[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) › Liver [Digestive system](https://durgical.com/en/anatomy/system/digestive-system/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) # Liver The liver is the largest organ inside the body, in the upper right belly under the [ribs](https://durgical.com/en/anatomy/ribs/); it makes bile, processes nutrients and clears toxins from the blood. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=abdomen&select=liver&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The largest internal organ, under the right ribs: right, left, caudate and quadrate lobes, divided by its blood supply into eight segments. ## What it does Processes nutrients from the gut, makes bile, proteins and clotting factors, stores energy and removes toxins and medicines. ## Key points - Couinaud's eight segments each have their own portal pedicle and [bile duct](https://durgical.com/en/anatomy/bile-duct/), while the hepatic veins run between them: that is what makes segment-by-segment resection possible - Cantlie line, from the gallbladder fossa to the inferior vena cava, divides the functional right and left liver; the falciform ligament only separates the anatomical lobes - In the hepatoduodenal ligament the common bile duct lies front-right, the proper hepatic artery front-left and the portal vein behind both, with the epiploic foramen just behind - The hepatorenal pouch (Morison pouch), between the liver and the right kidney, is the most dependent upper abdominal space when lying supine: free fluid and blood gather there first ## Key facts **Where** Right upper quadrant under right dome of diaphragm (ribs 7–11), extends to left; intraperitoneal except bare area **Blood supply** Portal vein (about 75%) and hepatic artery proper (about 25%); drained by hepatic veins into IVC **Nerve** Hepatic plexus (celiac sympathetic and vagal fibres); capsule by phrenic and lower [intercostal nerves](https://durgical.com/en/anatomy/intercostal-nerves/) (pain referred to right shoulder) **Function** Makes bile, albumin and clotting factors; stores glycogen; metabolizes nutrients, drugs and toxins; makes urea ## Relations **Above** [Diaphragm](https://durgical.com/en/anatomy/diaphragm/), separating it from the right [pleura](https://durgical.com/en/anatomy/pleura/) and lung base; at the bare area it lies directly on the diaphragm with no [peritoneum](https://durgical.com/en/anatomy/peritoneum/), framed by the coronary and triangular ligaments **Behind** [Inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) in its groove, receiving the [hepatic veins](https://durgical.com/en/anatomy/hepatic-veins/); [right adrenal gland](https://durgical.com/en/anatomy/suprarenal-gland-abdomen/) and the upper pole of the right [kidney](https://durgical.com/en/anatomy/kidney/); abdominal [esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/) behind the left lobe **In front** Anterior abdominal wall and costal margin, with the [falciform ligament](https://durgical.com/en/anatomy/falciform-ligament/) attaching it to the wall above the umbilicus **Below** Visceral surface marked by the [gallbladder](https://durgical.com/en/anatomy/gallbladder/), [duodenum](https://durgical.com/en/anatomy/duodenum/), hepatic flexure of the colon, right kidney and [stomach](https://durgical.com/en/anatomy/stomach/); the [lesser omentum](https://durgical.com/en/anatomy/lesser-omentum/) runs from the porta hepatis and fissure for the ligamentum venosum to the stomach **Contents** Porta hepatis: right and left hepatic ducts in front, branches of the [proper hepatic artery](https://durgical.com/en/anatomy/proper-hepatic-artery/) in the middle, the [portal vein](https://durgical.com/en/anatomy/hepatic-portal-vein/) bifurcation behind, plus hepatic nerve plexus and lymphatics ## How to find it Percussed along the right midclavicular line: dullness starts near the 5th intercostal space and ends