B6P4: The Liver Nia :)

1 Nia :)
Terms
Abdominal cavity: Body cavity that holds the bulk
of viscera (containing most of the digestive &
urinary systems along with some reproductive
organs). Located below (or inferior to) thoracic
cavity separated by the diaphragm, & above the
pelvic cavity. Also part of abdominopelvic cavity.
Hepatic lobule: A small division of the liver defined
at the histological scale.
Portal canal: Any of the various spaces in the liver
that contain CT & the branching of bile ducts,
portal vein, hepatic artery, nerves & lymphatics.
Sinusoid: Tiny endothelium-lined passage for blood
in the tissue of an organ. A small BV similar to a
capillary but with a discontinuous endothelium.
Jaundice yellowish coloration of sclera, skin &
mucous membranes due to a yellow compound,
bilirubin.

Basic
Portal triad: Branch of hepatic artery, bile duct,
branch of hepatic portal vein.
Gall bladder: pear-shaped sac located in a
depression of the posterior surface of liver. Hangs
from anterior-inferior margin of liver.
Liver: Largest mass of glandular tissue in the body,
largest internal organ (1.5kg, 2.5% of body weight).
Reddish-brown with 4 lobes of unequal size &
shapes.
Upper right & partially in upper left quadrants of
abdominal cavity, protected by ribcage.
Resting just below the diaphragm, lies to the right
of stomach, overlies the gallbladder.
Enclosed in capsule of fibrous CT (Glissons
capsule); a serous covering (visceral peritoneum)
surrounds capsule).
Gross structure
Right lobe may include an inferior quadrate lobe &
a posterior caudate lobe but belong to the left
lobe.

2 large lobes (right & left), 2 smaller lobes
(quadrate & caudate).
Apart from a patch where it connects to the
diaphragm (bare area), the liver is covered
entirely by visceral peritoneum serous covering:
*A thin, double-layered membrane that reduces
friction against other organs.
*Folds back on itself to form the falciform
ligament: Attaches the liver to the posterior
portion of the anterior body & the right & left
triangular ligaments.
The right & left coronary ligaments are narrow
extensions of parietal peritoneum that suspends
the liver from the diaphragm.
Falciform ligament: Visible on the front (anterior
side) of liver. Divides the liver into a smaller left
lobe & a larger right lobe.
Behind (visceral surface), there are 2 additional
lobes btwn the right & left: Caudate (the more
superior/ posterior) & quadrate (the more
inferior/ medial).
Divided up by: Ligamentum venosum &
ligamentum teres (A remnant of the umbilical vein
of foetus)
*Anything left of these is the left lobe
*Transverse fissure (porta hepatis) divides the
caudate from quadrate lobe.
*Right sagittal fossa, which the IVC runs over,
separates these 2 lobes from the right lobes.
IVC divides R lobe & caudate lobe.
The central area where the common bile duct,
hepatic portal vein & hepatic artery proper enter is
hilum/ porta hepatis. The duct, vein & artery
divide into left & right branches, & the portions of
the liver supplied by these branches constitute the
functional left & right lobes.

Embryology
Develops as an endodermal evagination from the
wall of the foregut to form hepatic diverticulum.
Diverticulum proliferates->hepatocytes ->arranged
in cellular liver cords -> parenchyma
B6P4: The Liver Nia :)


2 Nia :)
Stalk of hepatic diverticulum = common bile duct
Outgrowth from common bile duct = cystic
diverticulum -> gallbladder & cystic duct.
Functions
1. Produces circulating plasma proteins
Eg: Albumin Regulating plasma volume & tissue
fluid balance by maintaining plasma colloid
osmotic pressure.
Lipoproteins mostly VDLs transport of
triglycerides from liver to other organs.
LDLs transport cholesterol esters from liver to
other tissues.
HDLs remove cholesterol from peripheral tissues &
transport to liver.
Glycoprotein in iron transport haptoglobin,
transferrin, hemopexin
Prothrombin & fibrinogen
Non-immune alpha (a) & beta (B)-globulins
2. Uptake, storage, distribution of nutrients
& vitamins
*Vitamin A (retinol): When level decreases, liver
mobilizes its storage sites in hepatic stellate cells.
Vit. A is released into circulation in form of retinol
bound to retinol-binding protein (RBP). Liver also
synthesises RBP.
Night blindness & multiple skin disorders.
*Vitamin D (cholecalciferol): Important in Ca &
phosphorus metabolism.
Liver converts dietary Vit. D
3
TO 25-
hydroxycholecalciferol (predominant form).
Distributed to skeletal muscles & adipose tissue.
Rickets & disorders of bone mineralization.
*Vitamin K Hepatic synthesis of prothrombin &
other clotting factors.
Transported to liver with chylomicrons where it is
rapidly absorbed, partially used & partially
secreted with VLDL.
Hypoprothrombinemia & bleeding disorders.
3. Storage, metabolism & homeostasis of
iron
*Synthesis proteins involved in iron transport &
metabolism:
Transferrin: plasma iron transport protein.
Haptoglobin: Binds to HB in plasma, entire
complex is removed by liver to preserve iron.
Hemopexin: Transport of free heme in blood.
*Fe is stored in hepatocyte cytoplasm in form of
ferritin hemosiderin granules.
Hemochromatosis liver damage due to excessive
hemosiderin in hepatocytes.
4. Degradation of drugs & toxins
Liver converts substances into soluble forms to be
excreted by kidneys by phase I (oxidation)
hydroxylation (adding OH glycoprotein) &
carboxylation (-COOH glycoprotein).
Phase II (conjugation) conjugation with
glucuronic acid, glycine/ taurine.
5. Metabolic pathways
Glucose metabolism store excess glucose &
glycogen (glycogenesis) break down glucose.
Lipid metabolism Hepatocytes store triglycerides,
break down FA to generate ATP, synthesise
cholesterol & use cholesterol to make bile salts.
Protein metabolism Hepatocytes deaminate
(remove NH2 glycoprotein) from AA so that AA can
be used for ATP production/ converted to
carbohydrates/ fats. Resulting toxic ammonia
(NH3) is converted to less toxic area which is
excreted in urine.
6. Synthesis of bile salts
Used in small intestine for emulsification &
absorption of lipids.
7. Phagocytosis
Stellate reticuloendothelial (Kupffer) cells of liver
phagocytize aged RBCs, WBCs & bacteria.
8. Excretion of bilirubin
Bilirubin derived from heme of aged RBCs is
absorbed by the liver from the blood & secreted
B6P4: The Liver Nia :)


