22. The anatomy, histology and development of the liver and biliary ducts... http://anatomytopics.wordpress.com/2008/12/22/anatomy-histo-embryolo...

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22. The anatomy, histology and development of the liver and biliary ducts
and gallbladder.
Posted in Abdomen by Sahaja on December 22, 2008

22. The anatomy, histology and development of the liver and biliary ducts and
gallbladder.
*Liver is intraperitoneal, except for bare area, and has FOREGUT origin

Anatomy of Liver

General Info
largest gland in the body and largest organ(after skin)
weighs app. 1500 g; 2.5 % of adult body weight
in late fetus: twice as large( 5% of body weight)
Location
lies mainly in the right upper quadrant of the abdomen
hidden and protected by the thoracic cage and diaphragm

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normal liver lies deep to ribs 7-11 on the right side and crosses the midline towards the left nipple.
L. occupies most of the right hypochondrium, the upper epigastrium and extends into the left
hypochondrium
inf to the diaphragm, which separate it from the pleura, lungs, pericardium and heart
Function
all nutrition absorbed from the gastrointestinal tract are initially conveyed first to the liver by the portal venous
system(except for fat)
metabolic activities, glycogen storage and secretion of bile,
degrade or conjugate toxic substances to render them harmless
Protein synthesis
Heparin production
Breakdown of Hemoglobin
Hematopoiesis = RBC production
Storage of vitamins, Fe, and Cu
Bile function:
bile passes from the liver via the biliary ducts
R & L Hepatic ducts, join to form the common bile duct, which unite to form the cystic duct to form the
bile duct
the liver produces bile continuously,
between meals it accumulates and is stored in the gallbladder, which also concentrates the bile by
absorbing water and salts.
when food arrives in the duodenum, the gallbladder sends concentrated bile through the bile ducts to the
duodenum

Surface Projection
Upper border = 5th rib @ mid inguinal line
Lower border = @ ant axillary line –> midinguinal line, follows the R costal arch, then @ end of 10th, asc
obliquely into epigastrium, crosses midline @ transpyloric line, @ 8th L rib, enters hypochondrium
Lower and upper border meet jsut medial to L midinguinal line
Topography
2 surfaces = diaphragmatic, and visceral.
the diaphragmatic surface of the liver is smooth and dome shaped, where it is related to the concavity of the inf
surface of the diaphragm

Impressions on the visceral surface:

1) gastric + pyloric areas: right side of the ant. aspect of the stomach

2) duodenal area: sup. part of the duodenum

3) lesser omentum: extends into the fissure for the ligamentum venosum

4) fossa for gallbladder

5) colic area: right colic flexure + right transverse colon

6) renal+ suprarenal areas: right kidney + suprarenal gland

Parts
separated into R & L lobe ant by falciform ligament (a fold of peritoneum that attaches the liver to ant ab wall)
(post) – split into 4 lobes by a number of structures that make a “H” pattern on the visceral surface
4 lobes are : R, L, caudate, and quadrate. (quadrate functionally part of L lobe, and caudate functionally
part of both)
H made up of R and L sagittal fissures & transverse limb:
R-ant = fossa of gallbladder (sits on quadrate)
R-post = IVC fossa
L ant = falciform and round ligament
L post = ligamentum venosum, and hepatogastric lig.
Transverse limb = Porta Hepatis = ( portal vein, hapatic artery + lymphatic vessels+ hepatic nerve
plexus+ hepatic ducts that supply + drain the liver enter and leave it.

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Round ligament = remnant of umbilical v., @ inf free edge of falciform ligament
Ligamentum venosum = remnant of Ductus venosus, which shunts a significant majority (80%) of the
blood flow of the umbilical vein directly to the inferior vena cava. Thus, it allows oxygenated blood from
the placenta to bypass the liver.
Peritoneal Relations of Liver
subphrenic recesses: sup. extensions of the peritoneal cavity(greater sac) exists between diaphragm + ant. +
sup. aspects of the diaphragmatic surface of the liver
seperated into right and left recesses by the falciform ligament
suphepatic space= portion of the supracolic compartment of the peritoneal cavity immediately inf. to the liver
hepatorenal recess= posterosuperior extension of the suphepatis space, lying between the right part of the
visceral surface of the liver and kidney/ suprarenal gland
cavity- deepest part(deepest next to rectovesical pouch) in supine position, fluid draining from the omental
bursa flows into this recess.
communicates ant. with the right subphrenic recess

