Ligaments and peritoneal reflections

Ligaments and peritoneal reflections

The liver is covered by visceral peritoneum (serosa), with a layer of connective tissue, the Glisson capsule, underneath. At the porta hepatis, the capsule envelops and travels along the portal tracts (triads) into the liver, carrying branches of the hepatic artery , portal vein and bile ducts. The liver is fixed in the right upper quadrant by the hepatic veins and ligaments formed from the peritoneal reflections. Division of the left triangular ligament on the superior surface of the left lobe mobilises the liver from the diaphragm, exposing the left lateral wall of the inferior vena cava (IVC). The right triangu - lar ligament similarly fixes the right lobe to the undersurface of the right hemidiaphragm, and division mobilises the liver su ffi ciently to allow it to be rotated to the left. Another major supporting structure is the falciform ligament (the remnant of the umbilical vein), which runs cephalad fr om the umbilicus, enters the liver at the interlobar fissure and passes anteriorly on the surface of the liver, attaching it to the anterior abdominal wall. Dividing the cephalad leaves of the falciform ligament exposes the suprahepatic IVC within a thin fibrous sheath. The final peritoneal reflection is the lesser omentum between the stomach and the liver, which contains the hilar structures in its right free edge.