Transcript Liver
Wang Jinde 王金德 instructor : prof .李明 Department of anatomy 人体解剖学教研室 Natural condition is hard. Humane enviroment is good. Students give me some inspiration. Keep away from alcohol .swf Liver 肝 Question: Where is the liver? What does it look like? What is the function of the liver? new words liver 肝 diaphragmatic surface 膈面 falciform ligament 镰状韧带 left lobe of liver 肝左叶 right lobe of liver 肝右叶 bare area 裸区 visceral surface 脏面 porta hepatis 肝门 ligamentum teres hepatis 肝圆韧带 new • • • • • • • • • • words ligamentum venosum fossa for gallbladder sulcus for vena cava secondary porta of liver quadrate lobe caudate lobe gallbladder fundus of gallbladder body of gallbladder neck of gallbladder 静脉韧带 胆囊窝 腔静脉沟 第2肝门 方叶 尾状叶 胆囊 胆囊底 胆囊体 胆囊颈 new • • • • • • words cystic duct 胆囊管 spiral fold 螺旋襞 common hepatic duct 肝总管 common bile duct 胆总管 hepatopancreatic ampulla 肝胰壶腹 sphicter of hepatopancreatic ampulla 肝胰壶腹扩约肌 目的要求 • 一、熟悉肝的功能。 • 二、掌握肝的形态、位置。 • 三、掌握肝外胆道系统。 The liver is the largest internal organ of the body, weighs about 1.3 kg in an adult. It is wedge-shaped, covered by onnective tissue (Glisson,s capsule). Its reddish brown color is due to its great vascularity. 功能 1、蛋白质、脂类、糖类及维生素等的合成、转化分解 to synthesize ,translate,and breakdown protein, lipid ,carbohydrate,vitamin,and so on. 2、激素、药物 的转化、解毒 detoxification of chemicals 3、抗体的生成 production of antibody 4、造血 hematopoiesis 5、胆汁的生成 Making bile to help digestion 肝的形态 两面：上面（膈面） 、下面（脏面） 四缘：前、后、左、右缘 Diaphragmatic surface膈 面 bare area falciform lig. Coronary lig. Convex and smooth 裸区 镰状韧带 冠状韧带 Coronary lig. falciform lig. Visceral surface 肝肾隐窝（hepatorenal recess） Visceral surface has a H-shaped fissures and grooves －Left limb of H – Anteriorly: fissure for ligamentum teres 肝圆韧带裂 – Posteriorly: fissure for ligamentum venosum 静脉韧带裂 Right limb of H – Anteriorly: fossa for gallbladder 胆囊窝 – Posteriorly: sulcus for vena cava 下腔静脉沟 Cross-bar of H is the porta hepatis 肝门: traversed by •proper hepatic artery Connective •hepatic portal vein tissue called hepatic pedicle •Nerves 肝蒂 • right and left hepatic ducts •lymphatic vessels Four lobes: • left •right •quadrate •caudate Left lobe caudate lobe Right lobe Quadrate lobe Inferior border –thin and sharp • Notch for ligamentum teres hepatis 肝圆韧带切 迹 • Nothch for gallbladder 胆囊切迹 Parenchymatous Organ Capsule Lobule Hilum or porta Porta Hepatis肝门： 肝固有动脉左右支 肝左右管 门静脉左右支 神经 淋巴出入的门户。 位置: Most of liver lies in the right hypochondriac region and epigastric region, less part extending into the left hypochondriac region Surface projection(体表投影) • Upper border: on the right midclavicular line it extends the level of 5th rib Lower border: Normally, the right lobe extends just beneath the costal margin, it doesn’t extend beyond the costal margin; • In children, compared with the adult , the liver being larger in proportion ,it extends below the costal arch within in 2cm. • on the anterior median line its lower border crosses 3~5cm below the xiphoid process. Liver Transplant • The removal of a diseased liver and replacement with a healthy liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used. 肝外胆道 Consists of • Gallbladder 胆囊 • Left and right hepatic ducts 肝左、右管 • Common hepatic duct 肝总管 • Common bile duct 胆总管 Obstruction of biliary system results jaundice in clinical condition. Gallbladder 胆囊 Position :lies in fossa for gallbladder on visceral surface of liver Gallbladder 胆囊 Four parts • Fundus of gallbladder 胆囊底 • Body of gallbladder 胆囊体 • Neck of gallbladder 胆囊颈 • Cystic duct 胆囊管 Function: stores and concentrate bile Fundus of gallbladder （胆囊底） Surface projection: at the junction of right midclavicular line and right costal arch Divisions and relations of common bile duct • Supraduodenal segment • Retroduodenalsegment • Pancreatic segment • Intraduodenal segment 胰头癌时， 为何会发生黄疸？ Intraduodenal segment Enters the wall of descending part of duodenum obliquely where jions the pancreatic duct to form the hepatopancreatic ampulla opens at the major duodenal papilla 胆汁排出途径 • 未进食 胆汁 肝胰壶腹括约肌收缩 肝总管 胆囊管 肝左、右管 胆囊储存、浓缩 进食进食后胆汁排出.swf 肝胰壶腹括约肌舒张，胆囊收缩， 胆汁 肝胰壶腹 胆囊 胆囊管 胆总管 十二指肠 单纯胆囊管结石, 会不会引起黄疸? Triangle of Calot • Boundaries: the common hepatic duct on the left, the cystic duct on the right, the liver, superiorily • Content: cystic artery Cystic a： 多于胆囊三角内起自肝右动脉，变异较多，手术时应予注意： 胆囊三角(Calot三角） 胆囊管、肝总管和肝的脏面围成的三角形区域，是胆囊手术中寻找胆囊动脉的标 志。 summary 1. describe porta hepatis , the lobes and the location of liver 2. describe the formation of the biliary ducts outside the liver 3. describe the subsection, the location, the function of the gallbladder in the living 4. describe the surface projection of the fundus of the gallbladder 5. describe the drainage way of bile 1. porta hepatis 肝门: Cross-bar of H traversed by •proper hepatic artery •hepatic portal vein •Nerves •hepatic ducts •lymphatic vessels Connective tissue hepatic pedicle 肝蒂 hepatic portal vein proper hepatic artery hepatic ducts Four lobes: • left •right •quadrate •caudate Left lobe caudate lobe Right lobe Quadrate lobe Position: Most of liver lies in the right hypochondriac region and epigastric region, less part extending into the left hypochondriac region 2. formation of the extrahepatic biliary system 3. the location, subsection, the function of the gallbladder Position :lies in fossa for gallbladder on visceral surface of liver Four parts • Fundus of gallbladder 胆囊底 • Body of gallbladder 胆囊体 • Neck of gallbladder 胆囊颈 • Cystic duct 胆囊管 Function: stores and concentrate bile 4.surface projection of the fundus of the gallbladder at the junction of right midclavicular line and right costal arch 5. drainage way of bile Bile is secreted by the liver cells Common hepatic duct Biliary ductuli Cystic duct Right and left hepatic ducts Gallbladder (store, concentrate) when the fat enters the small intestine, the gallbladder contracts, the sphincter of hepatopancreatic ampulla relax Common bile duct Major duodenal papilla 思考题 1.试述在进食与非进食的情况下，胆汁 的产生及排泄途径。 2．名词：肝门； Calot三角 参考书目 • 1．系统解剖学 钟世镇 高等教育出版社 • 2. 系统解剖学（双语版） 刘执玉 科学出 版社 • 3．系统解剖学实习指导 昆明医学院人体 解剖教研室