Recesses of Liver

Ligaments of Liver

bare area of liver: diaphragmatic surface is covered with visceral peritoneum, except there.
It lies in direct contact with the diaphragm.
is demarcated by the reflection of peritoneum from the diaphragm to it as the ant(upper) + post(lower)
layers of the coronary ligament.
Right triangular ligament: end of coronary lig on R side
Left triangular ligament: end of coronary lig of L side
Hepatogastric ligament
Hepatorenal ligament
Hepatoduodenal ligament = remnant of ventral mesoduodenum, connect portal v. and duodenal cap
Hepatogastric and hepatoduodenal ligament together make up the borders of epilploic (omental) foramen, that

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leads from greater sac to lesser sac (behind the stomach), some say it also makes up the lesser omentum
ventral mesogastrium – liver develops in this, and the liver divides it into two ligaments: the lesser omentum &
falciform ligament.
Bare area – no peritoneal coverage. Borders on both sides is falciform ligament, anterior and posterior leaf of
coronary ligament, triangular ligament where ant/post leaves of coronary ligament unite. *Location of where
hepatic v enter IVC
Blood Supply
receives O2 blood from hepatic a
have many many many variations
de-O2, nutrient rich, poss toxic blood –> portal v (portal v discussion another topic, please look at that one)
Hepatic a proper –>ascends in hepatoduodenal lig (R edge of lesser omentum) splits into R and L Hepatic a, R
hepatic gives cystic a, Hepatic a immediately split into segmental branches
R Hepatic = R lobe, R 1/2 of caudate lobe
L Hepatic = L lobe, quadrate lobe, L 1/2 of caudate lobe
Hepatic v – drains blood of liver, usually 3 of them, Sinusoids of liver –> bigger br –> hepatic v –> IVC (@ bare
area)
Lymph supply
Liver is major lymph producing organ
Superficial lymph nodes
in fibrous capsule of liver, just below the peritoneum
Deep lymph nodes
in CT with portal triads and hepatic v.
Superficial l.n. from ant diaphragmatic and visceral surface, and deep lymph vessels from around portal triads
–> hepatic nodes, along hepatic vessels and ducts in lesser omentum–> celiac nodes –> cisterna chili
Superficial l.n. from post diaphragmatic and visceral surface –> bare area of liver –> phrenic nodes, a or to
lymph nodes with hepatic v to IVC, thru diaphragm –> post mediastinal nodes –> R lymph/thoracic duct
lymph can also go –> L gastric, parasternal, and from round ligament area, umbilical nodes.
Innervation
hepatic n plexus @ porta hepatis, these branches come from the celiac plexus which sits around the celiac
trunk
SNS = from celiac plexus
PNS = ant/post vagal trunks
N fibers run with arteries

Biliary Ducts & Gall Bladder

*Intraperitoneal, part of foregut

Gallbladder
Location
Jxn of R 9th CC and lat border of rectus abdominus where midinguinal line crosses 10th rib (fundus of it)
General Info/Topography
Pear shaped sac on inf surface of liver in fossa b/wR lobe and quadrate lobe.
lies right next to the 1st/2nd part of diaphragm
touches transverse part of colon
SP = above, can only be palpated if gallstone present * made of calcifications of cholesterol and/or bilirubin.
Gallstones more common in women than men, especially those with multiple pregnancies and/or overweight, and
older.
Function
receives and stores bile and concentrated by absorbing H20 and salts and stores it
contracts to expel bile via (+) by CCK, which is produced by duodenal mucosa when food arrives there
Bile used to breakdown fat and fat soluble vitamins
Parts
Fundus – wide end, projects from the inf border of liver, located at tip of right 9th CC
Body – on visceral surface of liver, in GB fossa
3eck – narrow, tapered and runs towards porta hepatic, location of cystic duct
Blood Supply

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primarily cystic a, from R Hepatic a

cystic v
from the biliary ducts and neck of gallbladder –> portal v, joins v from hepatic ducts and upper bile duct
from fundus and body –> visceral surface of liver –> hepatic sinusoids
Lymph Drainage
cystic lymph nodes –> hepatic lymph nodes –> celiac lymph nodes
Innervation
SS = R phrenic n
SNS = celiac plexus
PNS = CN X
fibers run with cystic a.