at the costal margin, a span commonly given as about 6–12 cm (texts vary). The lower edge is felt at the right costal margin as it moves down with a deep breath. The gallbladder point, used for the Murphy sign, is at the tip of the right 9th [costal cartilage](https://durgical.com/en/anatomy/costal-cartilage/). ## Examination - Hepatojugular reflux: steady pressure over the right upper quadrant for about ten seconds; a jugular venous pulse that rises and stays up while pressing suggests right heart failure or raised right-sided filling pressures - Character of the edge on deep inspiration: a smooth, soft edge is normal; a firm, irregular or nodular edge suggests cirrhosis or metastases; a liver that pulses with each beat suggests severe tricuspid regurgitation - Scratch test: with the stethoscope over the liver, a light scratch moving toward it across the [skin](https://durgical.com/en/anatomy/skin/) sounds louder once it reaches the liver edge; a rough guide to the lower border when the [abdomen](https://durgical.com/en/anatomy/region/abdomen/) is hard to palpate, with limited accuracy ## On imaging Ultrasound comes first: size, echotexture (bright in fatty liver, coarse and nodular in cirrhosis), focal lesions, bile duct width and portal flow on Doppler. On contrast CT and MRI the segments are mapped by the three hepatic veins (vertical planes) and the portal bifurcation (horizontal plane). MRCP shows the biliary tree without injecting the ducts. ## Common problems - Fatty liver disease, very common with obesity and diabetes. - Hepatitis (viral, alcohol). - Cirrhosis: scarring that can lead to liver failure and portal hypertension. - Liver cancer and metastases. ## How it is diagnosed Blood tests (liver enzymes), ultrasound, elastography, CT or MRI, biopsy. ## Treatment - Treat the cause (weight loss, antiviral medicines, stopping alcohol); surgery to remove segments; liver transplant for failure. ## Clinical notes - Amoebic liver abscess (Entamoeba histolytica), still seen in Latin America: usually a single abscess in the right lobe with fever and right upper quadrant pain; the pus is classically described as 'anchovy paste' - Hydatid cyst (Echinococcus granulosus), endemic in sheep- and dog-raising areas of South America: slow-growing cysts, mostly in the right lobe, with daughter cysts on imaging; spillage at surgery risks anaphylaxis and spread - Portal hypertension from cirrhosis opens portosystemic collaterals: esophageal varices, caput medusae around the umbilicus and rectal varices - Pringle maneuver: clamping the hepatoduodenal ligament stops hepatic arterial and portal inflow during bleeding or resection; bleeding that continues points to the hepatic veins or inferior vena cava - Resections and partial grafts follow Couinaud segments; living-donor transplant (right lobe for adults, left lateral section for children) relies on the liver's ability to regenerate ## Anatomical variants - Aberrant hepatic arteries are common: a replaced or accessory right hepatic artery from the [superior mesenteric artery](https://durgical.com/en/anatomy/superior-mesenteric-artery/), or a left one from the [left gastric artery](https://durgical.com/en/anatomy/left-gastric-artery/) (Michels classification) - Bile duct variants (for example, the right posterior duct draining into the left hepatic duct) are mapped before right-lobe living-donor transplant - Riedel lobe: a [tongue](https://durgical.com/en/anatomy/tongue/) -like downward extension of the right lobe that can be mistaken for an enlarged liver or a mass ## Development Grows from the hepatic diverticulum of the foregut into the septum transversum, which is why it keeps a bare area against the diaphragm; in the fetus it is a main site of blood cell formation. ## Related conditions - [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/) - [Portal