Ligaments
The support of the liver is mostly by ligaments. The major ligaments include the falciform ligament hepatogastric ligament coronary ligament triangular ligaments right left ligamentum teres (round ligament) ligamentum venosum ligament of the inferior vena cava The falciform ligament is a fold of peritoneum that encloses the round ligament anteriorly. On the superior aspect of the liver it departs from the round ligament, branches, reflects on itself, and becomes continuous with the liver capsule. As it branches to the right it reflects on itself, becomes continuous with the liver capsule and becomes the anterior and superior component of the right coronary ligament. As it branches to the left it reflects on itself, becomes continuous with the liver capsule and becomes the anterior and superior component of the left coronary ligament. The superior border of the bare area is formed. falciform ligament at the same time continues toward the porta hepatis through the liver (between the right and left lobe) with the round ligament. The double layer on its superior aspect has divided to form the right and left coronary ligament. The double layer on its inferior aspect also divides and becomes continuous with Glissons’ capsule around the porta hepatis. The most superior aspect of the falciform ligament is attached to the diaphragm and it is named the pars affixa at this point. If we follow the lesser omentum (hepatogastric ligament) to the liver it continues as a double fold to enter the liver between the caudate lobe posteriorly and the medial segment of the left lobe of the liver surrounding the ductus venosum to form the ligamentum venosum. Within the liver it courses anteriorly toward the porta hepatis and posteriorly toward the posterior aspects of the liver. The anterior and inferior extension of the lesser omentum divides and becomes continuous with Glissons’ capsule around the porta hepatis. The posterior and superior extension of the hepatogastric ligament (lesser omentum) branches, reflects on itself and becomes continuous with the liver capsule. As it branches to the right it reflects on itself, becomes continuous with the liver capsule and becomes the right inferior coronary ligament. As it branches to the left it reflects on itself, becomes continuous with the liver capsule and becomes the inferior left coronary ligament. The superior and inferior components become continuous laterally. On the right the union is called the right triangular ligament. On the left the left triangular ligament extends toward and attaches to the diaphragm to end in a large fold and a strong fibrous band called the a ppendix fibrosa hepatis. The inferior border of the bare area is formed. coronary ligament is formed from a reflection of peritoneum in the region of the bare area of the liver and is continuos with the right branch of the falciform ligament superiorly and anteriorly and with the right branch of the hepatogastric ligament (lesser omentum) posteriorly and inferiorly. coronary ligament has both superior and inferior components, between which lies the bare area of the liver. On the right side coronary ligament separates the right subphrenic space from the right subhepatic space (Morrison’s Pouch). The coronary ligament on the left side separates the left subphrenic space into an anterior and posterior compartment. The right triangular ligament is situated at the right extremity of the bare area of the liver and ends as a small fold passing to the diaphragm. The left triangular ligament is situated at the left extremity of the bare area and ends in a large fold becoming a strong fibrous band called the appendix fibrosa hepatis. Its anterior layer is continuos with the left branch of the falciform ligament. The lesser omentum is continuous with the left triangular ligament. The bare area is thus an area on the posterior aspect of the liver bounded by the coronary ligaments. The inferior vena cava traverses the liver through and posterior to the bare area. The right adrenal forms an impression on the liver in the region of the bare area. The ligamentum teres (round ligament) represents the obliterated left umbilical vein. It originates from the umbilicus, courses up the anterior abdominal wall within the the peritoneum and then enters the falciform ligament coursing toward the left portal vein and ligamentum venosum. The pathognomonic sign of portal hypertension is finding a patent umbilical vein which is acting as a porto-systemic shunt, from the left portal vein to the periumbilical veins (caput medusa),and into the systemic circulation. The ligamentum venosum lies between the caudate lobe posteriorly and the lateral segment of the left lobe. It is a remnant of the ductus venosus which was a fetal conduit to shunt blood from the the umbilical vein (carrying metabolically rich blood from the mother) to the ivc. By this mechanism the immature inactive fetal liver has maternal blood shunted passed it and directly to the right atrium. The liver is free of a capsule at the bare area where it is in direct contact with the diaphragm. The space between the bare area of the liver and the diaphragm is filled with areolar connective tissue and the inner capsule remains intact at this point. The lesser omentum consists of a double layer of omentum. It surrounds the abdominal portion of the esophagus and connects the lesser curve of the stomach and the first 2 cms of the duodenum to the stomach. The hepatogastric ligament (lesser omentum) forms the anterior limits of the lesser sac, and lies posterior to the left lobe of the liver. The right border of the hepato duodenal ligament (lesseromentum) forms the anterior border of the foramen of Winslow in which the portal triad runs. The posterior border of the foramen is formed by the ivc. The lesser omentum extends into the ligamentum venosum, and then extends to the porta hepatis and the posterior and inferior components of the coronary ligament. Ligament of the inferior vena cava;
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Ligaments of the liver |
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00425 gallbladder wall fx edema dx CHF liver heart cardiac dx CHF liver CHF acute cardiac failure CTscan Courtesy Ashley Davidoff MD |
Falciform ligament
The falciform ligament is a fold of peritoneum that encloses the round ligament anteriorly. On the superior aspect of the liver it departs from the round ligament, branches, reflects on itself, and becomes continuous with the liver capsule. As it branches to the right it reflects on itself, becomes continuous with the liver capsule and becomes the anterior and superior component of the right coronary ligament. As it branches to the left it reflects on itself, becomes continuous with the liver capsule and becomes the anterior and superior component of the left coronary ligament. The superior border of the bare area is formed. The falciform ligament at the same time continues toward the porta hepatis through the liver (between the right and left lobe) with the round ligament. The double layer on its superior aspect has divided to form the right and left coronary ligament. The double layer on its inferior aspect also divides and becomes continuous with Glissons’ capsule around the porta hepatis. The most superior aspect of the falciform ligament is attached to the diaphragm and it is named the pars affixa at this point.