Biliary System:

Bile is made in Liver and stored in gallbladder. Bile is released into the duodenum when food arrives, and therefore fat
needs to be broken down. Hepatocytes secrete bile into bile canaliculi in b/w them.
Bile canaliculi unite to from intrahepatic bile ducts, that lie in portal triads with the hepatic portal v and hepatic
arteries.
Bile ductules combine to form R and L Hepatic ducts
R & L Hepat ducts combine to form Common Hepatic Duct
Cystic duct to gall bladder is from common hepatic duct
have spiral valves (Heister’s valves) which keep duct open si if common bile duct closed, bile –> cystic duct –>
GB
Common Hepatic + Cystic duct = Common bile duct
10 cm long and 1 cm in diameter
lies in b.w hepatic a and portal v
ususally embedded into post. surface of the head of the pancreas.
Left side of the desending part of the duodenum, the bile duct comes into contact with the main pancreatic
duct.
These ducts run oblique through the wall of this part of the duodenum, where they unite to form the
hepatopancreatic ampulla, the dilation within the major duodenal papilla.
distal end of ampulla opens into great duodenal papilla (about 1/3 way down descending part of duodenum, also
called papilla of Vater, or Greater Duodenal papilla)
Sphincter of Oddi holds the opening of the papilla closed – there are three parts to it, forming a sphincter for the bile
duct, pancreatic duct, and for the papilla itself. PNS activity opens it.

Histology of Liver and Gallbladder

#57 Pig Liver * H&E

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Structures to
Identify:

Fxn’l lobule
central v
Bile duct
hepatic a
portal v
CT septa
lymph nodule
sinusoids
bile canaliculi
Kupffer cells
Glisson’s capsule
Hepatocytes (parenchyme)

Low power magnification: you see the lobular patternof the human liver, but less CT than for pic liver. Pig liver shows
hepatic lobules the best b/c of prominent CT septa invaginating from surrounding Glisson’s capsule.

Medium power magnification: hepatic lobules containing the central vein are dermacated by narrow stripes of interlobular
CT made of reticular fibers.

Organization of Hepatic Lobules:

Functional units of the liver, described as lobules or acini, are made up of irregular interconnecting sheets of
hepatocytes seperated from one another by the blood sinusoids.
parenchyme of liver is hepatocyte – normally 2 layers with sinusoids in b/w
Sinusoids convery mixed blood of Liver –> drain into central v.

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radiating from central v –> periphery of lobule = plates of hepatic cells, with hepatic sinusoids in b/w, where venous
and arterial blood mix
Space of Disse = b/w hepatocytes basal surface (sinusoids),
Perisinisoidal space b/w endoth of sinusoids and parenchyme
have microville that go into space and absorb protein from sinusoids
contain Ito cells and hepatocytes

3 ways of describing Hepatic lobules:

Classical lobule model – has at its center the v surrounded by Space of Mall, (b/w CT stroma and outermost
hepatocytes), sinusoids, and hepatic triad
Portal lobule model – emphasizes exocrine fxn of liver and has bile duct in center (part of portal triad)
Liver acinus model – best correlation among blood perfusion and metabolic activity and liver pathology
eliptical region between 2 central v and interlobular septum, divided into 3 zones
hepatic a, portal v, and bile duct from portal triad at periphery of lobules

Portal tracts contain the portal triad: with in the interlobular CT septa, each lobule has several portal triads surrounding it.

1. interlobular vein: branch of portal vein

2. interlobular artery: a branch of the proper hepatic artery, a thick- walled vessel with smaller diameter and the typical
structure of arterioles or arteries

3. interlobular bile duct: ducts of variable size, lined by simple cuboidal or columnar epithelium

Cells of Liver

Kupffer cells – belong to MPS, derived from monocytes, lie in sinusoid walls with endothelium, have pacytoic
capabilites to help degrade RBCs and Fe/ferritin. In case of splenectomy, # inc to make up the difference in Hgb and
RBC breakdown = see them best in RAT slide #57C, special staining required to see properly.
Ito cells – in space of Disse, stores vit A (precursor of retinol) that is needed for proper vision.
Note = In pathological cases, differentiate into myofibroblasts and secrete collagen, causing fibrosis.
Hepatocytes – main parenchymal cells of liver, last 5 months, need lots of mitochondria for energy
polyhedral in shape
tight junction in b.w w/ bile canaliculi
peroxisomes (H2O2 –> H2O +O2)
Smooth ER to detox drugs
Endocrin fxn = secret apolipoproteins
lysosomes for degradation

