c l i n i c a l f o l i o s : n a r r a t i v e





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Hepatic Anatomy, Caudal View: 1

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With the advent of new imaging techniques and minimally invasive interventions it is essential to understand anatomy from a total, three-dimensional perspective. The caudal (CT scan) view of the upper abdominal organs shows a kidney-shaped disposition with the viscera extending posteriorly into the deep subphrenic recesses and the high ridge of the vertebral column extending anteriorly into the abdominal space. The aorta and inferior vena cava ride the ridge of the vertebral column. The superior mesenteric artery and vein occupy a central position as they pass downward through the root of the transverse mesocolon to the small bowel mesentery. As it crosses the lesser curve of the stomach, the body of the pancreas

The pancreas and duodenum are draped across the great vessels with the body and tail of the pancreas extending diagonally upward to the left.  may be apposed to the underside of the lateral segment of the left lobe of the liver through the lesser omentum if the stomach has a J-shaped configuration. With the rigid vertebral column behind and the closeness of the anterior abdominal wall in front, this portion of the pancreas is susceptible to blunt anterior abdominal trauma. The tail of the pancreas lies behind the junction of fundus and body of the stomach. The spleen occupies the posterior left subphrenic recess and the posterior portion of the right hepatic lobe extends back to a corresponding position on the right.

The esophagus lies directly anterior to the aorta as it enters the abdomen and the fundus of the stomach fills the remainder of the left subphrenic space. The body and antrum of the stomach fill the left upper quadrant. The gastric attachment of the greater omentum lies along the greater curve of the stomach.

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Hepatic Anatomy, Caudal View: 2

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The hepatic hilum is a deep transverse groove on the underside of the liver. A line through the gallbladder bed, hilum and inferior vena cava marks the boundary between left and right hepatic lobes. A fissure housing the round ligament and falciform ligament extends back from the edge of the left lobe to the left side of the hilum and separates the medial from the lateral segments (see segmental anatomy).  The medial segment of the left lobe consists of the quadrate lobe anteriorly and caudally. Posteriorly and cranially is the caudate lobe which has dual citizenship by virtue of its shared drainage and blood supply. The caudate lobe connects to the right lobe by the narrow caudate process which forms the roof of the epiploic foramen.

The underside of the liver is indented by impressions made by right kidney, adrenal, hepatic flexure of colon, duodenum and fundus of the stomach. A posterior notch marks the site of the esophagus. Peritoneal reflections can be seen on the right in this view,  with the posterior leaf of the right coronary ligament extending from the right triangular ligament, across the renal and adrenal fossae and between the caudate lobe and inferior vena cava. The left coronary and triangular ligaments are on the cephalad side of the left lobe and are not visible in this view.

The gastrohepatic (lesser) omentum extends from the hilum to the esophagus attaching in the groove of the ligamentum venosum. The hilum of the liver is encircled by a separation of leaves at the medial end of the hepatogastric (lesser) omentum.

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Hepatic Anatomy, Caudal View: 3

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This reflected edge with its portal structures is called the hepatoduodenal ligament and forms the anterior boundary of the epiploic foramen. The inferior vena cava below the peritoneal reflection is the posterior margin.       

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This page was last modified on 3/1/1999.