Bdsmed102 68

Course Code: BDSMED102
Course Title: General Human Physiology
Course Leader
Dr Ambarish
E Mail:ambarish@yahoo.co.in
1
Faculty of Dental Sciences © Ramaiah University of Applied Sciences
Lecture- 68-Liver Functions and Tests
- Intended Learning Outcome
2
Liver Functions and Tests
3
Functional Anatomy
• Functional Anatomy is now recognized based upon

the studies of vascular and biliary casts made by
injecting vinyl into the vessels and bile ducts.
• This classification correlates with the imaging

techniques.
• EACH SEGMENT is supplied by an independent portal

pedicle which forms the basis of sublobar resections.
4
Portal Traid
5
Functional Anatomy Continued…..
• CANTLIE, s LINE divides the liver into right

and left lobes.
• RIGHT LIVER--
– Right hepatic vein divides into sectors:
– anterior {SEGMENTS V & VIII}
– posterior {segments VI & VII}.
• LEFT LIVER--
– Umbilicus fissure divides into sectors
– Medial {segments IV}
– Lateral {segments II & III} 6
Main Portal Vein
• Right • Left
Anterior - V and VIII • Medial -- IV
Posterior - VI and VII • Lateral -- II and III
• Segment I is
separate and
drains directly into
inferior venacava
not through
hepatic vein.
7
Cells In Liver
• Hepatocytes
• Sinusoidal cells
– Endothelial cells
– Kupffer cells
– Hepatic stellate cells/Ito cells.
– Pit cells.
• Approximately 202 x 103 cells in each mg of the
liver of which 171 x 103 are parenchymal and 31x
103 is littoral (sinusoidal).
8
Kupffer Cells
• Highly mobile macrophages. Attached to the

endothelium – particularly in the pre-portal area.
• Ito cells also called Fat storing cells /lipocytes/hepatic
stellate cells. Present in the sub-endothelial space of
disse.
• Pit cells: Highly mobile liver-Intended natural killer
lymhocytes .
9
Principle Functions of liver
1. Formation and secretion of bile.
2. Nutrient and vitamin metabolism : Glucose and
other sugars , Amino acids , Lipids , vitamins
3. Inactivation of various substances: Toxins , Steroids
4. Synthesis of plasma proteins
5. Immunity: Kupffer cells
10
Synthetic Functions
ENZYMES CLOTTING FACTORS

Fibrinogen , I
Alkaline phosphatase Prothrombin , II
SGOT Factor V
SGPT VII
SICD IX
X
Normal:5-13 KA unit
Normal:5-40 units%
11
Synthesis
UREA CHOLESTEROL
Liver removes ammonia from It is synthesized from the
the body to synthesize urea. acetate.
N- 20 – 40 mg%
Plasma proteins
N- 150 – 240 mg%
12
Metabolic
ON CARBHOHYDRATE METABOLISM PROTEIN METABOLISM

Glucogenesis Liver Synthesize
Glycogenolysis Plasma proteins
Glyconeogenesis Blood clotting factors
Enzymes
Urea
Regulate the blood glucose level. Lipoprotein from aminoacids.
N- 80 – 120 mg/dl.
Pre – hepatic coma. N- AA – 30 -65 mg/dl
13
On Fat Metabolism
Metabolism Synthesis
Lipoproteins
Helps in B-Oxidation of fatty acids to  HDL, LDL, VLDL, Chylomicrons
active acetate i.e., aceto – acetate. Saturated fatty acids
 From acetate via krebs cycle
Non-esterified fatty acids
Reach liver via blood are esterified
to form trigycerides in liver. Cholesterol and phospholipids
for cell membrane.
 Lecithin, sphingomyelin, cephalin
Fatty liver and cirrhosis-portal etc
hypertension.
14
Liver Functions - Continued…..
Excretion Neutralization
 It removes many drugs, Bile is the reservoir of
toxins, bile pigments and alkali which neutralize
various inorganic substances the acid
e.g ., Copper,
chyme from the stomach.
Zinc, mercury.
15
Miscellaneous Functions Of Liver
Storage organ Hormone inactivation

