 This is the demonstration of the liver. My finger is in this space here, behind the extravatic border drag. This is the epiploid for oven or the omen for oven or the winch cloves for oven. So, the anterior boundary is formed by the structures in the extravatic border drag. The posterior boundary is formed by the inferior vena keva and the right supra renal gland. The supra boundary is formed by the liver and the inferior boundary is formed by the first part of the diodenum. So, this is a triangular shaped window which is called the epiploid for oven and which leads into this space here, which is actually the space behind the stomach and that space is referred to as the lesser sag or the fomental bursa. So, this is the epiploid for oven. Now let us take a look at the spaces around the liver. There are three principal spaces around the liver. The first space is where my finger hand is gone in. This is the known as the subfrenic recess because it is under the diaphragm, subfrenic means under the diaphragm. And you could see the subfrenic recess is divided into two parts, a right part and a left part by the falciform ligament. And the subfrenic recess communicates with the rest of the patron in cavity. The next space is on the under surface of the liver, on the visceral surface of the liver. This is referred to as the sub hepatic space. And posterior continuation of the sub hepatic space is where my finger is gone in. My finger has gone in very deep. This is referred to as the hepato renal recess. Why is it called the hepato renal? Because this is the left kidney and this is the liver. So, therefore, this is the hepato renal recess also referred to as the mollicent pouch. Let us come back to the subfrenic space. If I were to push my finger, my hand does not go beyond a certain stage. Similarly, on this side also, my hand does not go beyond a particular stage. What is blocking my hand? The anterior layer of the coronary ligament is blocking my hand. Similarly, if I were to push my hand in the hepato renal recess, at a particular place my hand will not go any further. So, what is blocking my hand? The posterior layer of the coronary ligament. So, these are the limits of the spaces. And hepato renal recess, we can see very clearly here, this is the hepato renal recess. It is one of the two most dependent portions of the peritoneal cavity, where abnormal fluid can collect when the patient is supine. Next. So, that brings me to the next, that is the peritoneal spaces. I have already referred to the lesser sac where my finger has gone in. If the stomach was here, then it would have been behind the stomach. So, the lesser sac is a space behind the lesser momentum, the stomach, this is the lesser sac. It is a space between the stomach and the bed of the stomach. So, this lesser sac which is also referred to as the omenical bursar has got superior recess, which also is going behind the labour. But it is stopped by the posterior of the coronary ligament. This lesser sac communicates through the omenical forearm where my finger has come and it communicates with the hepato renal recess. And this lesser sac also communicates with the rest of the peritoneal cavity. The rest of the peritoneal cavity is referred to as the greater sac. There is a very important surgical correlation pertaining to the lesser sac. The posterior boundary of the lesser sac is this structure here, which is the pancreas. In alcoholic or any other pancreatitis, after the inflammation of the pancreas or side, fluid exudes and collects inside the lesser sac and informs the big swelling behind the stomach and that is called the pseudo pancreatic cyst. And when we have a patient with pseudo pancreatitis, so any fluid connection, what other surgical access do we have? Let me put back the colon here. This was the location of the transverse colon and this is the greater momentum. So, this is a gastroponic ligament. We can split the gastroponic ligament here and we can lift up the stomach and we can enter the lesser sac. So, this provides a surgical access to the lesser sac by splitting the gastroponic ligament. Now let us take a look at the rest of the peritoneal cavity, which is the greater sac. The portion above the transverse colon is called the supra-coalic compartment. The portion below the transverse colon is the infracolic compartment and we can see that all of these spaces are in communication with each other. Fluid from the supra-coalic compartment and the infracolic compartment can travel on either side of the descending and descending colon and these depressions that we see here, these are referred to as the paracolic cutters and from there they can track down and they can collect in the appendix, where my finger is called it. So, this is the second most dependent part of the peritoneal cavity. The first being the epitoneal recess and the second being the peritoneal cavity. So, this is about the general peritoneal cavity and the peritoneal spaces and their inter-communications with each other. Now, let us come to the port hepitis. Port hepitis is this structure, the horizontal limb of the edge which I mentioned and we can see that entering the port hepitis we have the common hepatic duct here. Next structure that is entering the port hepitis is the hepatic artery and the third structure that is entering the port hepitis is the portal way, all of which we will divide into a right and left branch. The port hepitis itself is not covered by visceral petronium, but the margins are attached by the hepatodeutonal ligament. This port hepitis is where the hepatodeutonal ligament is attached and the fissure for the ligamentum venosa where my finger is gone in is where the hepato gastric ligament is attached. So, therefore, the lesser momentum is attached to the liver in the form of an L shape. So, this is the attachment of the lesser momentum to the liver and the lesser momentum if you were to look at it in the stomach, this is the portion which gives rise to the membranous part of the hepatogastric and this is the portion which gives rise to the hepatodeutonal part. Hepatodeutonal gets attached to the port hepitis margins, hepatogastric gets attached to the fissure for ligamentum venosa. Now, let us take a look at this one special triangle which is used in gallbladder surgery. This triangular space that we see here this is called the callot's triangle or the cholecystohepatic triangle it is bounded by the common hepatic duct, the cystic duct and the liver this is the callot's triangle. The most important content of the callot's triangle is this artery here and that is the cystic artery which has to be ligated when we are doing a cholecystic to me or gallbladder surgery and it also contains a lymph node known as a cystic node. So, this is the importance of the callot's triangle and finally, when we are doing a gallbladder surgery or any surgery in this region, suppose there is accidental bleeding from the hepatic artery what is the best way to stop it? My one finger has gone into the epiploid 4mm, my thumb is in front and I grip the structures of the portotribe between my two fingers and by so doing I am compressing the hepatic artery. When I do that it stops the bleeding and allows me to catch the bleeding point. This procedure is a very important surgical maneuver and that is referred to as the Pringles maneuver. This is a patient who has obviously got micro nodular cirrhosis he may have been an alcoholic this is also referred to as Lenic cirrhosis and the liver has got hobnane appearance so sometimes this is also referred to as a hobnane. These such patients they can develop what is known as portal hypertension where the portal vein gets engorged that is called portal hypertension the blood pressure inside the portal vein increases. Then there are certain areas in the body where portosystemic communications become big one of that site is the lower end of the esophagus and we can see an engorged vein here. This is a portosystemic anastomosis site. The other site is the para umbilical vein which runs in the free margin of the alzipond ligament. The third is the recta and the fourth site is the retropedrial areas of the colon. So these are the four sites of portosystemic anastomosis which become big in cases of cirrhosis with portal hypertension. So this was a rather extensive coverage of the liver, the paternal cavity, the gallbladder surgery, portal hypertension cirrhosis. Thank you very much for watching. Have a nice day. Talk to Sanjay Sanyal.