LiverRahilla Khatoon, Moza Al-Khulaifi, James

Alexander and Irsalan Asif

1

Overview

• Anatomy of the liver.

• Blood supply of the liver

• Porto-systemic anastamoses

• Computed tomography and plain film radiography

• Liver surgery planning

2

Anatomical liver

Lobes

• Left lobe

• Right lobe

• Caudate lobe

• Quadrate lobe

Liagaments

• Falciform ligament

• Coronary ligament

• Triangle ligament

• Ligament venosum

• Ligament teres

3

Lobes and ligaments of the liver

http://edoctoronline.com/medical-atlas.asp?c=4&id=22006

4

Blood supply of the liver

• Oxygenated blood goes via the aorta to the hepatic artery and goes on to

supply the liver.

• Nutrients are supplied to the liver by deoxygenated blood rich in nutrients

carried from the spleen, stomach and intestine via the portal vein.

• Blood is carried back to the heart from the liver via the hepatic vein to the

inferior vena cava.

5

Porto-systemic anastomosis

• The Porto-systemic anastomosis referred to the connection that

occur between the veins of portal circulation and the systemic

circulation.

• The most common cause of the liver anastomosis is portal

hypertension.

• The portal hypertension is caused by the cirrhosis of the liver.

• In Cirrhosis of the liver the scar tissue causes a blockage to the

blood flow through the liver, Slowing its function.

Johnson, K. (2012 ). Cirrhosis of the Liver . Available: http://www.webmd.com/digestive-disorders/cirrhosis-liver?page=3.

Different regions of anastomosis

Region Portal circulation Systemic circulation

Esophageal Esophageal branch of left

gastric vein

Esophageal branches of

Azygos vein

Rectal Superior rectal vein Middle rectal veins and inferior

rectal veins

Paraumbilical Paraumbilical vein Superficial epigastric vein

Retroperitoneal

right colic vein, middle colic

vein, left colic vein Renal vein, suprarenal vein,

paravertebral vein, and gonadal vein

Intrahepatic Left branch of portal vein Inferior vena cava

What is a CT Scan

• CT stands for computed tomography

• The first functional CT scanner was constructed in 1972 and Dr. Hounsfield received the Nobel Prize for this work in 1979

• Provides cross-sectional imaging

• Origin of tomography is tomos Greek for ‘slice’

• Uses X-rays and computer technology and is non-evasive

• Shows details of body such as bones,muscles,fat and organs

8

How does CT scan work

1. Table with a motor moves a patient into a hollow opening

of the CT imaging system

2. As the patient passes through the CT imaging system, x

rays rotate around the inside of producing a narrow beam

irradiating a section of the patient's body.

9

1. http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htm

2. http://drawbridgedds.com/DB_PRO_imaging.php

How does CT scan work contd….

3. Detectors record the x rays exiting the patient's

body as an x-ray "snapshot“. Many different

"snapshots" are collected.

4. The data is sent to a computer to construct a cross-

sectional image (slice).

10

http://science.howstuffworks.com/cat-scan2.htm

What is Plain film radiography

• Produces 2D images from X-rays

• Uses a plain film for to generate the image

• Generate X-rays for a part of the body to be examined

• Used to diagnose internal injury of the skull, face, spine, bones of thorax

and upper and lower limbs

11

Plain film Radiography: The machine

• Basic Components are X-ray source, a beam-

limitation device and an image receptor (film).

• X-ray source is a high-voltage glass vacuum diode

tube.

• Electrons pass from the cathode to the anode.

• X-rays are produced when the electrons slam into

the anode.

• Collimator allows the operator to limit radiation

exposure to area of interest.

• The film is both light and X-ray sensitive.

12

https://www.medicalradiation.com/types-of-medical-imaging/imaging-using-x-rays/radiography-plain-x-rays/

How does Plain film radiography(X-ray) work

• To X-ray a patient's foot, the foot is placed on top of

the X-ray film cassette.

• The machine is directed towards the foot and the

operator adjusts the collimator and selects the

penetrating power and quantity of radiation.

• Remnant radiation that exits the patient and strikes the

film forms the latent (invisible) image.

• Painless/minimal risk to patient

13

http://www.mpmschoolsupplies.com/ideas/3709/halloween-skeletons/

Differences between plain film radiography and

CT scan

• CT scan is an X-ray slice of the body whereas plain film radiography is ‘photograph like’

• Radiation amounts

• Cost

• Availability

14

How CT images are useful

• CT scan of the liver is performed to assess the liver for tumors, injuries,

bleeding and infections particularly when X-rays, physical examination, and

ultra sound are not conclusive.

• CT scan of the liver may be used to distinguish between obstructive and

non-obstructive jaundice

• Shows exactly where blood vessels are

• Can pre-plan a surgery route to make for the least amount of time under

anesthetic for the patient15

Example: CT Scans - Neuroblastoma

Neuroblastoma in the liverNormal liver

16

http://www.walgreens.com/marketing/library/contents.jsp?docid=1176&doctype=2

Example: CT Scans - Metastases

Normal liverLiver with Metastases

17

http://www.walgreens.com/marketing/library/contents.jsp?docid=1176&doctype=2

Example: CT Scans - Cirrhosis

Normal liverLiver with Cirrhosis

18

http://www.walgreens.com/marketing/library/contents.jsp?docid=1176&doctype=2

Conclusion

• Anatomy of Liver

• Porto systemic anastamoses

• Both plain film radiography and CT scans use x-rays to generate an image

• The imaging methods show soft and hard tissue

• They are useful to show us what the inside of our bodies look like

19

References

• http://science.howstuffworks.com/cat-scan2.htm

• http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htm

• http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=92&ContentID=P07691

• http://www.ehow.com/about_6645389_plain-film-x_rays-basics.html

• http://www.walgreens.com/marketing/library/contents.jsp?doctype=1&docid=003789

• Gray's Anatomy for Students Gray H, Drake R, Vogl W, Mitchell A, Tibbitts R, Richardson P. Philadelphia: Elsevier/Churchill Livingstone; 2010. p. 226

• Johnson, K. (2012 ). Cirrhosis of the Liver . Available: http://www.webmd.com/digestive-disorders/cirrhosis-liver?page=3. Last accessed 25th March 2014.

• Netter,F. (2010). Portocaval Anastomosis. Available: http://www.wikilectures.eu/index.php/Portocaval_Anastomosis. Last accessed 25th March 2014.

20

ANY QUESTIONS?

21