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LIVER AND BILIARY SYSTEM

D R A N I L C H A U D H A RY
A S S O C I AT E P R O F E S S O R
PHYSIOLOGY

The small intestine receives not only


chyme from the stomach but also
secretions from the liver and pancreas.

LIVER
Location
R. Hypochondrium
Epigastric region

4 Lobes
Left
Quadrate
Caudate
Right

Each lobe has lobules Contains hepatocytes


Surround sinusoids Feed into central
vein

LIVER

The Liver
has tremendous
variety of
functions,
including the
secretion of
bile for
digestive
purposes.
-Largest Gland of
Body

STRUCTURE OF LIVER
Liver largest internal organ.
Hepatocytes form hepatic plates that are 12 cells thick.
Arranged into functional units called lobules.each with
diameter of 0.5 to 2 mm.

Plates separated by sinusoids.


More permeable than other capillaries.

Contains phagocytic Kupffer cells.


Secretes bile into bile canaliculi, which are
drained by bile ducts.

MICROSCOPIC ANATOMY

Hepatic lobules tiny cylinders make up


interior of liver; functional units of liver
Lobule central vein; surrounded by
radiating sheets of cuboidal cells
hepatocytes
Between plates of hepatocytes blood filled
channels hepatic sinusoids
Blood filtering between hepatocytes comes
from intestines
Sinusoids Kupffer cells hepatic
macrophages; removes bacteria & debris
from blood

Hepatocytes secret bile into the bile canaliculi and bile


ductules.

bile ductule

STRUCTURE OF LIVER

(CONTINUED)

Insert fig. 18.20

LIVER HISTOLOGY

Liver lobule is the basic


functional units of the
liver
Each lobe is divided:
by connective tissue
into about 100,000
liver lobules
about 1 mm diameter
each

Figure 2420

LIVER

Dual blood
supply
Hepatic portal vein
Direct input from small
intestine

Hepatic artery/vein
Direct links to heart

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HEPATIC BLOOD SUPPLY


1/3 of blood supply:

arterial blood from hepatic artery proper

2/3 venous blood from hepatic portal


vein, originating at:
esophagus
stomach
small intestine
most of large intestine

Hepatocytes are liver cells


Adjust circulating levels of nutrients:
through selective absorption and secretion

Blood Leaving the Liver returns to


systemic circuit
Via hepatic veins:
which open into inferior vena cava

MICROSCOPIC ANATOMY OF THE


LIVER

THE PATHS OF BLOOD AND BILE IN


HEPATIC LOBULE

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HEPATOCYTES
In a liver lobule form a series of
irregular plates arranged like wheel
spokes
Blood enters liver sinusoids:
from small branches of hepatic portal vein
from hepatic artery proper

As blood flows through sinusoids:


hepatocytes absorb solutes from plasma
and secrete materials such as plasma proteins

Hepatic triad 3 or more lobules meet ; contains 2 blood vessels


and 1 bile duct
After filtering thru sinusoids blood collects in central vein
Flows into L & R hepatic veins and enters inferior vena cava
Bile canaliculi - narrow channels between sheets of
hepatocytes ; liver secretes bile here
Bile passes into bile ductules of triads & into R & L hepatic ducts

Hepatic ducts merge Common hepatic duct


Common hepatic duct + Cystic duct from gallbladder join Bile
duct
Bile duct joins Pancreatic duct at Hepatopancreatic ampulla and
enters duodenum
Hepatopancreatic sphincter regulates passage of bile and
pancreatic juices into duodenum

Bile ductules hepatic ducts


common

hepatic duct

cystic
duct
common hepatic duct
common bile duct

gallbladder
hepatopancreatic
sphincter

pancreas
duodenum

FUNCTIONS OF THE
LIVER

Bile production: 600-1000 mL/day. Bile salts (bilirubin), cholesterol,


fats, fat-soluble hormones, lecithin
Neutralizes and dilutes stomach acid
Bile salts emulsify fats. Most are reabsorbed in the ileum.
Secretin (from the duodenum) stimulates bile secretions, increasing water
and bicarbonate ion content of the bile
Storage
Glycogen, fat, vitamins, copper and iron. Hepatic portal blood comes to liver
from small intestine.
Nutrient interconversion
Amino acids to energy producing compounds
Hydroxylation of vitamin D. Vitamin D then travels to kidney where it is
hydroxylated again into its active form
Detoxification
Hepatocytes remove ammonia and convert to urea
Phagocytosis
Kupffer cells phagocytize worn-out & dying red & white blood cells, some
bacteria
Synthesis
Albumins, fibrinogen, globulins, heparin, clotting factors

LIVER
Detoxifies/removes
Drugs
Alcohol

Stores
Gycolgen
Vitamins (A, D, E, K)
Fe and other minerals
Cholesterol

Activates vitamin D
Fetal RBC production
Phagocytosis
Metabolizes absorbed food
molecules
Carbohydrates
Proteins
Lipids

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DETOXIFICATION OF THE
BLOOD
Liver can remove hormones, drugs,
and other biologically active
molecules from the blood by:
Excretion into the bile.
Phagocytosis by Kupffer cells.
Chemical alteration of the molecules.
Ammonia is produced by deamination of amino acids in
the liver.
Liver converts it into urea.
Excreted in urine.

DETOXIFICATION OF THE
BLOOD
(CONTINUED)

Inactivation of steroid hormones and drugs.


Conjugation of steroid hormones and xenobiotics make them anionic.
Can be transported into bile by multispecific organic anion transport
carriers.
Steroid and xenobiotic receptors stimulate production of cytochrome
P450 enzymes.

SECRETION OF GLUCOSE, TRIGLYCERIDES AND KETONES


Liver helps regulate blood glucose concentration by:
Glycogenesis and lipogenesis.
Glycogenolysis and gluconeogenesis.
Contains enzymes required to convert free fatty acids into
ketone bodies.

PRODUCTION OF PLASMA
PROTEINS
Albumin and most of the plasma
globulins (except gama globulins)
are produced by the liver.
Albumin:
Constitutes 70% of the total plasma protein.
Contributes most to the colloidal osmotic pressure in the
blood.

Globulins:
Transport cholesterol and hormones.
Produce blood clotting factors I, II, III, V, VII, IX,
XI.

LIVER FUNCTIONS

produces glycogen from glucose


breaks down glycogen into glucose
converts noncarbohydrates to glucose
oxidizes fatty acids
synthesizes lipoproteins, phospholipids, and cholesterol
converts carbohydrates and proteins into fats
deaminates amino acids
forms urea
synthesizes plasma proteins
converts some amino acids to other amino acids
stores glycogen, vitamins A,D, B12, iron, and blood
phagocytosis of worn out RBCs and foreign substances
removes toxins from blood
produces and secretes
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CLINICAL APPLICATION
Hepatitis

inflammation of the liver


most commonly caused by viral infection
can be caused by reactions to drug, alcoholism or
autoimmunity
Signs and Symptoms
Hepatitis A not washing hands
headache
or eating raw shellfish
low fever
Hepatitis B chronic; serum
fatigue
Hepatitis C serum
vomiting
Hepatitis D very severe; only
rash
produces symptoms if infected
foamy urine
with B; serum
pale feces
Hepatitis E, F, G more rare
jaundice
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pain