hypertension](https://durgical.com/en/conditions/portal-hypertension/) - [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/) - [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/) - [Amoebic liver abscess](https://durgical.com/en/conditions/amoebic-liver-abscess/) - [Gallbladder cancer](https://durgical.com/en/conditions/gallbladder-cancer/) - [Autosomal dominant polycystic kidney disease](https://durgical.com/en/conditions/autosomal-dominant-polycystic-kidney-disease/) - [Pyruvate kinase deficiency](https://durgical.com/en/conditions/pyruvate-kinase-deficiency/) - [Arsenic poisoning](https://durgical.com/en/conditions/arsenic-poisoning/) - [Lactic acidosis](https://durgical.com/en/conditions/lactic-acidosis/) - [Diabetic ketoacidosis](https://durgical.com/en/conditions/diabetic-ketoacidosis/) - [Phenylketonuria (PKU)](https://durgical.com/en/conditions/phenylketonuria/) - [Tyrosinaemia type I (hepatorenal)](https://durgical.com/en/conditions/tyrosinaemia-type-i/) - [Ornithine transcarbamylase (OTC) deficiency](https://durgical.com/en/conditions/ornithine-transcarbamylase-deficiency/) - [Hyperammonaemia](https://durgical.com/en/conditions/hyperammonaemia/) - [Carcinoid syndrome](https://durgical.com/en/conditions/carcinoid-syndrome/) - [Von Gierke disease (glycogen storage disease type I)](https://durgical.com/en/conditions/von-gierke-disease/) - [Cori disease (glycogen storage disease type III)](https://durgical.com/en/conditions/cori-disease/) - [Andersen disease (glycogen storage disease type IV)](https://durgical.com/en/conditions/andersen-disease/) - [Hers disease (glycogen storage disease type VI)](https://durgical.com/en/conditions/hers-disease/) - [Glucose-6-phosphate dehydrogenase (G6PD) deficiency](https://durgical.com/en/conditions/glucose-6-phosphate-dehydrogenase-deficiency/) - [Hereditary fructose intolerance](https://durgical.com/en/conditions/hereditary-fructose-intolerance/) - [Classic galactosaemia](https://durgical.com/en/conditions/classic-galactosaemia/) - [Gaucher disease](https://durgical.com/en/conditions/gaucher-disease/) - [Niemann–Pick disease](https://durgical.com/en/conditions/niemann-pick-disease/) - [Hurler syndrome (mucopolysaccharidosis type I)](https://durgical.com/en/conditions/hurler-syndrome/) - [Hunter syndrome (mucopolysaccharidosis type II)](https://durgical.com/en/conditions/hunter-syndrome/) - [High anion gap metabolic acidosis](https://durgical.com/en/conditions/high-anion-gap-metabolic-acidosis/) - [Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency](https://durgical.com/en/conditions/medium-chain-acyl-coa-dehydrogenase-deficiency/) - [Zellweger syndrome (Zellweger spectrum)](https://durgical.com/en/conditions/zellweger-syndrome/) - [Jamaican vomiting sickness (ackee poisoning)](https://durgical.com/en/conditions/jamaican-vomiting-sickness/) - [Pyruvate carboxylase deficiency](https://durgical.com/en/conditions/pyruvate-carboxylase-deficiency/) - [Familial hypertriglyceridaemia](https://durgical.com/en/conditions/familial-hypertriglyceridaemia/) - [Acute intermittent porphyria](https://durgical.com/en/conditions/acute-intermittent-porphyria/) - [Porphyria cutanea tarda](https://durgical.com/en/conditions/porphyria-cutanea-tarda/) - [Gilbert syndrome](https://durgical.com/en/conditions/gilbert-syndrome/) - [Crigler-Najjar syndrome](https://durgical.com/en/conditions/crigler-najjar-syndrome/) - [Dubin-Johnson syndrome](https://durgical.com/en/conditions/dubin-johnson-syndrome/) - [Rotor syndrome](https://durgical.com/en/conditions/rotor-syndrome/) - [Neonatal jaundice](https://durgical.com/en/conditions/neonatal-jaundice/) - [Hereditary hemochromatosis](https://durgical.com/en/conditions/hereditary-hemochromatosis/) - [Thalassemias (α and β)](https://durgical.com/en/conditions/thalassemias/) - [Kwashiorkor](https://durgical.com/en/conditions/kwashiorkor/) - [α1-antitrypsin deficiency](https://durgical.com/en/conditions/1-antitrypsin-deficiency/) - [Acetaminophen