MLAB 2401: Clinical Chemistry

Keri Brophy-Martinez
Liver Anatomy and Physiology
Where is the Liver?
Upper right quadrant,
beneath the diaphragm
Largest internal organ
Weighs ~ 1500 grams
 Anatomy of the Liver
Consists of 2 lobes divided by falciform
ligament
There is no known difference between the
lobes
 Liver
Vascular organ
Hepatic artery
Supplies O2 rich blood
from heart to liver
Provides 20-30% of blood
supply to liver
Portal vein
Supplies nutrient rich From
blood from the digestive Aorta
tract
Provides 70-80% of blood
to liver From GI tract
 Microscopic Anatomy of the Liver
Lobules make up the
liver
6-sided structure
Central vein with portal
triads at each corner
Triad contains a hepatic
artery, portal vein and
bile duct surrounded by
connective tissue
Function in metabolic
and excretory actions
 Microscopic Anatomy of Liver
Cell types
Hepatocytes
70% of volume of liver
Regenerative
Perform major functions
of liver
Kupffer cells
Macrophages acting as
phagocytes
 Biochemical Function of the Liver
Excretion/Secretion
Synthesis
Detoxification
Storage
Immunologic
 Excretory System
Excretion of bile acids,
cholesterol, bilirubin

Begins at the bile

canaliculi, enters
hepatic ducts, then to
common hepatic & bile
duct
 Excretion/Secretion
Liver processes and excretes
Bile
Water, electrolytes, phospholipids, bile salts or acids,
bile pigments, cholesterol , heme waste products, and
other substances from blood
3L produced/day
1L excreted/day
Functions
Bile acids needed for fat absorption
Mechanism to remove cholesterol and waste
Bilirubin is the principal pigment in bile
Bilirubin Metabolism
 Metabolism of Bilirubin

Around 126 days, RBCs are phagocytized and hgb released

Hgb broken down into:

Heme
Converted to bilirubin
Globin
Broken into amino acids and recycled
Iron
Bound by transferrin and returned to iron stores in the
liver or bone marrow
 Metabolism of Bilirubin
Bilirubin
Bound by albumin and taken to liver (unconjugated or indirect
bilirubin)
Water insoluble
Can not be removed from body

Once at the liver, unconjugated bilirubin flows into sinusoidal tissue and
albumin releases it
Ligandin, picks up the unconjugated bilirubin and presents it to glucuronic
acid
In the liver it becomes conjugated with the help of UDP-glucuronyl
transferase
Water soluble
Combines with gallbladder secretions and expelled into intestines
 Metabolism of Bilirubin
Intestinal bacteria degrade conjugated bilirubin to form
urobilinogen
80% of urobilinogen formed is oxidized to stercobilin and
excreted in feces, giving stool the brown color
20% of urobilinogen formed
Absorbed by extrahepatic circulation to be recycled
through liver and re-excreted
Enters systemic circulation to be filtered by kidney and
excreted in urine
 Synthesis
Synthesize many biological compounds
Carbohydrates
Metabolism important
Uses glucose for its own cellular energy
Circulates glucose to peripheral tissue
Stores glucose as glycogen
Major player in maintaining stable glucose
concentration due to glycogenesis, glycogenolysis and
gluconeogenesis
 Synthesis
Lipids
Liver gathers free fatty acids from diet and breaks them
down to Acetyl- CoA to form triglycerides,
phospholipids or cholesterol
Converts insoluble lipids to soluble forms
70% of cholesterol produced by the liver
Proteins
Almost all proteins made in the liver
Exceptions are immunoglobulins and hgb
 Detoxification
Liver serves as a gatekeeper between the circulation and
absorbed substances
First pass: every substance absorbed in GI tract passes
through liver
Detoxification includes drugs and poisons, and metabolic
products like ammonia, alcohol, and bilirubin
3 mechanisms
Binds material reversibly to inactivate
Chemically modify compound for excretion
Drug metabolizer for detox of drugs and poisons
 Storage
Glycogen
Vitamins
Iron
Blood
 Immunologic
Phagocytosis of bacteria
IgA secretion
 References
Biofortified. (2012). Retrieved from
http://www.biofortified.org/2010/03/glowing-phagocytosis/
Bishop, M., Fody, E., & Schoeff, l. (2010). Clinical Chemistry:
Techniques, principles, Correlations. Baltimore: Wolters
Kluwer Lippincott Williams & Wilkins.
http://www.livercancer.com/liver_anatomy.html
Sunheimer, R., & Graves, L. (2010). Clinical Laboratory
Chemistry. Upper Saddle River: Pearson .