Editing Liver (section)

=== '''Fissures''' ===

** The limit between the      territories supplied by two adjacent pedicles. The blood flow from one      pedicle cannot trespass the fissure, although continuity is secured by      the sinusoids. Therefore, very helpful in defining anatomical resections.
** ''The      important fissures do not exist as such, but have to be made by the      surgeon''
** ''Some      sources say 'scissura' can be used interchangeably, but 'fissure' is more      common''
** Main fissure
*** Separates the right side       from the left, with a constant vertical plane through Cantlie's line
**** Posteriorly: from        supra-hepatic IVC, through the middle of the cystic fossa, then passes        slightly to the left at the porta hepatis to pass in the middle of the        region where the portal structures bifurcate, and then across the        caudate process
**** Anteriorly: Cantlie's line        can be estimated from the middle of the gallbladder notch back to the        point where the falciform ligament disappears posteriorly
**** Runs between segments V        and VIII, and segment IV
*** Main trunk of middle       hepatic vein lies within this fissure
** Left fissure
*** Separates left lateral from       left medial
*** Runs between two points:
**** On superior liver edge,        halfway between falciform ligament and left edge of liver
**** Left side of base of        falciform ligament in front of IVC
*** Contains main trunk of left       hepatic vein
** Umbilical fissure
*** Lies deep to the falciform       ligament attachment
*** Contains the left portal       pedicle
*** Often also contains an       important vein - the vein of the umbilical fissure
*** Note that the umbilical       fissure is not a scissura because it does not contain a hepatic vein -       it just contains the left portal pedicle
** Fissure venosum
*** The continuation of the       umbilical fissure on the posterior surface of the liver
*** Lesser omentum passes in       here
*** Contains the obliterated       ductus venosum
*** Lies more or less in the       coronal plane, and is continued in the plane of the dorsal fissure -       with fingers placed in the fissure venosum, they point to the dorsal       fissure in front
** Dorsal fissure
*** The least definable fissure
*** Separates posterior segment       IV from segment I
** Right fissure
*** Between right anterior and       right posterior sectors
*** Contains right hepatic vein
*** Indicated by the point       midway between GB bed and right extremity of liver, but in about 40% of       cases lies much closer to the right margin of the GB bed, and can also       be found in the opposite direction sometimes
*** Can sometimes be seen on       the under surface of the liver as the fissure of Gans
** '''Porta      hepatis'''
*** The transverse fissure in       the liver between the quadrate lobe in front and the caudate process and       caudate lobe behind
*** Receives structures of the       hepatic pedicle at its left end, and GB neck at its right end
*** Note that the CBD tends to       be in the free edge of lesser omentum, while the artery lies in front of       the PV

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