Peritoneal Relations of the Liver

00:01 So, let's just talk about the peritoneal relations because this is important in how the liver is essentially suspended from the diaphragm and holds it in position within the abdomen.

00:11 Lying all the way over the surface of the liver is this visceral peritoneum and where we have it covering the right and left lobes, those two layers of peritoneum unite and form the falciform ligament, which protects to the inside of the anterior abdominal wall.

00:28 And as I mentioned, previously, the round ligament here is a remnant of the embryological development process that is allowing blood to pass from the umbilicus, from the mother into the actual developing embryo and fetus passing through this route.

00:42 And the round ligament is the remnant of that.

00:46 Here we can see that again, where you've got the left lobe of the liver.

00:49 So we're looking at it as if we're standing on the left side of the human, and the stomach, and the anterior lateral abdominal wall have been removed from this left side.

00:58 So you can now see how the falciform ligament is running from the anterior surface of the liver to the anterior abdominal wall, and its most inferior free edge, we have the round ligament and this again is what I alluded to enabled blood to pass from oxygen rich blood from the mother, through the umbilical cord up to the anterior abdominal wall and then through the liver into the general circulation of the developing fetus.

01:23 So here we can see the anterior surface of the liver again, and its peritoneal relations.

01:29 We can see as the layers of peritoneum converge in the falciform ligament, it projects anteriorly.

01:35 We can now see that as we go over the superior surface of the liver, the projection of peritoneum no longer stays with the liver, but it's actually reflected up to the underside of the diaphragm.

01:46 And this is where we have a transition from visceral peritoneum into parietal peritoneum.

01:52 The peritoneum that's lining the body wall.

01:54 And as this is occurring on the anterior aspect of the liver, we call this the anterior layer of the coronary ligament.

02:02 Remember peritoneal ligaments are double layers and this is the anterior layer of it.

02:08 Reflection of the peritoneum of the anterior surface of the liver passing upwards and to the diaphragm.

02:14 One of the layers of the coronary ligament that helped to suspend the liver within its position.

02:22 Here we're looking at the inferior and the posterior surface of the liver.

02:25 And again, you can see that slightly dull appearance of the liver inferiorly, where we've got layers of peritoneum.

02:32 And here we can see, again, the anterior layer of the coronary ligament projecting upwards.

02:37 Here now we have exactly the same thing happening, but more on the posterior aspect.

02:42 And this is the posterior layer of the coronary ligament, and that would also project to the diaphragm and be that transition from visceral peritoneum into parietal peritoneum.

02:53 Where we see the anterior layer and the posterior layer of the coronary ligament converge on the right, and where they converge on the left, these become very tightly adhered and these become triangular ligaments.

03:07 So these are triangular ligaments on the left and right extremes of the liver where the anterior and posterior layers of the coronary ligaments converge.

03:17 And these have additional support in holding the liver in place as it is suspended from the diaphragm.

03:25 Clearly now, we have an area of the liver that is not covered by peritoneum, and we call that the bare area.

03:31 Where anteriorly the peritoneum came over the surface the liver and was reflected.

03:36 Then on the posterior surface, it came over the liver and was reflected to the diaphragm in between those two common ligaments, in between the anterior and posterior layers of the coronary ligament, we find the bare area which doesn't have any peritoneal covering.

03:54 Here we can see the ligamentum venosum, which was the embryological structure, a continuation of the round ligament that we saw previously.

04:01 And this again, is an important structure that allowed blood to pass from the developing from the mother during development from the umbilicus through the anterior abdominal wall towards the liver.

04:12 It then bypassed the liver and went to the inferior vena cava, so that nutrient rich blood could pass straight to the developing embryos heart, the heart within the developing embryo would then circulate that blood around the body.

04:26 So it was a bypass mechanism, allowing blood to pass directly from the mother through the umbilicus, through the structures to the inferior vena cava, so it could be returned to the heart.

04:36 We all know that blood returned to the heart via the inferior vena cava allows it to then go around general circulation.

04:42 Obviously, within the heart, there's the mechanism to bypass the lungs, but we can leave that for another topic.

04:49 So let's have a look at the liver again.

04:51 again, understanding the relationship with the peritoneum.

04:54 And here we can see where we have the liver.

04:56 This time the diagram has been rotated.

04:58 So anteriorly we're looking at it on the right hand side.

05:02 We've got the anterior aspect.

05:03 And posteriorly, we're looking at it on the left hand side of the screen.

05:07 And here we can see where we have the bare area of the liver.

05:10 Where those two layers of peritoneum are being reflected away towards the diaphragm, leaving an area of the liver uncovered by peritoneum.

05:19 Between the diaphragm and the liver where we have that space is known as the sub phrenic recess.

05:26 And between the liver and the kidney, we've now got a space which is known as the hepatorenal recess.

05:31 These are important spaces because free fluid can move into these spaces when we're either standing up or when we're laying in the supine position.

05:39 It's important to appreciate those spaces for the movement of free fluid.