Viscera (heart, lungs, liver, gastrointestinal tract)
Liver
Hepar
- Origin
- Occupies the right hypochondrium and epigastrium, extending into the left hypochondrium directly beneath the diaphragm
- Insertion
- Anchored to the diaphragm and anterior abdominal wall by the falciform and coronary ligaments; attached to stomach via lesser omentum
- Function
- Metabolic master organ: bile synthesis, plasma protein production (albumin, clotting factors), glucose/glycogen regulation, detoxification, and iron/vitamin storage
- Innervation
- Hepatic plexus (vagus nerve CN X, sympathetic celiac plexus T6-T9, capsule via right phrenic nerve C3-C5)
- Movement & chain
- Descends 2-3 cm during deep inspiration
- Palpation
- Palpation of the smooth inferior liver edge beneath the right costal margin on inspiration; liver span percussion (normal 8-12 cm in midclavicular line)
- Clinical
- Liver cirrhosis with portal hypertension, ascites, esophageal varices, and hepatic encephalopathy; hepatocellular carcinoma (HCC); viral hepatitis; non-alcoholic fatty liver disease (NAFLD).
- Segmental innervation
- T6-T9 spinal segments (Glisson's capsule referred pain to right shoulder via C3-C5 phrenic nerve)
- In clinical practice
- Monitoring LFTs and coagulation (PT/INR), tracking abdominal girth and daily weights in ascites, administering lactulose/rifaximin for encephalopathy, post-liver biopsy positioning
- Region in the model
- Viscera (heart, lungs, liver, gastrointestinal tract)