22: Liver


The liver lies beneath the diaphragm and conforms to its shape, with a large diaphragmatic surface and a smaller visceral inferior surface. The sharp inferior border separates the diaphragmatic and inferior surfaces anteriorly. The porta hepatis, the entry for arterial and portal blood, lies at the junction of the inferior and diaphrgamatic surface posteriorly.
The diaphragmatic surface is interrupted medially by the falciform ligament, which attaches to the midline of the anterior abdominal wall.
The right posterior part of the liver is not covered by peritoneum and is connected to the diaphragm by loose connective tissue; this is referred to as the 'bare area' of the liver. More medially, the lesser omental sac intervenes. The lesser omentum extends from the liver to the stomach.

Gross Anatomical Structure

The liver was historically divided into right, left, caudate and quadrate lobes.

Right lobe

The right lobe consists of the liver right of the falciform ligament. It is the largest of the gross anatomical lobes. Two prominences exist on the inferior surface, adjacent to the porta hepatis - the caudate and quadrate lobes.

Left lobe

The left lobe lies to the left of the falciform ligament and is smaller than the right, tapering as it progresses left.

Caudate lobe

The caudate lobe is the prominence posterior to the porta hepatis. The inferior vena cava is to the right. It is functionally related to the left lobe but lies on the right side of the falciform ligament.

Quadrate lobe

The quadrate lobe is the prominence anterior to the porta hepatis, and medial to the gallbladder fossa.

Functional Anatomical Structure

The liver is functionally divided into 9 segments, based on drainage by hepatic veins. This is most important for liver surgery.
Segment I corresponds with the caudate lobe, and is located posterior to the porta hepatis. Biliary drainage is via both the right and left hepatic ducts.
Segment II is the leftmost of the segments, divided from segment III by the left portal fissure.
Segment III lies between segments II and III, typically draining via the left hepatic vein.
Segment IV lies right of Segment III, left of the central hepatic vein.
Segment V is inferior and right of segment IV. It drains to central and right hepatic veins.
Segment VI is the most right and inferior of the segments, draining via the right hepatic vein.
Segment VII is the most right and superiro of the segments, draining via the right hepatic vein.
Segment VIII is medial to segment VII and superior to segment V.
Segment IX is a newly described segment, and indicates the part of segment I that is posterior to segment VIII.

Macroscopic Appearance

The liver typically has a shiny appearance due to the coating peritoneum. Beneath this it is typically a dark red.

Microscopic Appearance

The liver is arranged into lobules surrounding tributaries of the hepatic veins. This lobules are classically viewed as hexagons in cross section, with the hepatic tributary lying in the centre. Branches of the portal vein, hepatic artery and biliary ducts travel in the connective tissue septa between each lobe. Blood passes from the portal vein and hepatic artery towards the central vein, whereas bile drains to the biliary ducts in the opposite direction. Hepatocytes are specialised epithelial cells that are usually polygonal in shape.


The diaphragm and right lung lie posterior, superior, lateral and anteriorly. The heart lies superior to the left lobe of the liver.
The anterior abdominal wall lies anterior and lateral.
The stomach is medial, separated by the lesser omentum and lesser omental sac.
The porta hepatis enters the liver on its postero-inferior surface.
The right kidney is inferior and posterior, as is the right adrenal gland.
The inferior vena cava is intimately related to the posterior surface.