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into bile. Most of bilirubin in bile is metabolised in
small intestine by bacteria & eliminated in faeces.

Blood supply
As blood from GIT passes through liver as part of
hepatic portal circulation, liver is site of metastasis
of cancer that originates in GIT.
Portal triad: Collectivestructures of hepatic portal
vein, hepatic artery, bile duct. Located at corners
of liver lobules.

Hepatic artery Hepatic portal vein
-Oxygenated blood -Deoxygenated blood that
contain nutrients, drugs,
microbes & toxins from GIT.

Liver sinusoids (O2, nutrients & toxic substances
taken up by hepatocytes, products manufactured
by hepatocytes & nutrients needed by other cells
are secreted back into blood).
Central vein
Hepatic vein
Inferior vena cava
Right atrium of heart
Blood flow
It is connected to 2 large vessels:
*Hepatic artery carries oxygenated blood from the
aorta, supply arterial blood to liver, accounting for
25% of its blood flow.
*Hepatic portal vein carries (AS ABOVE) from small
intestine & the descending colon. Supplying
approx. 75% of livers blood supply, the hepatic
portal vein carries venous blood drained from the
spleen, GIT & its associated organs.
Oxygen is provided from both sources, approx. half
the livers demand is met by hepatic portal vein &
half is met by hepatic arteries.
Blood flows through the sinusoids.
O2, most nutrients, certain toxic
substances ate taken up by hepatocytes.
Manufactured products by hepatocytes &
nutrients needed by other cells are
secreted back into the blood.
Emties into the central vein of each
lobule. The central coalesce into hepatic
veins, which leave the liver & empty into
the IVC.

Histology (Liver is organised into functional units
Hepatic lobules)
Hexagonal arrangements of tissue surrounding a
central vein.
At each of the 6 outer corners are 3 vessels
hepatic artery, hepatic portal vein, bile duct.
Blood from both hepatic artery & portal vein flows
from periphery of lobule into sinusoids: Large
expanded capillary spaces which run btwn rows of
liver cells to central vein like spokes in bicycle
wheel.
1. Hepatocytes
Major functional cells of liver, specialized epithelial
cells with 5-12 sides that make up about 80% of
the volume of liver.
Form 3D arrangements (hepatic laminae) plates of
hepatocytes, one cell thick bordered by
endothelial-lined vascular spaces (hepatic
sinusoids).
Hepatic laminae highly branches, irregular
structures.
Arranged btwn sinusoids in plates 2 cells layer
thick, so each lateral edge faces a sinusoidal pool
of blood.
Central veins of all lover lobules converge to form
the hepatic vein, which carries blood away from
the liver.
Continuously secrete bile into bile canaliculus
which carry bile to small bile ductules, which
empty into a bile duct at periphery of each lobule.

2. Bile canaliculi
Thin bile-carrying channel.
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Grooves in cell membranes btwn neighbouring
hepatocytes provide space for canaliculi into which
hepatocytes secrete bile.
Bile canaliculi -> bile ductules -> bile ducts ->
(merging) larger right & left hepatic ducts ->
common hepatic duct -> (joins cystic duct from
gallbladder) common bile duct -> bile enters small
intestine to participate in digestion.
3. Hepatic sinusoids
Highly permeable blood capillaries btwn rows of
hepatocytes.
Branch of hepatic artery & hepatic portal vein:
converge & deliver blood into central vein ->
hepatic veins -> inferior vena cava (bile flows in
opposite direction).
Contains fixed phagocytes (stellate
reticuloendothelial Kupffer cells), destroy worn-
out WBC & RBC, bacteria & foreign matter in
venous blood draining from GIT.
4. Kupffer cells
Resident macrophagaes, located in the liver lining
the walls of the sinusoids that form part of
the reticuloendothelial system (RES).
Engulf & destroy old RBCs & bacteria that pass
through in the blood.

Gallbladder
Mucosa simple columnar epithelium arranged in
rugae resembling those in stomach.
Wall lacks submucosa.
Middle, muscular coat of wall consists of smooth
muscle fibres.
Contraction of smooth muscle fibres ejects the
contents of gallbladder into cystic duct.
Outer coat visceral peritoneum.
Function: Store & concentrate bile produced by
liver.
In concentration process, water & ions are
absorbed by gallbladder mucosa.