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5.2.17 Liver: peritoneal attachments

TRANSCRIPT

(4.06)

Next we'll look at the peritoneal folds and lines of attachment, along which the visceral peritoneum of the liver becomes continuous with the parietal peritoneum of the diaphragm, and posterior abdominal wall. Although these attachments are formed only of peritoneum, they're referred to as ligaments. We'll look first at the falciform ligament which is in front, then at the coronary ligament, the right and left triangular ligaments, and the lesser omentum.

Here's the falciform ligament. It's a slender fold that runs from the highest part of the liver, down to this pronounced notch on the anterior border, the hepatic notch.

Here's the falciform ligament in a more intact dissection Its anterior border is attached to the anterior abdominal wall, and its posterior border hangs free, all the way down to the umbilicus.

In its free border there's a cordlike structure, the ligamentum teres, the remnant of the umbilical vein. The ligamentum teres runs through the hepatic notch, onto the underside of the liver.

Along this line the two layers of peritoneum that form the ligament become continuous on each side with the peritoneum covering the liver. In the intact body this cut edge of the ligament is attached to the underside of the diaphragm, along this line. Here, it still is attached.

That attachment ends back here, where the right and left sides of the falciform ligament diverge, becoming continuous to right and left with this fold of peritoneal attachment, the coronary ligament. The line of attachment of the falciform ligament, and the hepatic notch, divide the liver into a small left lobe, and a much larger right lobe.

That division exists only on the surface: internally the liver is divided quite differently. To follow the peritoneal attachments of the liver round to the back we'll return to this ...

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(4.06)

Next we'll look at the peritoneal folds and lines of attachment, along which the visceral peritoneum of the liver becomes continuous with the parietal peritoneum of the diaphragm, and posterior abdominal wall. Although these attachments are formed only of peritoneum, they're referred to as ligaments. We'll look first at the falciform ligament which is in front, then at the coronary ligament, the right and left triangular ligaments, and the lesser omentum.

Here's the falciform ligament. It's a slender fold that runs from the highest part of the liver, down to this pronounced notch on the anterior border, the hepatic notch.

Here's the falciform ligament in a more intact dissection Its anterior border is attached to the anterior abdominal wall, and its posterior border hangs free, all the way down to the umbilicus.

In its free border there's a cordlike structure, the ligamentum teres, the remnant of the umbilical vein. The ligamentum teres runs through the hepatic notch, onto the underside of the liver.

Along this line the two layers of peritoneum that form the ligament become continuous on each side with the peritoneum covering the liver. In the intact body this cut edge of the ligament is attached to the underside of the diaphragm, along this line. Here, it still is attached.

That attachment ends back here, where the right and left sides of the falciform ligament diverge, becoming continuous to right and left with this fold of peritoneal attachment, the coronary ligament. The line of attachment of the falciform ligament, and the hepatic notch, divide the liver into a small left lobe, and a much larger right lobe.

That division exists only on the surface: internally the liver is divided quite differently. To follow the peritoneal attachments of the liver round to the back we'll return to this view of the liver by itself.

Here, divided, is the part of the coronary ligament that we saw from in front. It continues round onto the back of the liver, surrounding this irregular bare area of the liver, which lies directly on the underside of the diaphragm, and the posterior abdominal wall.

The coronary ligament is continuous with a line of peritoneal reflection that goes round the front of the inferior vena cava, and back to the top. Four double folds of peritoneum extend from the edges of the line of reflection. Passing forward is the falciform ligament as we've seen.

Passing to right and left near the top of the liver are the two triangular ligaments. Seen from in front, here's the right triangular ligament. It ends here. Here's the left triangular ligament: it extends up onto the diaphragm a little beyond the tip of the left lobe.

The last peritoneal attachment to look at is the lesser omentum. This is the lesser omentum, it goes all the way down to here. Its lower part emerges from this complex area, the porta hepatis, which we'll come back to. Here's the lesser omentum seen from in front. As we've seen, it passes from the liver, to the lesser curve of the stomach, all the way up to the diaphragm.

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