LIVER, GALLBLADDER AND PANCREAS

THE HUMAN LIVER«

STRUCTURE AND POSITION OF THE LIVER

It is largely protected by the ribs.  It is situated in the upper right portion of the abdominal cavity immediately below the diaphragm.PHYSIOLOGIC ANATOMY OF LIVER  The liver is the largest internal organ or gland of the body. and covered by a thick capsule of connective tissue called Glisson's capsule. The liver is a dark reddish-brown organ. . It weighs about 1200 -1600 gm or 3 pounds in an adult. It is wedge-shaped.

left. They are approximately 2 mm high and 1 mm in circumference.  The lobules are polyhedral in shape. . Each lobe is further divided into lobules. They are all connected by liver tissue. quadrate and caudate lobes. The liver is divided by fissures (fossae) into four lobes: the right (the largest lobe). They are composed of cubical liver cells and the ramifications of the vessels of the liver.

 These hepatic lobules are the functioning units of the liver. old red blood cells.  The hepatocytes secrete bile into the bile channels and also perform a variety of metabolic functions. bacteria and debris from the blood that flows through the sinusoids. sugar.  Between each row of hepatocytes are small cavities called sinusoids. Each of the approximately 1 million lobules consists of a hexagonal row of hepatic cells called hepatocytes. nutrients. . Each sinusoid is lined with Kupffer cells. phagocytic cells that remove amino acids.

to remove bacteria and foreign particles from the blood. . and to detoxify toxins and other harmful substances. The main functions of the sinusoids are to destroy old or defective red blood cells.

 The liver is connected to the diaphragm and abdominal walls by five ligaments: the membranous falciform (also separates the right and left lobes). inferior. anterior and posterior. .  The superior surface is in contact with the under surface of the dome-shaped diaphragm which separates it from the bases of the lungs. right and left triangular ligaments. coronary. and the fibrous round ligament (which is derived from the embryonic umbilical vein)  The liver possesses four surfaces: superior.

. The inferior surface is related to other abdominal viscera. including the kidney and right (hepatic) flexure of the colon on the right and the fundus of the stomach on the left.

 In the centre of the inferior surface is the hilum or gate of the liver. enter and the bile ducts leave the liver. The anterior surface is separated from the right lower ribs and costal cartilages by the margin of the diaphragm and in the midline is related to the anterior abdominal wall. This is also called the portal fissure and through it the important blood vessels. . inferior vena cava and lower end of the oesophagus.  The posterior surface crosses the vertebral column in the midline and is also related to the aorta. the hepatic artery and portal vein.

A LIVER LOBULE .

It supplies 20% of the liver's blood. this blood has an oxygen saturation of 95-100%. which arises from the aorta and supplies one-fifth of the blood to the liver. . It is a blood vessel which supplies the liver with oxygenated blood.VESSELS OF THE LIVER  The hepatic artery.

this blood has an oxygen saturation of only 70% because some O2 has been taken up in the spleen and intestine. The portal vein. which is formed from the spleenic vein and the superior mesenteric vein. HEPATIC PORTAL VEIN  a blood vessel which drains venous blood into the liver from the entire gastrointestinal tract. . supplies four-fifths of the blood to the liver. This portal (venous) blood brings to the liver the nutrients absorbed by the mucosa of the small intestine. It supplies the remaining 80% of the liver's blood.

The hepatic vein returns the blood from the liver to the inferior vena cava. . there are no valves in the hepatic veins. HEPATIC VEIN  which is one of several short vein originating within the lobes of the liver as small branches. These lead directly to the inferior vena cava.  BILE DUCTS  Are formed by the union of the bile capillaries which collect the bile from the liver cells. draining blood from the liver. which unite to form the hepatic veins.

 INFERIOR VENA CAVA . the hepatic artery and portal vein and two leaving. the hepatic vein and the bile duct. two entering. .formed by the union of the right and left common iliac veins. There are thus four main vessels transfers the substances to the liver. collects blood from parts of the body below the diaphragm and conveys it to the right atrium of the heart.

 75% of the blood flowing to the liver comes through the portal vein. the remaining 25% is oxygenated blood that is carried by the hepatic artery. .FLOW OF BLOOD TO THE LIVER  Approximately 1500 ml of blood enters the liver each minute.  Venous blood from the entire gastrointestinal tract (containing nutrients from the intestines) is brought to the liver by the hepatic portal vein.

 Branches of this vein pass in between the

lobules and terminate in the sinusoids. Oxygenated blood is supplied in the hepatic artery.  The blood leaves the liver via a central vein in each lobule, which drains in the hepatic vein.  Branches of the portal vein, the hepatic artery and the bile ducts are enclosed together in a connective tissue called Glisson s capsule. The blood from the portal vein comes into close proximity with the liver cells, each lobule is penetrated by a network of blood sinusoids or hepatic capillaries.