The ligamentum teres
The ligamentum teres (round ligament) represents the obliterated left umbilical vein. It originates from the umbilicus, courses up the anterior abdominal wall within the the peritoneum and then enters the falciform ligament coursing toward the left portal vein and ligamentum venosum. The pathognomonic sign of portal hypertension is finding a patent umbilical vein which is acting as a porto-systemic shunt, from the left portal vein to the periumbilical veins (caput medusa),and into the systemic circulation. The ligamentum venosum lies between the caudate lobe posteriorly and the lateral segment of the left lobe. It is a remnant of the ductus venosus which was a fetal conduit to shunt blood from the the umbilical vein (carrying metabolically rich blood from the mother) to the ivc. By this mechanism the immature inactive fetal liver has maternal blood shunted passed it and directly to the right atrium.
ligamentum venosum
The ligamentum venosum lies between the caudate lobe posteriorly and the lateral segment of the left lobe. It is a remnant of the ductus venosus which was a fetal conduit to shunt blood from the the umbilical vein (carrying metabolically rich blood from the mother) to the ivc. By this mechanism the immature inactive fetal liver has maternal blood shunted passed it and directly to the right atrium.
Gastrohepatic ligament
If we follow the lesser omentum (hepatogastric ligament) to the liver it continues as a double fold to enter the liver between the caudate lobe posteriorly and the medial segment of the left lobe of the liver surrounding the ductus venosum to form the ligamentum venosum. Within the liver it courses anteriorly toward the porta hepatis and posteriorly toward the posterior aspects of the liver. The anterior and inferior extension of the lesser omentum divides and becomes continuous with Glissons’ capsule around the porta hepatis. The posterior and superior extension of the hepatogastric ligament (lesser omentum) branches, reflects on itself and becomes continuous with the liver capsule. As it branches to the right it reflects on itself, becomes continuous with the liver capsule and becomes the right inferior coronary ligament. As it branches to the left it reflects on itself, becomes continuous with the liver capsule and becomes the inferior left coronary ligament. The superior and inferior components become continuous laterally. On the right the union is called the right triangular ligament. On the left the left triangular ligament extends toward and attaches to the diaphragm to end in a large fold and a strong fibrous band called the appendix fibrosa hepatis. The inferior border of the bare area is formed.
Coronary ligament
The right coronary ligament
right coronary ligament The coronary ligament has both superior and inferior components, between which lies the bare area of the liver. On the right side coronary ligament separates the right subphrenic space from the right subhepatic space (Morrison’s Pouch) (see diagram page 5 Friedman). The coronary ligment on the left side separates the left subphrenic space into an anterior and posterior compartment. The right triangular ligament is situated at the right extremity of the bare area of the liver and ends as a small fold passing to the diaphragm. The left triangular ligament is situated at the left extremity of the bare area and ends in a large fold becoming a strong fibrous band called the appendix fibrosa hepatis. Its anterior layer is continuos with the left branch of the falciform ligament. The lesser omentum is continuous with the left triangular ligament.
The left coronary ligament
The coronary ligament has both superior and inferior components, between which lies the bare area of the liver. On the right side coronary ligament separates the right subphrenic space from the right subhepatic space (Morrison’s Pouch) (see diagram page 5 Friedman). The coronary ligment on the left side separates the left subphrenic space into an anterior and posterior compartment. The right triangular ligament is situated at the right extremity of the bare area of the liver and ends as a small fold passing to the diaphragm. The left triangular ligament is situated at the left extremity of the bare area and ends in a large fold becoming a strong fibrous band called the appendix fibrosa hepatis. Its anterior layer is continuos with the left branch of the falciform ligament. The lesser omentum is continuous with the left triangular ligament.
Applied Anatomy
The ligamentum teres and umbilical vein in portal hypertension the umbilical vein in ligamentum teres becomes patent and forms anastamoses with systemic circulation caput Medusa umbilical ligaments and malignancy sister Mary Joseph nodule is a malignant node in the periumbilical region that has spread along the lymphatics around peritoneal ligaments including the umbilical ligament