More General Info

Liver cells are large, polygoneal cells with round, centrally located nucleus and prominent nucleus
Binucleate cells are seen in this section. The hepatocytes form flat, anastomosing cords;
Sinusoids are found between the hepatic cords, the sinusoids are lined by a discontinous layer of endothelium with
flattend and condensed nuclei.
Kupffer cells are also present there, they are larger+ darker then the other cells of the sinusoids; sinusoids contain all
the cellular elements of blood

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The space as a fine slit between the sinusoid lining cells + the hepatocytes(the space of disse)is at the limit of the
resulution of the LM.
Sometimes the hepatic capsule(Glisson’s capsule) is visible as a thin layer of CT, covered by simple squamous
epithelium(visceral peritoneum) on the surface.
It also contains substances that bind to metabolites in the intestine to aid absorption.
A series of ducts of increasing diameter diameter + complexity, beginning with canaliculi between individual
hepatocytes + ending with the common bile duct, deliver bile from the liver + gallbladder to the duodenum.

Endocrine v Exocrine Function

each liver has both exocrine + endocrine functions;

exocrine secretion of the liver:
secretes bilirubin (byproduct of RBC breakdown produced by Kupffer cells)
Antibodies – produced in LP of SI/LI taken from blood by hepatocytes –> bile –> lumen of SI = control
bacteria level there.
produce bile which contains conjugated+ degrated waste products that are delivered back to the intestine for
disposal.
release up to 1L of bile to canaliculi daily
Bile flow: Bile canaliculi –> bile duct –> hepatic duct –> cystic duct –> gallbladder –>cystic duct –>
common bile duct –> duodenum
The endocrine secretion of the liver
are released directly into the blood that supplies the liver cells
these secretions include albumin, nonimmune alpha + beta globulins, prothrombin + glycoprotins including
fibronectin
activation of vitamin D, thyroxin, and growth hormone
Glucose (released from stored glycogen) + T3 (the more active deiodination product of thyroxine), are also
released directly into the blood.

Blood Supply/Lymph Drainage w/in liver

from portal v (spleen, stomach, pancreas, SL, LI) + hepatic a proper

portal blood contains:
absorbed degrade materials from GI tract
blood cells from spleen
pancreatic endocrine secretions
venous blood from portal v mixes with arterial blood from hepatic a proper in a 75%/25% ratio in portal
capillaries
flows within perilobular a/v
as said perviously, blood drains into sinusoids, lined with discontinous endothelium- which allows the communication
of hepatic blood with hepatocytes
remember that blood and bile never mix, they have seperate flow channels
Lymph –> Space of Mall, located in endothelial lining –>drain into v. –> thoracic duct

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# 57A Pig Liver *AZA3

blue = collagen
stains CT capsule, loose CT (collagen type I and II)
stains reticular fibers in space of Disse
AZAN = azocarmine red, and aniline blue

#57C Rat Liver * Toluidin Blue & 3uclear fast red

Structures to Identify: sinusoids, Kupffer cells, Endothelium cells, Hepatocytes, Bile canaliculi
To demonstrate structures of parenchyme of liver
Kupffer cells are clearly visible, b/c they phagocytose the dye – present in sinusoids
Hepatocytes clearly defined
NFR stains nuclei red
Sometimes, bile canaliculi will be visible b/w hepatocytes

#58 Human Liver *H&E

Structures to Identify: portal v, bile duct, hepatic a/v, central v, parenchyme, lymph nodules
same features as rat, but CT stroma not as prominent
if hepatic v, present, it will be alone and not in hepatic triad

Histology of Gallbladder #56 *H&E

Structures to Identify:

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Mucosa – deep folds when GB empty

smooth m
glands ( only in neck region)
Rokitansky-Aschoff sinuses
a/v
adventia/serosa

General Info

concentrates and stores bile for delivery into duodenum – done by salt active transport from bile and passive
movement of H2O in response to salt transport
Bile flow = R/L Hepatic ducts –> common hepatic duct –> cystic duct –> GB–> cystic duct –> common bile dcut –>
duodenal papilla of Vater

Mucosa

characterized by tall columnar epithelium with so called diverticuli or crypts, where the mucosa makes deep folds.
LOOK FOR THESE – v. characteristic of GB = Rokitansky – Aschoff sinuses
advential invaginations of mucosal membrane
common site of bile stones inflammation, as these can close themselves off into closed sacs, where bacteria can
collect
can extend into musc. layer
from as a result of inc pressure in GB and damage to wall of GB
has absorption function like in SI/LI
concentration of mitchondria found on basal/apical surfaces
Na/K ATPases on lat cell surfaces (not seen, theory only)
cells also have microvilli to increase surface area = absorption of H2O andminerals = concentrate bile
LP = rich in fenestrated capillaries for absorption and lymphocytes as usual

3o Submucosa or Musc Mucosa!!

