ANATOMY AND PHYSIOLOGY

Liver
The liver is the largest glandular organ in the body; its office is to secrete bile. It is oblong and
oval in shape, and occupies the position on the right side, under the lower ribs. Metabolized
carbohydrates, protein and fats and it have production of bile salts. It detoxification of
endogenous and exogenous substances Blood reservoir and ammonia, steroids and vitamin
ADEK. They have excretion of adrenal cortex hormone. It storage of vitamins such as Vitamin A
and D. it Bilirubin metabolism and the Phagocytosis by kupffer cells. As a brief introduction, the
liver has two primary functions, producing bile and producing insulin. For now, the insulin
production that leads to maintaining proper blood sugar levels is of little importance. After the
liver produces bile, it sends it to the gallbladder and the small intestine along the same pathway,
the ducts (hepatic, cystic and common bile ducts).
Spleen
It Acts as reservoir of red blood cells and sequesters the old, worn-out RBCs thereby removing
them from the circulation
Gall Bladder
The gall bladder serves as a holding tank for bile that is used to digest a particularly large or fatty
meal. It served a great function when humans are rare, but extremely large and uncooked meals
of animal flesh. Now, other than the fast food epidemic, the liver secretes enough bile to handle
typical meals and so the gallbladder could be removed without any real medical consequences.
Physically, the gallbladder is fairly small (4 cm or 2 in.) and is lodged almost entirely in the side
of the liver.
Is a pear shaped organ located on the liver that stores bile. It store and concentrates the (greenish
liquid composed of water, cholesterol, bile salts, electrolyte and phospholipids) produce by the
liver. It Important in fat emulsification and intestinal absorption of fatty acids, cholesterol and
other lipids
Cystic Duct
Short duct that joins the gall bladder to the common bile duct. The Bile can flow in both
directions between the gallbladder and the common hepatic duct and the (common) bile duct.
hepatic and the cystic ducts are fairly short and primarily move the bile from the liver to the
gallbladder. At that point, they seem to merge to become the common bile duct, which passes
into the beginning of the small intestine, an area called the duodenum.
Pancreas
The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the
stomach. This is a fairly large and complex organ whose primary purpose appears to be creating
enzymes for digestion. After it produces these enzymes, it then secretes them into the duodenum
(fancy word for start of the small intestine) at the same or nearly the same point as the common
bile duct from the liver and gallbladder.

As a brief introduction, the liver has two primary functions, producing bile and producing
insulin. For now, the insulin production that leads to maintaining proper blood sugar levels is of

little importance. After the liver produces bile, it sends it to the gallbladder and the small
intestine along the same pathway, the ducts (hepatic, cystic and common bile ducts).
Pancreatitis is caused when the pancreatic duct is blocked and therefore, the enzymes upset the
balance of the pancreas and cause swelling and digestion of the organ itself. Clearly not a good
thing.
.
Neonatal Hyperbilirubinemia or Neonatal Jaundice is one of the most common problems
encountered in term newborns. Although up to 60 percent of term newborns have clinical
jaundice in the first week of life. Jaundice is considered pathologic if it presents within the first
24 hours after birth.
ABO incompatibility is a reaction of the immune system that occurs if two different and not
compatible blood types are mixed together. ABO incompatibility disease afflicts newborns
whose mothers are blood type O , and who have a baby with type A, B, or AB.
Ordinarily, the antibodies (IgG) against the foreign blood types A and B that circulate in mother's
bloodstream remain there, because they are of a type that is too large to pass easily across the
placenta into the fetal circulation. Some fetal red cells always leak into mother's circulation
across the placental.These fetal red cells stimulate the formation of a smaller type of anti-A or
anti-B antibody which can pass into the baby's circulation and there cause the destruction of fetal
red cells. The increased rate of destruction of red cells causes a subsequent increase in waste
product production. This excess waste product, bilirubin, can overwhelm the normal waste
elimination processes and lead to jaundice, the presence of excess bilirubin. .
During the pregnancy, the placenta excretes bilirubin. When the baby is born, the liver of
the baby must take over this function. There are several causes of hyperbilirubinemia and
jaundice, including (1) Physiologic Jaundice this is normal response to the babys limited
ability to excrete bilirubin in the first days of life. The manifestation of jaundice is after 24 hours
(2) Pathologic Jaundice this may be related to inadequate liver function due to infection or
other factors. The manifestation of jaundice is within 24 hours (3) Breast milk Jaundice about
2% of the breastfed babies develop jaundice after the first week. Some develop breast milk
jaundice in the first week due to low calorie intake or dehydration and (4) Jaundice from
hemolysis jaundice may occur with the breakdown of RBCs due to hemolytic disease of the
newborn (RH disease), having too many RBCs or bleeding.

Metabolism of Bilirubin
Bilirubin is a byproduct of destruction of aged red blood cells. It gives bile a greenish
black color and produces the yellow tinge of jaundice.
Aged red blood cells are taken up anddestroyed by macrophages of the mononuclear phagocyte
system, primarily in the spleen and liver. (In the liver these macrophages are Kupffer cells.)
Within these cells, hemoglobin is separated into its component parts heme and globin.
The globin component is further degraded into its constituent amino acids, which are
recycled to form new protein. The heme moiety is converted to biliverdin by the enzymatic
cleavage of iron. The iron attaches to transferrin in the plasma and can be stored in the
liver or used by the bone marrow to make new red blood cells.
The biliverdin is enzymatically converted to bilirubin in the macrophage of the mononuclear
phagocytic system and then is released into the plasma.
In the plasma, bilirubin binds to albumin and is known as unconjugated bilirubin,or free
bilirubin, which is lipid soluble.

In the liver, unconjugated bilirubin moves from plasma in the sinusoids into the hepatocyte.
Within hepatocytes it joins with glucuronic acid to form conjugated bilirubin,which is water
soluble.
Conjugation transforms bilirubin from a lipidsoluble substance that can cross biologic
membranes to a water-soluble substance that can be excreted in the bile.
When conjugated bilirubin reaches the distal ileum and colon, it is deconjugated by bacteria
and converted to urobilinogen.
Urobilinogen is then excreted in the urine as urobilin; a small amount is recirculated back into
the liver and eliminated in feces.

REFERENCES:

WEBSITE:
http://www.nlm.nih.gov/medlineplus/ency/article
http://labtestsonline.org
http://www.merckmanuals.com

BOOKS:
Wongs Nursing Care of Infants and Children, Eight Edition
Nurses pocket guide by Doenges et al.