Glycogen, fat, protein, Cortisol, aldosterone, insulin,
vitamins(A andB12),substances glucagon, testosterone and
concern wit blood formation thyroxine.
and regeneration of blood.
16
Liver Function Tests: Assess The Synthetic Functions
Of Liver
Tests to reversal of A/G ratio:Thymol turbidity test
Tests for coagulability of blood
Liver enzymes estimation
Blood urea estimation
Blood ammonia
Urine ammonia
17
Liver Function Tests : Tests to assess metabolic
functions of liver
For carbohydrate metabolism For fat metabolism

 Galactose tolerance test S. cholestrol
 Blood glucose estimation S. triglyerides
 For protein metabolism S. phospholipids
 Estimation of blood amino Total lipids
acid level S. ketone bodies
 urine examination
18
Liver Function Tests :
Assess bile secretory capacity Assess detoxicating power of liver

Total serum bilirubin Hippuric acid excretion tests
Urine bilirubin and bile salts Bromosulphalein excretion
Urine urobilinogen tests
Faecal stercobilinogen
Faecal fat estimation Miscellaneous tests
Isotope scan
Ultra sound scan
Cat scanning
Liver biopsy
19
Bile-Introduction
• Total output : 600 to 1000 ml /day.

• It is golden yellow in colour
due to bile pigments –biliverdin and bilirubin.
• Some components of the bile are reabsorbed in the
intestine and then excreted again by the liver.
(enterohepatic circulation).
• The entire pool recycles twice per meal and 6-8 times
/day.
20
Composition of Bile
Composition of human hepatic duct bile.

Water 97.0%
Bile salts 0.7%
Bile pigments 0.2%
Cholesterol 0.06%
Inorganic salts 0.7%
Fatty acids 0.15%
Lecithin 0.1%
Fat 0.1%
Alkaline phosphatase . . .
21
Difference Hepatic And Gall Bladder Bile
Hepatic BILE GB BILE
pH 7.0 - 8.6 6.8 – 7.8
Sp. Gr 1.008- 1.016 upto 1.059
Water % 97 89
Bile salts g % 1.0 6.0
Bile pigments 0.05 0.3
Cholesterol 0.1 0.6
Lecithin 0.05 0.3
Mucin 0.5 3.0
Na+ mEq / L 145 130
K+ 5 12
Ca++ 5 23
Cl - 100 25
HCO3- 28 10
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Bile salts
23
Bilurubin- Enterohepatic Circulation
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Bile - Functions
Bile salts and acids Bilurubin

Helps in Conjugation of free bilurubin, bile
Activation of lipase. pigments with UDPGA( uridine
Emulsification of fats. diphosphate glucuronic acid) in
the presence of glucuronyl
transferase to form water
Help in digestion and solubles bilurubin
absorption of fats. glucunorides.
Help in absorption of fat
soluble vitamins. Hepatic jaundice.
Steatorrhoea
25
Summary
• Liver is the metabolic factory of the body.

• Liver synthesizes several biomolecules like
enzymes , proteins, lipids.
• Bile is secreted by hepatocytes.
• Bile is necessary for fat digestion.
• Abnormalities of the liver can be assessed by liver
function tests.
26
Disclaimer
All data and content provided in this

presentation are taken from the
reference books, internet – websites
and links, for informational purposes
only.
27

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Course Code: BDSMED102

Course Title: General Human Physiology

• Functional Anatomy is now recognized based upon

• This classification correlates with the imaging

• EACH SEGMENT is supplied by an independent portal

• CANTLIE, s LINE divides the liver into right

• Highly mobile macrophages. Attached to the

ENZYMES CLOTTING FACTORS

N- 150 – 240 mg%

ON CARBHOHYDRATE METABOLISM PROTEIN METABOLISM

Storage organ Hormone inactivation

For carbohydrate metabolism For fat metabolism

Assess bile secretory capacity Assess detoxicating power of liver

• Total output : 600 to 1000 ml /day.

Composition of human hepatic duct bile.

Bile salts and acids Bilurubin

• Liver is the metabolic factory of the body.

All data and content provided in this

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