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Liver
Anatomy Abdomen Tiesworks.jpg
Human liver shown in abdomen
Details
Latin Jecur, iecur
Greek

Hepar ()

root hepat- (-)

Precursor

Foregut

System

Digestive system

Artery
Hepatic artery
Vein
Hepatic vein and hepatic portal vein
Nerve
Celiac ganglia and vagus nerve[1]
Identifiers
Gray's

p.1188

MeSH A03.620
TA

A05.8.01.001

FMA

7197

Anatomical terminology

The liver is a vital organ of vertebrates and some other animals.[2] In the human it
is located in the upper right quadrant of the abdomen, below the diaphragm. The
liver has a wide range of functions, including detoxification of various metabolites,
protein synthesis, and the production of biochemicals necessary for digestion.[3]

The liver is a gland and plays a major role in metabolism with numerous functions in
the human body, including regulation of glycogen storage, decomposition of red
blood cells, plasma protein synthesis, hormone production, and detoxification.[3] It

is an accessory digestive gland and produces bile, an alkaline compound which aids
in digestion via the emulsification of lipids. The gallbladder, a small pouch that sits
just under the liver, stores bile produced by the liver.[4] The liver's highly
specialized tissue consisting of mostly hepatocytes regulates a wide variety of highvolume biochemical reactions, including the synthesis and breakdown of small and
complex molecules, many of which are necessary for normal vital functions.[5]
Estimates regarding the organ's total number of functions vary, but textbooks
generally cite it being around 500.[6]

Terminology related to the liver often starts in hepar- or hepat- from the Greek word
for liver, hpar (, root hepat-, -).[7][8]

There is currently no way to compensate for the absence of liver function in the long
term, although liver dialysis techniques can be used in the short term.[9] Liver
transplantation is the only option for complete liver failure.

Contents

1 Structure
1.1 Gross anatomy
1.1.1 Surfaces
1.1.2 Impressions
1.2 Microscopic anatomy
1.3 Functional anatomy
1.4 Couinaud classification system
2 Development
2.1 Fetal blood supply
2.2 During childhood
3 Physiology
3.1 Blood supply
3.2 Biliary flow
3.3 Synthesis
3.4 Breakdown
3.5 Other functions

3.6 Relation to medicine and pharmacology

4 Clinical significance
4.1 Disease
4.2 Symptoms
4.3 Diagnosis
4.4 Biopsy / scan
4.5 Liver regeneration
4.6 Liver transplantation
5 Society and culture
5.1 Food
6 Other animals
7 Additional images
8 See also
9 References
10 Sources
11 External links

Structure
Capillaries, sinusoid on right

The liver is a reddish brown wedge-shaped organ with four lobes of unequal size and
shape. A human liver normally weighs 1.441.66 kg (3.23.7 lb).[10] It is both the
largest internal organ and the largest gland in the human body. Located in the right
upper quadrant of the abdominal cavity, it rests just below the diaphragm, to the
right of the stomach and overlying the gallbladder.[4]

The liver is connected to two large blood vessels, the hepatic artery and the portal
vein. The hepatic artery carries oxygen-rich blood from the aorta, whereas the
portal vein carries blood rich in digested nutrients from the entire gastrointestinal
tract and also from the spleen and pancreas.[9] These blood vessels subdivide into
small capillaries known as liver sinusoids, which then lead to a lobule.

Lobules are the functional units of the liver. Each lobule is made up of millions of
hepatic cells (hepatocytes) which are the basic metabolic cells. The lobules are held
together by fine areolar tissue which extends into the structure of the liver, by
accompanying the vessels (veins and arteries) ducts and nerves through the
hepatic portal, as a fibrous capsule called Glisson's capsule.[11] The whole surface
of the liver is covered in a serous coat derived from peritoneum and this has an
inner fibrous coat (Glisson's capsule) to which it is firmly adhered. The fibrous coat
is of areolar tissue and follows the vessels and ducts to support them.
Gross anatomy
The upper surface of the liver showing two lobes
Visceral surface showing four lobes

Gross anatomy traditionally divided the liver into two portions a right and a left
lobe, as viewed from the front (diaphragmatic) surface; but the underside (the
visceral surface) shows it to be divided into four lobes and includes the caudate and
quadrate lobes.[12]

The falciform ligament, visible on the front of the liver, divides the liver into a left
and a much larger right lobe. From the visceral surface, the two additional lobes are
located between the right and left lobes, one in front of the other. A line can be
imagined running from the left of the vena cava and all the way forward to divide
the liver and gallbladder into two halves.[13] This line is called Cantlie's line.[14]

Other anatomical landmarks exist, such as the ligamentum venosum and the round
ligament of the liver (ligamentum teres), which further divide the left side of the
liver in two sections. An important anatomical landmark, the porta hepatis, also
known as the transverse fissure of the liver, divides this left portion into four
segments, which can be numbered starting at the caudate lobule as I in an
anticlockwise manner. From this visceral view, seven segments can be seen,
because the eighth segment is only visible in the parietal view.[15]
Surfaces

On the diaphragmatic surface, apart from a large triangular bare area where it
connects to the diaphragm, the liver is covered by a thin double-layered membrane,
the peritoneum, that reduces friction against other organs.[16] This surface covers
the convex shape of the two lobes where it accommodates the shape of the
diaphragm. The peritoneum folds back on itself to form the falciform ligament and
the right and left triangular ligaments.[17]

These peritoneal ligaments are not related to the anatomic ligaments in joints, and
the right and left triangular ligaments have no known functional importance, though
they serve as surface landmarks.[17] The falciform ligament functions to attach the
liver to the posterior portion of the anterior body wall.