Musc ext

below LP, contains unordered smooth m layers

contract when activated by hormones from SI enteroendocrine cells

contract dec volume of GB –> bile expelled into cystic duct
lots of elastic fibers interwoven with it
have CT covering smooth m bundles with a/v/lymphatics/nevers

Outer Layers:

On Liver side = adventia – (CT layer rich in elastic fibers, n fibers, adipose tissue – no peritoneal coverage)
if is adventia, will have intercalated ducts to absorb bile and aberrant bile ducts = Ducts of Luschka
these ducts are non-functional
located on post wall of GB
may be present, are remnants of bile duct system
look like small lumen surrounded by cuboidal epithelium
none are connected to lumen of GB, some may be connected to liver
On unattached side = serosa – (visceral peritoneum, layer of mesothelium and loose CT
subserosa with it = thin squamous like layer

Embryology of Liver/Gallbladder
Liver primordium appears in the middle of 3. week, as outgrowth of the endodermal epithelium at the distal end of the
foregut
This outgrowth, the hepatic diverticulum, or liver bud, consits of rapidly proliferating cells that penetrate the septum
transversum= the mesodermal plate between the pericardial cavity and the stalk of the yolk sac.
While hepatic cells continue to penetrate the septum, the connection between the hepatic diverticulum+ the forgut

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(duodeneum) narrows, forming the bile duct.

A small ventral outgrowth is formed by the bile duct, + and this outgrowth gives rise to the gallbladder+ the cystic
duct.
During furhter development, epithelial liver cords intermingle with the vitelline + umbilical veins, which form hepatic
sinusoids.
Liver cords differentiate into the parenchyme(liver cells) + form the lining of the biliary ducts.
Hematopoietic cells, Kupfer cells + CT cells are derived from mesoderm of the septum transversum
When liver cells have invaded the entire septum transversum, so that the organ bulges caudally into the abdominal
cavity–> mesoderm of the septum transversum lying between the liver and the foregut+ the liver+ ventral abdominal
wall become membranous –> forming the lesser omentum+ falciform ligament.
Together, having formed the peritoneal connection between the forgut+ the ventral abdominal wall, they are known as
the ventral mesogarstrium.

The surface of the liver differentiate into visceral peritoneum, exept on its cranial surface.

In this region, the liver remains in contact with the rest of the original septum transversum.
this portion of the septum, which consits of densey packed mesoderm, will form the central tendon of the diaphragm
the surface of the liver that is in contact with the tendon of the diaphragm = bare area of the liver (never covered by
peritoneum)

@ 10 th week: weight of liver app. 10 % of the total body weight

this may be attributed partly to the large numbers of sinusoids,also imp. Factor: is its hematopoietic function.
large nests of proliferating cells, which produce red + white blood cells, lie between hepatic cells+ and wall of the
vessels.
this activity gradually subsides, during the last 2 month of intrauterine life + only small hematopoietic islands remain at
birth.the weight of the liver is then only 5% of the total body weight.

@ 12th week: bile is formed by hepatic cells

since the gallbladder + cystic duct have developed + the cystic duct has joined the hepatic duct to form the bile duct,
bile can enter the gastrointestinal tract, consequence= contents take on a dark green colour.
due to positional changes of the duodenum, the entrance of the bile ducts gradually shifts from the initial ant. position
to a posterior one, and consequently the bile duct passes behind the duodenum.

Possibly related posts: (automatically generated)

What is gallbladder?
“I have what?…..oh no!”
The Gall of Some People

Tagged with: bile, bile canaliculi, Bile duct, coronary ligament, cystic duct, ducts of luschka, Duodenal papilla, epiploic
foramen, falciform ligament, foregut, Gallbladder, glisson's capsule, Heister's valves, hepatorenal recess, infraphrenic recess,
Intraperitoneal, Ito cells, kupffer cells, lesser omentum, lesser sac, ligamentum venosum, Liver, mesogastrium, papilla of
vater, portal triad, rokitansky aschoff sinuses, round ligament, space of Disse, space of Mall, sphincter of Oddi

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