toxicity](https://durgical.com/en/conditions/acetaminophen-toxicity/) - [Alcoholic liver disease (biochemistry)](https://durgical.com/en/conditions/alcoholic-liver-disease/) - [Disulfiram–ethanol reaction](https://durgical.com/en/conditions/disulfiram-ethanol-reaction/) - [Hypervitaminosis A (vitamin A toxicity)](https://durgical.com/en/conditions/hypervitaminosis-a/) - [Vitamin K deficiency bleeding of the newborn](https://durgical.com/en/conditions/vitamin-k-deficiency-bleeding-of-the-newborn/) - [Wilson disease](https://durgical.com/en/conditions/wilson-disease/) - [Dengue](https://durgical.com/en/conditions/dengue/) - [Malaria](https://durgical.com/en/conditions/malaria/) - [Obesity](https://durgical.com/en/conditions/obesity/) - [Leptospirosis](https://durgical.com/en/conditions/leptospirosis/) - [Leishmaniasis](https://durgical.com/en/conditions/leishmaniasis/) - [Metabolic syndrome](https://durgical.com/en/conditions/metabolic-syndrome/) - [Cutaneous drug reactions and DRESS](https://durgical.com/en/conditions/cutaneous-drug-reactions-and-dress/) - [Acute alcohol (ethanol) intoxication](https://durgical.com/en/conditions/acute-alcohol-intoxication/) - [Iron poisoning](https://durgical.com/en/conditions/iron-poisoning/) - [Anticoagulant poisoning (warfarin and superwarfarins)](https://durgical.com/en/conditions/anticoagulant-poisoning/) - [Anticonvulsant toxicity (phenytoin, carbamazepine, valproate)](https://durgical.com/en/conditions/anticonvulsant-toxicity/) - [Isoniazid toxicity](https://durgical.com/en/conditions/isoniazid-toxicity/) - [Mushroom poisoning (Amanita)](https://durgical.com/en/conditions/mushroom-poisoning/) - [Hypoglycaemia (including insulin-induced)](https://durgical.com/en/conditions/hypoglycaemia/) - [Polypharmacy and potentially inappropriate medications in older adults](https://durgical.com/en/conditions/polypharmacy-and-potentially-inappropriate-medications-in-older-adults/) - [Malnutrition and unintentional weight loss in older adults](https://durgical.com/en/conditions/malnutrition-and-unintentional-weight-loss-in-older-adults/) - [Hepatic encephalopathy](https://durgical.com/en/conditions/hepatic-encephalopathy/) - [Ascites and spontaneous bacterial peritonitis](https://durgical.com/en/conditions/ascites-and-spontaneous-bacterial-peritonitis/) - [Metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD)](https://durgical.com/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/) - [Acute liver failure](https://durgical.com/en/conditions/acute-liver-failure/) - [Autoimmune hepatitis](https://durgical.com/en/conditions/autoimmune-hepatitis/) - [Primary biliary cholangitis](https://durgical.com/en/conditions/primary-biliary-cholangitis/) - [Primary sclerosing cholangitis](https://durgical.com/en/conditions/primary-sclerosing-cholangitis/) - [Drug-induced liver injury](https://durgical.com/en/conditions/drug-induced-liver-injury/) - [Hepatorenal syndrome](https://durgical.com/en/conditions/hepatorenal-syndrome/) - [Budd-Chiari syndrome](https://durgical.com/en/conditions/budd-chiari-syndrome/) - [Pyogenic liver abscess](https://durgical.com/en/conditions/pyogenic-liver-abscess/) - [Cholangiocarcinoma (bile duct cancer)](https://durgical.com/en/conditions/cholangiocarcinoma/) - [Portal vein thrombosis](https://durgical.com/en/conditions/portal-vein-thrombosis/) - [Benign liver lesions (haemangioma, focal nodular hyperplasia, adenoma)](https://durgical.com/en/conditions/benign-liver-lesions/) - [Disseminated intravascular coagulation](https://durgical.com/en/conditions/disseminated-intravascular-coagulation/) - [Anaemia of chronic disease (anaemia of inflammation)](https://durgical.com/en/conditions/anaemia-of-chronic-disease/) - [Graft-versus-host disease](https://durgical.com/en/conditions/graft-versus-host-disease/) - [Hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu)](https://durgical.com/en/conditions/hereditary-haemorrhagic-telangiectasia/) - [Carcinoma