Lower Bordery marked by a line joining
@ts: 1- A point on the Lt sth intercostal space at
the Lt. lateral vertical plane.
2- A point,on the lt. costal margin at the tip
3- Midway between xiphi-sternum & umbilicus.
4- Tip of right gth costal cartilage.
5- Following the costal margin to the mid-axillary line.
Right border: from 5ih rib to 7th and 11th rib in mid-axillary line.
SiZe: 8 - 12 cm length x 3 cm width.
Site: fossa for gallbladder on the inferior surface of the Rt. lobe of the liver.
Power of Concentration: 1o times
Projects beyond the inferior border of the liver.
ls covered by peritoneum all around.
- Anteriorly: anterior abdominal wall.
- Posteriorly: transverse colon.
Surface anatomy: at junction between Rt. linea semilunaris and Rt. costal margin
(tip of Rt. gth costal cartilage).
8phaillots1vrts€l lnoffi cudahlots
In contact with gall bladder fossa of liver, to the right side of the quadrate lobe.
. lts inferior surface is covered by peritoneum.
. Related to: 1't part of the duodenum.
ins vatve or Heister(mainrv in cvstic duct)
- The mucous membrane of the bile duct secretes mucous at a higher pressure
than the pressure at which the liver cells can secrete bile.
- surgical lmportance: this causes white bile (mucous) ) bad prognosis.
- Cystic artery: a branch 'of Rt.
artery passing in the triangle of
(between the cystic duct & liver)
- Accessory cystic A.: if present (from Rt.
or Lt. hepatic A. or common hepatic A.)
N.B: The Rt. hepatic artery passes behind
cystic veins ) Rt. branch of portal vein.
- Cystic LN of Lund at the junction of cystic duct & CHD ) to cellac LN
.Bounded by: liver, CHD & cystic duct .lt contains.'cystic artery & LN of Lund
- Parasympathetic: hepatic branch of anterior vagus.
- Sympathetic: from Tz-g (pain is reffered to inferior angle of Rt. scapula).
. Sensory: by the Rt. phrenic C3,4,5 (the same segments as the supra-clavicular
nerves ) so pain in gall bladder is referred to Rt. shoulder).
anterior & posterior segmental hepatic
Lt, hepatic duct: union of medial
& lateral segmental hepatic ducts.
Diameter of the common hepatic duct
'Has a spiral valve in its interior of
.Allows bile to flow to & from the
.Usually joins the common hepatic duct on its Rt. side.
[@ fne Rt. hepatic duct rarely enters the gallbladder near its junction with the cystic
. Formed by union of common hepblic duct & cystic duct.
. It is divided into 4 parts & its length is 3 - 4 inches.
. lts length inversely proportional to the length of the hepatic duct.
. Diameter by U/S ) CBD 6 mm (dilated if > 1 cm) & I mm by chr raphy.
hrffiduodenal padls Ftlcr$ticil.Et
n+*opamerlic impurn {funpulla of vater}
- lt is formed by union of cystic duct & common hepatic duct (Y-shaped).
- lt runs downwards in the free border of the lesser omentum.
- The portal vein lies behind it while the hepatic artery lies on its left side.
- lt is separated from IVC by foramen of Winslow.
- The wall of the supra-duodenal part has a venous plexus which can be seen
- lt is behind the 1"t part of duodenum.
- On its left side lies the gastro-duodenal artery; and the portalvein behind them.
- Behind the head of pancreas (cancer head of pancreas ) obstructive jaundice).
D. Termination of the CBD (lntra-duodenal portion)
a. Either unites with the main pancreatic duct to form hepato-pancreatic duct which
b. Or common bile duct and main pancreatic duct open separately at ampulla of
Vater (it may terminate without ampulla).
The duodenal papillae permitpassage of dilator 3 mm in diameter.
Anomalies of the Gall Bladder:
3) Double gallbladder with single duct or double ducts.
5) lntra-hepatic gall bladder.
6) Sessile gallbladder (the surgeon may injure the CBD during cholecystectomy).
8) Low insertion of the cystic duct.
9) Accessory cholecysto-hepaticduct.
10) Cystic duct joins the CBD on its left side.
1)Cystic artery may pass in the front of the CBD.
2)Accessory cystic artery may arise from the Rt. or Lt. hepatic artery or other
3)The Rt. hepatic artery may be tortuous in front of the bile duct (Caterpillar turn or
4)Accessory Rt. hepatic artery may arise from the superior mesenteric artery.
5) Cystic veins + open in the liver.
O.fcoeorytlrplc Uucl E &oetcorylbpetcDuc[ F.roamcdrmccs G. onrHrs*utcdr
Cornmunicates l sser peritoneal sac_to gr"u,"fiGneal
sac ter ffbor{flneolflrrr{bad krl
Anterior: Free border of lesser om( ) portar vein: porterioLtum,
) CBD: anterior & to the right. F Hepatic artery: anterior & to the left.
o Site of Porto-caval anastomosis.
o During cholecystegjoTy,. control of bleeding from cystic artery is achieved by Prinqles
maqguver ) pul the index finger of the Lt. hand in the foramen of Winslow & cornpress
the free border of lesser omentum against the thumb ) compression of hepatic artery.
o Site of exposure of supra-duodenal portion of CBD for removal of stones.
. A site for internal hernia (epiplocele) where the foramen represents the defect.
S&. The spleen arises from the left side of the dorsat mesogastrium.
'rF r lt is mesodermal in origin & later has its own lymphatic & vascular element.
, The spleen is rarely absent.
. The mesenchymal cells that fails to fuse becomes accesssory spleens.
- Splenic vessels and tail of pancreas 30%.
- Splenic ligaments & mesocolon.
. lf accessory spleens are left after spleenectomy )hyperplasia & recurrence.
tS ljfiir}fir€rBl|nd ffi tfie0aruH$nd B,m*urr
The odd numbers 1, 3, 5, 7,9 & 11 summarize certain statistical features of spleen.
ufidmunorne FEWm** -rutrr I Unem
.Lt. hypochondrium oppositetothe gth, lOth & 11th ribswith its long axis parallel to
.lt normally does not descend below the costal margin.
It has 2 ends, 2 borders & 2 surfaces
o Lateral (anterior) end: broad, at mid-axillary line.
. Medial (posterior) end: tapering,4 cm from T10.
. gry1lgl@gglgtr sharp & usually has a notch.
. lnferior border: rounded & smooth.
1 . Diaphrusmatic= related to the diaphragm.
2. Viscerul: has 4 impressions & the hilum:
) Between the hilum & the upper border.
) lt is related to the fundus of the stomach.
F lt is related to the tail of pancreas.
) Between the hilum & lower border.
F lt is related to the front of the Lt. kidney.
) Close to the anterior end of the spleen.
F lt is related to Lt. colic flexure.
- lt is completely covered with peritoneum.
) lt is attached to the anterior margin of the hilum & transmits short gastric
vessels and gastro-epiploic vessels.
) lt is a part of greater omentum.
> lt can be divided easily as it has no important contents.
F Attached to the posterior margin of the hilum & tail of pancreas & transmits the
splenic vessels, nerves & lymphatics.
F Difficult to be cut as it contains important structures.
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