Visceral surface of liver

The visceral surface (inferior surface), is uneven, concave, directed downward, backward, and to the left, and is in relation with the stomach and duodenum, the right colic flexure, and the right kidney and suprarenal gland.

The surface is almost completely invested by peritoneum; the only parts devoid of this covering are where the gallbladder is attached to the liver, and at the porta hepatis where the two layers of the lesser omentum are separated from each other by the bloodvessels and ducts of the liver.

The inferior surface of the left lobe presents behind and to the left the gastric impression, moulded over the antero-superior surface of the stomach, and to the right of this a rounded eminence, the tuber omentale, which fits into the concavity of the lesser curvature of the stomach and lies in front of the anterior layer of the lesser omentum.

The under surface of the right lobe is divided into two unequal portions by the fossa for the gallbladder; the portion to the left, the smaller of the two, is the quadrate lobe, and is in relation with the pyloric end of the stomach, the superior portion of the duodenum, and the transverse colon. The portion of the under surface of the right lobe to the right of the fossa for the gallbladder presents two impressions, one situated behind the other, and separated by a ridge. The anterior of these two impressions, the colic impression, is shallow and is produced by the right colic flexure; the posterior, the renal impression, is deeper and is occupied by the upper part of the right kidney and lower part of the right suprarenal gland. Medial to the renal impression is a third and slightly marked impression, lying between it and the neck of the gall-bladder. This is caused by the descending portion of the duodenum, and is known as the duodenal impression.

Just in front of the inferior vena cava is a narrow strip of liver tissue, the caudate process, which connects the right inferior angle of the caudate lobe to the under surface of the right lobe. It forms the upper boundary of the omental foramen (epiploic foramen) of the peritoneum.

The visceral surface of the liver contains three fissures or fossae (the right and left sagittal fossae and the transverse fissure) which are oriented in the shape of the letter ‘H’.

1 - The left sagittal fossa (not an official term, seems to be analogous to the umbilical fissure), is a deep groove, which extends from the notch on the anterior margin of the liver to the upper border of the posterior surface of the organ; it separates the right and left lobes. The left sagittal fossa is subdivided into two parts:

• The anterior part of left sagittal fossa is the fissure for ligamentum teres (Fissure for round ligament; fossa for the umbilical vein), that lodges the umbilical vein in the fetus, and its remains, the round ligament of liver, (the ligamentum teres) in the adult; it lies between the quadrate lobe and the left lobe of the liver, and is often partially bridged over by a prolongation of the hepatic substance, the pons hepatis.

• The posterior part of left sagittal fossa is the fissure for ligamentum venosum (fossa for the ductus venosus), that lies between the left lobe and the caudate lobe; it lodges in the fetus, the ductus venosus, and in the adult a slender fibrous cord, the ligamentum venosum, the obliterated remains of that vessel.

2 - The right sagittal fossa that is composed by two fossa/grooves:

• The fossa for the gallbladder (fossa vesicæ felleæ) that is a shallow, oblong fossa, placed on the under surface of the right lobe, parallel with the left sagittal fossa. It extends from the anterior free margin of the liver, which is notched by it, to the right extremity of the porta.

• The groove for vena cava (fossa for the inferior vena cava; fossa venæ cavæ) that is a short deep depression, occasionally a complete canal in consequence of the substance of the liver surrounding the vena cava. It extends obliquely upward on the posterior surface between the caudate lobe and the bare area of the liver, and is separated from the porta by the caudate process. On slitting open the inferior vena cava the orifices of the hepatic veins will be seen opening into this vessel at its upper part, after perforating the floor of this fossa.

3 - The transverse fissure (not an official term, correspond to the porta hepatis) that is a short but deep fissure, about 5 cm. long, extending transversely across the under surface of the left portion of the right lobe, nearer its posterior surface than its anterior border. It joins nearly at right angles with the left sagittal fossa, and separates the quadrate lobe in front from the caudate lobe and process behind. It transmits the portal vein, the hepatic artery and nerves, and the hepatic duct and lymphatics. The hepatic duct lies in front and to the right, the hepatic artery to the left, and the portal vein behind and between the duct and artery.