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Chapter 31: Liver

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With regard to hepatic anatomy, the falciform ligament divides the _______ from the _______.

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A. Caudate lobe, quadrate lobe

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B. Right lobe, left lobe

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C. Left medial section, left lateral section

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D. Left medial section, right lobe

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Answer: C

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The falciform ligament divides the left lateral section from the left medial section. The plane between the gallbladder fossa and the inferior vena cava (IVC—referred to as Cantlie’s line) divides the right and left lobes. The falciform ligament, along with the round, triangular, and coronary ligaments may be divided in a bloodless plane during liver resection (Figs. 31-1 to 31-3). (See Schwartz 10th ed., p. 1265.)

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Fig. 31-1. Hepatic ligaments suspending the liver to the diaphragm and anterior abdominal wall.

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Fig. 31-2. In situ liver hilar anatomy with hepatoduodenal and gastrohepatic ligaments. Foramen of Winslow is depicted.

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Fig. 31-3. Couinaud liver segments (I through VIII) numbered in a clockwise manner. The left lobe includes segments II to IV, the right lobe includes segments V to VIII, and the caudate lobe is segment I. IVC = inferior vena cava.

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The most common variant of normal hepatic artery anatomy is

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A. Replaced left hepatic artery from the left gastric artery

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B. Completely replaced common hepatic artery from the superior mesenteric artery (SMA)

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C. Replaced right and left hepatic arteries

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D. Replaced right hepatic artery from the SMA

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Answer: D

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Understanding the anatomic variants of the hepatic arterial supply is important to avoid complications during liver surgery. The standard arterial anatomy is as follows: the common hepatic artery arises from the celiac trunk, and then divides into the gastroduodenal and proper hepatic artery. In a standard configuration, the proper hepatic artery gives rise to the right gastric artery, but this is variable. The proper hepatic artery then divides into the right and left hepatic artery (Fig. 31-4). However, this standard arterial configuration only occurs in 76% of patients. The most common variants include replaced right hepatic artery from the SMA (10–15%), replaced left hepatic artery from the left gastric artery (3–10%), replaced right and left hepatic arteries (1–2%), and the completely replaced common hepatic artery from the SMA (1–2%) (Fig. 31-5). (See Schwartz 10th ed., p. 1266.)

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Fig. 31-4. Arterial anatomy of the upper abdomen and liver, including ...

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