Anatomy of the hepatobiliary:

1) Pancreas:

➢ The pancreas is an elongated accessory digestive gland that is located between duodenum on the right and spleen on the left. It crosses the L1-L2 level of the transpyloric plane.

i. Function:

a) Exocrine: releases pancreatic juice from the acinar cells for digestion through the main pancreatic duct and accessory duct.

b) Endocrine: Releases insulin and glucagon from the B and Alpha Islets of langerhans cells directly into the blood.

ii. Compartments:

a) Head:

• The head of the pancreas embedded onto the C-shaped of the duodenum just to the right of the superior mesenteric artery.

• The embedded is just below the transpyloric plane.

• The uncinate process is just the extending process of the head of the pancreas that are posterior to the superior mesenteric artery

• The pancreatic head is superior to IVC, right renal artery and vein,left renal vein and abdominal aorta.

b) Neck:

• The neck of the pancreas is anterior to the superior mesenteric artery and vein.

• Besides, inferior mesenteric vein form with splenic vein to form portal hepatic vein.

• It is cover by peritoneum adjacent to stomach

c) Body:

• The body is continuation of the neck of the pancreas left of the sup mesenteric vessels and overlies aorta and L2 vertebrae just above the transpyloric plane and runs to the omental bursa.

• The anterior surface form is cover by peritoneum and lies in the floor of omental bursa and form the bed of the stomach

• However, posterior surface is devoid of peritoneum and in contact with left kidney, aorta, left suprarenal gland and renal vessels.

d) Tail:

• The tail is anterior to the left kidney and closely related to splenic hilum and left colic flexure.

• The tail is relatively mobile and it is passes between splenorenal ligament with splenic vessels.

iii. Pancreatic & Accessory duct:

• Pancreatic duct is originated from the tail of the pancreas that runs through the parenchyma and turns inferiorly into the head of the pancreas relatively close to the bile duct.

• The pancreatic duct unite with the bile duct to form ampulla of vater at the summit of the major duodenal papilla.

• On the other hand, the accessory duct opens into the summit of the minor duodenal papilla.

• In regarding to the pancreatic duct , there were three sphincter which is sphincter of the pancreatic duct, sphincter of the bile duct and hepatopancreatic sphincter(of oddi).

iv. Blood vessels:

• Arterial supply:

Abd aorta TO Sup Mesenteric artery TO Inf pancreatico duodenal artery(ant and post).

Abd Aorta TO Celiac artery TO gastroduodenal Artery TO Sup pancreatico duodenal artery(ant and post).

Abd Aorta TO Celiac Artery TO Splenic Artery TO Greater pancreatic Artery

• Venous SUpply:

Sup mesenteric veins TO Sup & Inf pancreatico duodenal veins(ant and inf).

Sup mesenteric veins + inf mesenteric veins FORMS Splenic Vein TO Pancreatic Vein.

v. Nerve Supply:

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• Mainly from the abdominopelvic splanchnic nerves and vagus nerve reach the pancreas via Celiac plexus and sup mesenteric plexus.

2) Liver:

➢ Liver is the largest single organ weighing 1500gram and it occupies 2.5% body weight.

➢ Liver mainly lies on the right hyponchrium or right illiac fossa crosses the midline to the left nipple

➢ Protected by the rib cage 7-11 and diaphragm.

a) Surfaces:

• Diaphragmatic Surface:

❖ Cover by peritoneum except the posterior surface the bare area.

❖ Convex in surface

❖ Have anterior, superior and some posterior.

❖ Separated from visceral surface by inferior border inf to the diaphragmatic surface.

• Visceral Surface:

❖ concave in surace

❖ It is located posteroinferior.

❖ cover by peritoneum except at the fossa of gallbladder and porta hepatis

❖ The porta hepatis is where the blood vessels(hepatic portal vein, lymphatic vessels and hepatic artery), hepatic nerve plexus and hepatic ducts supply enter and leave.

b) Recesses:

• Subphrenic Recesses:

❖ Extensions from the peritoneal(greater) sac.

❖ The sac exists between diaphragm and ant and sup aspects of diaphragmatic surface.

❖ It is divided into two by falciform ligament which are reflection of peritoneum that extends from liver to ant abdominal wall.

❖ Portion of supracolic compartment of peritoneal cavity inf to liver is subhepatic space.

• Hepatorenal Recess:

❖ It is extensions from the subhepatic space

❖ It lie between the right kidney, right suprarenal gland, and right visceral surface of the liver.

c) Ligaments:

• Coronary Ligaments:

❖ This ligaments have anterior and posterior layer.

❖ The layer meets on the right to form the right triangular ligaments which diverge to the left to enclose the triangluar bare area.

❖ However, the layer meets on the left to form the left triangular ligaments.

❖ The ant layer end up to the left to meet with falciform ligament whereas the post layer end up to meet the right layer of the lesser omentum.

d) Fissure:

• The two fissures linked centrally by the transverse porta hepatis forming a H word.

• Right Fissure:

❖ It is form ant by the grooves of fossa of the gallbladder.

❖ Post form by the grooves of IVC

• Left Fissure:

❖ it is form ant by the fissure of round ligament

❖ Post by the fissure of ligamentum venosum.

e) Portal triad:

It contain hepatic artery, hepatic portal vein and bile duct. It is enclose by the lesser omentum where it runs from the liver to the lesser curvature of the stomach and 2cm thick sup part of duodenum. The thick free edge of the stomach forms of the porta hepatis and duodenum and the hepatoduodenal ligament is the remainder of the lesser omentum extends between the groove of ligamentum venosum and lesser curvature of the stomach which encloses the structure that runs through porta hepatis.