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Thursday, October 09, 2008

A surgeon excises a portion of liver to the left of the attachment of the faliciform ligament. The segments that have been resected at

Question 17
A surgeon excises a portion of liver to the left of the attachment of the faliciform ligament. The segments that have been resected at
a.       1a and 4
b.      1 and 4b
c.       2 and 3
d.      1 and 3
C) 2 and 3
Gray Page 38th Edition 1797, Sabiston Surgery
New Question from Repeated Topic
Although much of the surface is smoothly continuous, the liver is customarily apportioned by anatomists into a larger right and a much smaller left lobe according to some surface markings and  peritoneal attachments, namely the line of attachment of the falciform ligament anteriorly, and the fissure for the ligamentum teres and ligamentum venosum on the liver's inferior surface. To the right of this groove are two prominences, the quadrate lobe in front, and the caudate lobe behind, separated from each other by the porta hepatis. The gallbladder lies (usually) in a shallow fossa to the right of the quadrate lobe.
The above statement (from Gray) clearly says that Caudate Lobe and Quadrate lobe are to the right of the attachment of the falciform ligament. So in this case, based on the diagram given below we can safely assume that these two lobes were not resected. (Do note that Segment 1 is Caudate Lobe)
Comments : Segmental anatomy as defined by Couinaud (the “French” system).
  • According to Couinaud's description, the three main hepatic veins divide the liver into four sectors.
  • He terms the planes through which the veins course the portal scissurae.
  • The right, main, and left portal scissurae define the four sectors, each of which receives a portal pedicle.
  • The main portal scissura divides the liver into right and left sectors. The right portal scissura divides the right and left livers into sectors.
  • It also divides the right liver into anterior and posterior sectors, each of which sectors contains two segments:
  • the anterior sector has segment V inferiorly and segment VIII superiorly, and
  • the posterior sector has segment VI inferiorly and segment VII superiorly.
  • The left portal scissura divides the left liver into superior and inferior sectors.
  • The umbilical fissure divides the anterior sector into two segments:
  • segment IV medially and segment III laterally.
  • The posterior sector has only one segment, segment II, which forms the posterior part of the left lobe.
  • The caudate lobe comprises segment I.
  • The portal veins and hepatic arteriole branches correspond to the segmental anatomy. Likewise, the bile ducts provide segmental drainage.
I) Caudate/Spigel lobe
II) Left posterolateral segment
III) Left anterolateral segment
IVa) Left superomedial segment
IVb) Left inferomedial segment
V) Right anteroinferior segment
VI) Right posteroinferior segment
VII) Right posterosuperior segment
VIII) Right anterosuperior segment
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All-Union Research Center of Mental Health, Academy of Medical Sciences of the USSR, Zagorodnoje shosse 2, korp 2, 113152 Moscow, USSR
Accepted: 9 December 1985  
Summary  Scanning electron microscopy (SEM) was used to examine choroid plexuses in the brain of two human adults aged 44 and 46, respectively, and 12 older subjects from 67 to 98 years of age. It was possible to obtain a three-dimensional view of the ring-like structures (Biondi bodies) located in the cytoplasm of choroid plexus epithelial cells in the older-age group. The filaments forming the rings were clearly visible. No such structures were found between epithelial cells. The intracellular location of the Biondi bodies and their state of preservation compared to other cytoplasmic elements suggest that they may have a destructive effect on epithelial cells of choroid plexuses. The same material was examined by transmission electron microscopy (TEM); the results obtained were in full agreement with the evidence obtained with SEM.
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