 Small vessels passing between the liver

lobules are called inter-lobular veins. From these, capillaries branch into the substance of the lobules, and unite to form a small vein in the centres of the lobules, intra-lobular veins. 
These vessels pour their contents into

other veins called sub-lobular veins, which unite and finally form several hepatic veins passing directly into the inferior vena cava.

 Bile is formed in minute spaces in the hepatic cells and discharged through fine bile capillaries or bile canaliculi; minute channels which commence between the liver cells, lying between two cells, but separated from the blood capillaries so that the blood and the bile never mix.

. by means of the contraction of the muscular covering of these ducts bile is carried away from the liver.  The largest bile ducts are lined by columnar epithelium and have an outer coat of fibrous and muscular tissue. The bile capillaries then pass to the margins of the lobules and pour their contents into the inter-lobular bile ducts which unite to form the hepatic ducts.

FUNCTIONS OF THE LIVER .

Circulatory Functions Secretary Functions Excretory Functions Protective and detoxifying functions Excretory Functions Hematologic Functions Metabolic and storage Functions . 3. 2. 6. 4. Liver functions are generally divided into six categories: 1. 7.Larges t and one of the most diverse functioning gland of the body. 5.

‡ ‡ ‡ :Filtration and storage of blood (650 ml = almost 10 % of the body s total blood volume). About 1400 ml/min of blood is flowing through the liver. High Lymph Flow: Liver is active site for production of lymph.‡ ‡ 2. In cardiac failure it can be stored there up to 1 liter of blood. Liver has a high protein concentration of about 6 g/dl. Half of lymph in body under resting condition arises in liver. .

 Formation and secretion of bile via hepatocytes. phospholipids (lecithin). K) Oxidation product of cholesterol . fatty acids.  80% of cholesterol is utilized in this manner Amino acids ( Glycine/Taurine) Minerals (Na. bile salts. antibodies and various electrolytes.  Bile an important emulsifying agent that is formed from cholesterol. cholesterol. bilirubin ( from hydrolysis of heme).  Bile contain water.

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.  Excretion of many drugs including sulfonamides. penicillin. Bile salts and certain waste products such as bilirubin and cholesterol are removed from body.  Foreign waste substances such as heavy metals and dyes can be withdrawn from the blood and excreted via biliary tract.  Calcium excretion from the body from liver to bile to gut to feaces. ampicillin and erythromycin.

cortisol. Removal of ammonia from blood and it conversion to urea. Conversion of hydrophobic substances into hydrophilic substances. aldosterone)  Detoxifying activity 2 types 1. . Kupffer cells loosely attached to epithelial cells of sinusoids. 2.  Kupffer cells = phagocytosis  Detoxication of various substances Metabolic products of intestine microbes Exogenous toxins (medicaments. poisons) Hormones (thyroxine. estrogen. alcohol.

prothrombin. Xlll.  Regulation of blood glucose level. IX (Christmas factor). Factors V. . Blood coagulation: Synthesis of most of the blood coagulating factors such as fibrinogen. Factor II (prothrombin).  Production of components of fibrinologic system namely plasminogen. VII (proconvertin). X (Stuart factor).  Embryonic hematopoieses. heparin.

fructose and lactic acid Synthesis of carbohydrate containing compounds: mucopolysaccharides .Glycogenolysis Glycolysis Glycogenesis lipogenesis Glyconeogenesis 10% from fat 50% from amino acids Conversion of galactose.

proteins.  Storage of vitamins and minerals. fats. . Metabolism and storage of carbohydrates.

 Glycolysis and glycogenesis in fed state. fast return when the blood concentration decreases = Glucose buffer function Gluconeogenesis and glycogenolysis in fasting state. storage.  Pentose phosphate pathway is source of the NADPH (reduction synthesis) and ribose (synthesis of nucleotides) .  Conversion of glactose and fructose to glucose.  Formation of many chemical compounds from intermediate products of carbohydrate metabolism. Storage of glycogen (1-4 %) removing excess of glucose from blood.

oxidation of fatty acids to supply energy for other body function.  Synthesis of large quantities of cholesterol (80% of cholesterol synthesized in the liver is converted into bile salts). phospholipids. and most lipoproteins  Fat synthesis from proteins and carbohydrate. Beta.  Inactivation of steroids and their excretion of the body .

