Clinical Anatomy of the Liver
The liver is the largest organ, amounting to about 2–3% of average body weight. The liver has three surfaces: diaphragmatic, visceral and posterior surfaces. The liver has two hemilivers, the large right hemiliver and the smaller left hemiliver, which is generally described in two ways, by morphologic anatomy and by functional anatomy. The two hemilivers are divided on the anterior surface of the liver by the falciform ligament and on the inferior surface by the round ligament as it runs into the umbilical fissure. At the upper margin, the two layers of the falciform ligament divide from each other. On the right side, the falciform ligament attaches the right diaphragmatic peritoneum and constitutes the upper layer of the right coronary ligament, which runs inferiorly to form the right triangular ligament, and then turns backwards to constitute the lower layer of the right coronary ligament. The area between these ligaments, which is completely devoid of peritoneum, is named as the bare area. The retrohepatic inferior vena cava (IVC) locates within this bare area on the undersurface of the liver. At its left extremity, the lower layer of the right coronary ligament passes through the posterior surface of the retrohepatic inferior vena cava and connects with the peritoneal reflexion from the right boundary of the Spigelian lobe of the caudate lobe. This right-sided part of this ligament posteriorly surrounding the retrohepatic IVC was referred to as the hepatocaval ligament (Makuuchi ligament). On the left side, the other layer of the falciform ligament constitutes the anterior layer of the left triangle ligament, which reflexes backwards to form the posterior layer. At the top of the fissure for the ligamentum venosum, it constitutes the anterior layer of the gastrohepatic ligament. The posterior layer of the gastrohepatic ligament is the reflexed peritoneum from the right boundary of the top portion of the Spigelian lobe of the caudate lobe. This layer then goes around the Spigelian lobe to join the lower layer of the coronary ligament. The gastrohepatic ligament ties to the ligamentum venosum, which divides the historically defined right and left hemilivers on its posterior surface. This common early description of liver anatomy was only based on external landmarks of the liver and has no strict relationship to functional anatomy. It is well accepted that the liver does not have reliable external landmarks as guides for anatomical hepatic resection.
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