of unknown primary](https://durgical.com/en/conditions/carcinoma-of-unknown-primary/) - [Mastocytosis (cutaneous and systemic)](https://durgical.com/en/conditions/mastocytosis/) - [Yellow fever](https://durgical.com/en/conditions/yellow-fever/) - [Toxocariasis (visceral and ocular larva migrans)](https://durgical.com/en/conditions/toxocariasis/) - [Echinococcosis (hydatid disease)](https://durgical.com/en/conditions/echinococcosis/) - [Schistosomiasis](https://durgical.com/en/conditions/schistosomiasis/) - [Brucellosis](https://durgical.com/en/conditions/brucellosis/) - [Viral haemorrhagic fevers (Ebola and others)](https://durgical.com/en/conditions/viral-haemorrhagic-fevers/) - [Relapsing fever (tick-borne and louse-borne borreliosis)](https://durgical.com/en/conditions/relapsing-fever/) - [Q fever](https://durgical.com/en/conditions/q-fever/) - [Liver fluke infections (fascioliasis, clonorchiasis, opisthorchiasis)](https://durgical.com/en/conditions/liver-fluke-infections/) - [HELLP syndrome](https://durgical.com/en/conditions/hellp-syndrome/) - [Intrahepatic cholestasis of pregnancy](https://durgical.com/en/conditions/intrahepatic-cholestasis-of-pregnancy/) - [Acute fatty liver of pregnancy](https://durgical.com/en/conditions/acute-fatty-liver-of-pregnancy/) - [Neonatal hypoglycaemia (including infant of a diabetic mother)](https://durgical.com/en/conditions/neonatal-hypoglycaemia/) - [Congenital (TORCH) infections: syphilis, toxoplasmosis, CMV and Zika](https://durgical.com/en/conditions/congenital-infections-syphilis-toxoplasmosis-cmv-and-zika/) - [Biliary atresia](https://durgical.com/en/conditions/biliary-atresia/) - [Chronic granulomatous disease](https://durgical.com/en/conditions/chronic-granulomatous-disease/) - [Reye syndrome](https://durgical.com/en/conditions/reye-syndrome/) - [Autosomal recessive polycystic kidney disease](https://durgical.com/en/conditions/autosomal-recessive-polycystic-kidney-disease/) - [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/) - [Blunt abdominal trauma](https://durgical.com/en/conditions/blunt-abdominal-trauma/) - [Liver injury](https://durgical.com/en/conditions/liver-injury/) ## Test yourself Think of the answer, then tap the question to see it. ## What line divides the functional right and left liver? Cantlie line, from the gallbladder fossa to the inferior vena cava; the falciform ligament only separates the anatomical lobes. ## Why can the liver be resected segment by segment? Each of Couinaud's eight segments has its own portal pedicle and bile duct, while the hepatic veins run between them. ## What is the dual blood supply of the liver? Portal vein about 75% and hepatic artery proper about 25%; it drains by the hepatic veins into the inferior vena cava. ## Why can liver capsule pain be referred to the right shoulder? The capsule is supplied by the phrenic and lower intercostal nerves. ## What is the typical amoebic liver abscess? Usually a single abscess in the right lobe with fever and right upper quadrant pain, from Entamoeba histolytica; the pus is classically «anchovy paste». [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/anatomy/liver/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** hepar; lobus dexter hepatis; lobus sinister hepatis; lobus caudatus; lobus quadratus TA2 3023 **Official Spanish (DeCS)** Hígado DeCS D008099 **English (TA2)** Liver ## Related - [Hepatic veins](https://durgical.com/en/anatomy/hepatic-veins/) - [Portal vein](https://durgical.com/en/anatomy/hepatic-portal-vein/) - [Celiac trunk](https://durgical.com/en/anatomy/celiac-trunk/) - [Proper hepatic artery](https://durgical.com/en/anatomy/proper-hepatic-artery/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=8272); [Anatomy, Abdomen and Pelvis: Liver](https://www.ncbi.nlm.nih.gov/books/NBK500014/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/liver/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/liver/