 Synthesis of plasma proteins: (90% of all plasma proteins. up to 50 g of plasma proteins daily) ± not immunoglobulins ‚ Acute-phase proteins ‚ Albumin ‚ Clotting factors ‚ Steroid-binding and other hormone-binding proteins . Oxidative deamination of aminoacids.  Transamination of amino acids  Synthesis of important nitrogenous chemical compounds  Formation of urea for removal of ammonia from the body fluids.

thiamine and pyridoxine are stored and metabolized. Fat soluble vitamins A and D are stored in liver  Water soluble vitamins B12. .  Other B complex vitamins and vitamin C also stored.

. zinc and magnesium also stored.  60% of excess body iron is stored either as ferritin or hemosiderin (hepatic cell contains apoferritin and when excess of iron in the blood it forms ferritin) = blood iron buffer  Significant quantities of other minerals such as manganese. Storage of iron and Copper.

CIRRHOTIC LIVER .

HBV LIVER FIBROSIS .

Physical signs of cirrhosis .

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LIVER FUNCTION TESTS .

are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver. which include liver enzymes. Combinations of up to five tests are measured at the same time on a blood sample. .LIVER FUNCTION TESTS  Liver function tests (LFTs or LFs).  Liver function tests are used to detect liver damage or disease.

Anti HCV)  Test for specific liver diseas . SG & A/G ratio ) Other liver tests not included specifically in LFT are  Hepatitis test (IgM anti HAV. SA.HBs AG.LIST OF LFT     Amino transferases (ALT &AST) Cholestatic liver enzyme( ALP & GGT) Hepatic excretion ( Total Bilirubin) Protein test (TP.

transaminase)  some to identify conditions linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphatase). albumin)  To check cellular integrity (eg. .GENRAL PURPOSE OF LFTs Different tests are specific indicators:  TO check functionality (eg. Several biochemical tests are useful in the evaluation and management of patients with hepatic dysfunction.

USEFULNESS OF LFTs These tests can be used  To detect the presence of liver disease  To distinguish among different types of liver disorders  To gauge the extent of known liver damage  follow the response to treatment. . Some or all of these measurements are also carried out on those individuals taking certain medications.

These include: 1) jaundice 2)Nausea 3)loss of appetite 4)bloody or black bowel movements 5)unusual weight change. 8)One or more of these tests may be requested when a person has been or may have been exposed to a hepatitis virus 11) swelling or pain in the belly 12)fatigue or loss of stamina. 6)family history of liver disease 7)a drug that can cause liver damage. dark urine and light-colored bowel movements 9)vomiting and diarrhea 10) vomiting of blood .When are these tests requested?  These tests are used when symptoms suspicious of a liver condition are noticed. 13) excessive alcohol intake.

MEASUREMENT SIGNIFICANCE OF DIFFERENT TESTS .

cirrhosis.renal failure. intra hepatic neoplasm. alcoholic hepatitis  Alt is low----. extra hepatic obstruction  AST> ALT---. vitamin B deficiency 6 .AMINO TRANSFERASES Normal value range  Alanine aminotransferases (ALT)  Aspartate aminotransferases (AST)  10-35 U/L  10-35 U/L ALT-AST level for diagnosis  ALT> AST----acute hepatitis. hemolytic jaundice.

MCV ------Alcohol abuse ‡ GGT (10 times more)----Biliary obstruction ‡ GGT. AP(3 times more) -------Cholestasis . Alcohol abuse ALT MCV-----Liver damage ‡ GGT.Glutamyl transferases (GGT)  Alkaline phosphatase (AP)  5-36U/L  35-104U/L GGT level for diagnosis ‡ GGT.CHOLESTATIC ENZYME Normal value range  Gamma.

GALLBLADDER« .

STRUCTURE OF GALLBLADDER .

GALLSTONE FORMATION .

GALLSTONE BLOCKING COMMON BILE DUCT AND PANCREATIC DUCT .

PANCREAS« .

ANATOMY OF THE PANCREAS  Situated in the abdominal cavity with the head nesting in the curve of the duodenum. .  It weighs up to 100g and is 12 to 15 cm long. body and a narrow tail.  It is pale gray/pink gland that consists of a broad head.

FUNCTIONS OF THE PANCREAS ENDOCRINE FUNCTIONS EXOCRINE FUNCTIONS .

ENDOCRINE FUNCTION  Endocrine means excretion of substances directly into the bloodstream. . including insulin and glucagon.

EXOCRINE FUNCTIONS  Exocrine means the excretion of substances via ducts.  An aqueous alkaline solution (rich in NaHCO3) actively secreted by duct cells that line the pancreatic ducts.  The exocrine pancreas secretes a pancreatic juice consisting of two components:  Pancreatic enzymes actively secreted by the acinar cells. .

POSITION AND STRUCTURE OF THE PANCREAS .

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PANCREATITIS .

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