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Describe the segmental anatomy of the normal liver. Discuss the process of liver regeneration after hepatic resection.

The liver is a complex organ that plays a vital role in various metabolic processes, including detoxification, protein synthesis, and the production of bile. It is divided into eight functional segments based on the distribution of blood vessels and bile ducts. Understanding the segmental anatomy of the liver is crucial for surgical procedures, such as hepatic resection, and for understanding liver regeneration.

The liver consists of two main lobes: the right lobe and the left lobe. Each lobe is further divided into functional segments, known as Couinaud segments or liver segments. The division is based on the hepatic veins, which act as natural anatomical boundaries.

Here is a breakdown of the segmental anatomy of the normal liver:

Right Lobe:

  1. Anterior segment (Segment VIII)
  2. Posterior segment (Segment V)
  3. Superior segment (Segment VII)
  4. Inferior segment (Segment VI)

Left Lobe:

  1. Superior segment (Segment IV)
  2. Medial segment (Segment IVa)
  3. Lateral segment (Segment II)
  4. Inferior segment (Segment III)

Each segment has its own blood supply, which consists of a branch of the hepatic artery and a branch of the portal vein. Additionally, each segment has its own biliary drainage, with bile ducts that eventually join to form the common bile duct.

Liver regeneration is a remarkable process that allows the liver to restore its mass and functionality after injury or surgical resection. After a hepatic resection, the remaining liver tissue undergoes a series of complex cellular events to compensate for the lost tissue. The process of liver regeneration can be summarized as follows:

  1. Parenchymal Cell Proliferation: The hepatocytes, which are the main functional cells of the liver, start to proliferate rapidly after resection. They enter the cell cycle and undergo multiple rounds of cell division to replace the lost tissue.
  2. Activation of Non-parenchymal Cells: Non-parenchymal cells, such as hepatic stellate cells and liver sinusoidal endothelial cells, also play a crucial role in liver regeneration. These cells become activated and contribute to the regeneration process by secreting growth factors and extracellular matrix components.
  3. Angiogenesis: The formation of new blood vessels, known as angiogenesis, is a critical step in liver regeneration. It ensures an adequate blood supply to the regenerating liver tissue. Endothelial cells and growth factors stimulate the growth of new blood vessels.
  4. Remodeling and Restoration: As the regeneration progresses, the liver tissue undergoes remodeling to restore its normal architecture and functionality. The newly formed hepatocytes integrate into the existing liver tissue, and the liver gradually returns to its original size and function.

The process of liver regeneration is orchestrated by a complex network of molecular signals and interactions between different cell types. It is a highly regulated and dynamic process that can take several weeks to months, depending on the extent of the liver resection and the overall health of the individual.