament, we see yet another fissure here. This is the fissure for the ligament of venousum which contain the ductus venousus which connects the umbilical vein directly to the inferior vena cava. Posterior to the gallbladder fossa. We have this structure here where my finger is located. Though it has not been dissected out, that is the fissure for the inferior vena cava. So, therefore, if we were to look at the whole thing in totality, we see one continuous fissure here. This is the fissure for the gallbladder and the fissure for the inferior vena cava which is on the right side. Then we have the fissure for the round ligament and the ductus venousus which is on the left side. So, this is the left sagittal fissure also known as the umbilical fissure. This is the right sagittal fissure which will later form portal fissures in the surgical segments. And finally, connecting the two limbs of the fissure, we have this segment here. This is referred to as the porta hepaticis. So, these are the fissures that we can see forming a rough edge structure on the visceral surface of the liver. Now, let's come to the extra hepatic portal triad. My finger has picked up some structures here. These three structures are the extra hepatic portal triad. So, now let's take a look at them. We have considerably separated them out to show the extra hepatic portal triad. This one, this is the common by duct. The right empty. Another empty here, hepatic artery. The hepatic artery starts as a common hepatic artery and after it gives out the gastrodeodontal artery, it becomes known as the hepatic artery proper. So, hepatic artery proper. And posteriorly, we have this structure here, portal way. So, these three structures constitute the extra hepatic portal triad. They are located within the two folds of petronium which is collectively referred to as the hepatodeodontal ligament. And the hepatodeodontal ligament stretches from the first part of the deodontum which is here and gets attached to the margins of the porta hepaticis. These extra hepatic portal triad structures enter the liver or leave the liver. The common by duct continues up and it gives up a cystic duct here and then it becomes known as the common hepatic duct and which enters the porta hepaticis. The hepatic artery also divides into a right and left right. And the portal way also divides in the hepaticis as the right and left portal ways. So, this was a detailed coverage of the basic surgical anatomy of the liver in situ. Stay tuned for the second video. Thank you very much for watching. Dr. Sanjay Sanyal signing out. Have a nice day.