The visceral surface or inferior surface, is uneven and concave. It is covered in

peritoneum apart from where it attaches the gallbladder and the porta hepatis.[16]
Impressions
Impressions on liver (posterior view)

There are several impressions on the surface of the liver which accommodate the
various adjacent structures and organs. Underneath the right lobe and to the right
of the gallbladder fossa, are two impressions, one behind the other and separated
by a ridge. The one in front is a shallow colic impression, formed by the hepatic
flexure and the one behind is a deeper renal impression accommodating part of the
right kidney and part of the suprarenal gland.[18]

The suprarenal impression is a small triangular depressed area on the liver. It is

located close to the right of the fossa between the bare area and the caudate lobe
and immediately above the renal impression. The greater part of the suprarenal
impression is devoid of peritoneum and it lodges the right suprarenal gland.[19]

Medial to the renal impression is a third and slightly marked impression, lying
between it and the neck of the gall-bladder. This is caused by the descending
portion of the duodenum, and is known as the duodenal impression.[19]

The inferior surface of the left lobe of the liver presents behind and to the left the
gastric impression.[19] This is moulded over the upper front surface of the stomach,
and to the right of this is a rounded eminence, the tuber omentale, which fits into
the concavity of the lesser curvature of the stomach and lies in front of the anterior
layer of the lesser omentum.
Microscopic anatomy
Liver structure showing cells
Microscopic anatomy of the liver

Microscopically, each liver lobe is seen to be made up of hepatic lobules. The

lobules are roughly hexagonal, and consist of plates of hepatocytes radiating from a

central vein.[20] The central vein joins to the hepatic vein to carry blood out from
the liver. A distinctive component of a lobule is the portal triad, which can be found
running along each of the lobule's corners. The portal triad, misleadingly named,
consists of five structures: a branch of the hepatic artery, a branch of the hepatic
portal vein, and a bile duct, as well as lymphatic vessels and a branch of the vagus
nerve.[21] Between the hepatocyte plates are liver sinusoids, which are enlarged
capillaries through which blood from the hepatic portal vein and hepatic artery
enters via the portal triads, then drains to the central vein.[22]

Histology, the study of microscopic anatomy, shows two major types of liver cell:
parenchymal cells and non-parenchymal cells. 7085% of the liver volume is
occupied by parenchymal hepatocytes. Non-parenchymal cells constitute 40% of
the total number of liver cells but only 6.5% of its volume.[23] The liver sinusoids
are lined with two types of cell, sinusoidal endothelial cells, and phagocytic Kupffer
cells.[24] Hepatic stellate cells are non-parenchymal cells found in the space of
Disse, between a sinusoid and a hepatocyte.[23] Additionally, intrahepatic
lymphocytes are often present in the sinusoidal lumen.[23]
Functional anatomy

The central area where the common bile duct, hepatic portal vein, and the hepatic
artery proper enter is the hilum known as the porta hepatis (gateway to the liver) or
the transverse fissure of the liver. The duct, vein, and artery divide into left and
right branches, and the areas of the liver supplied by these branches constitute the
functional left and right lobes.The functional lobes are separated by the imaginary
plane, Cantlie's line, joining the gallbladder fossa to the inferior vena cava. The
plane separates the liver into the true right and left lobes. The middle hepatic vein
also demarcates the true right and left lobes. The right lobe is further divided into
an anterior and posterior segment by the right hepatic vein. The left lobe is divided
into the medial and lateral segments by the left hepatic vein.
Couinaud classification system

The fissure for the round ligament of the liver (ligamentum teres) also separates the
medial and lateral segments. The medial segment is also called the quadrate lobe.
In the widely used Couinaud (or "French") system, the functional lobes are further
divided into a total of eight subsegments based on a transverse plane through the
bifurcation of the main portal vein.[25] The caudate lobe is a separate structure
which receives blood flow from both the right- and left-sided vascular branches.[26]
[27] The Couinaud classification of liver anatomy divides the liver into eight
functionally independent segments. Each segment has its own vascular inflow,
outflow and biliary drainage. In the centre of each segment there is a branch of the
portal vein, hepatic artery and bile duct. In the periphery of each segment there is
vascular outflow through the hepatic veins.[28] The division of the liver into

independent units means that segments can be resected without damaging the
remaining segments.[29] To preserve the viability of the liver following surgery,
resections follow the vessels defining the peripheries of each segment. This means
that resection lines parallel the hepatic veins, leaving the portal veins, bile ducts,
and hepatic arteries intact.[25]

The classification system uses the vascular supply in the liver to separate the
functional units (numbered I to VIII):

unit I is the caudate lobe and is situated posterior l and it may receive its supply
from both the right and the left branches of portal vent. It contains one or more
hepatic veins which drain directly into the IVC.[25]

The remainder of the units (II to VIII) are numbered in a clockwise fashion:[28]

units II and III lie lateral to the falciform ligament with II superior to the portal
venous supply and III inferior
unit IV lies medial to the falciform ligament and is subdivided into IVa (superior)
and IVb (inferior)

Units V to VIII make up the right hemiliver:[28]