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The structure of the liver

The liver is a large, grandular organ weighing approximately 1.5 kg in the adult. It is
composed of the right and left lobe. The left lobe contains two lobes called the
quadrate and caudate lobes. The lobes consist of many lobules that perform the
functions of the liver. The lobules process many substances in the hepatocytes,
parenchymal cells of the liver. The venous blood supply carried by a branch of the
portal veins carries highly concentrated foodstuffs, including fats,carbohydrates, and
proteins that have ben absorbed from the small intestine. The arterial blood supply
provides high concentrations of oxygen for the metabolism of these substances. The
lobules are composed of sinusoids, rows of cuboidal hepatocytes , bile capillaries and
branches of the hepatic artery and portal vein. The sinusoids and surroundings
hepatocytes process the raw materials delivered to the liver from the small intestine.
The sinusoids are lined with cells of the clear phagocyte system, which are called
Kupffer cells. The porous endothelial lining allows plasma proteins to pass from the
sinusoid to narrow space around the hepatocyte called the space of Disse. This space
connects with the lymphatic system and allows drainage of plasma proteins and
excess fluid.
Within the liver lobules are canaliculi, which hold the bile procduced by the
hepatocytes . a mesh work of bile ducts forms from the canaliculi and terminates
eventually in the common bile duct, which empties into the duodenum during
digestion. The gallbladder receives bile from the liver and then stores, concentrates,
and releases it into the common bile duct under appropriate stimulation.
Left lobe
Right lobe

Inferior vena cava

Gall bladder
Front View

Portal vein

Hepatic Artery

Back View
Left Lateral View

Right Lateral View


Common hepatic duct
Common bile duct

Top View

Cystic duct

Bottom View
BLOOD SUPPLY
Blood is supplied to the liver through divisions of the hepatic artery end portal
vein, which pass through the complex sinusoidal network to form venules and veins.
An admixture of venous and arterial blood is carried into the sinusoids, which are the
capillaries of the liver and provide both oxygen and nutrients to be processed. The
venules and veins terminate in the hepatic vein, which empties into the inferior vena
cava. The liver requires access to a large quantity of the circulation; about 30 % of the
cardiac output flows through the liver each minute, making this organ a large
reservoir for blood. Even with its large volume and flow, the pressure in the portal
system remains low. The liver can distend and increase its volume by a great margin
before portal pressure increases.
 
FUNCTION OF THE LIVER
The liver performs a wide variety of vital, life sustain functions. The hepatocyte
is responsible for maintaining these functions through its numerous organelles. The
liver has over 500 functions
 
PROTEIN SYNTHESIS AND METABOLISM
The liver is critical in protein metabolism through its deamination of amino
acids, urea formation, and ammonia removal , plasma protein formation, and
interconversion among the different amino acids. About 90 % of all the plasma
proteins are formed in the liver cells. Maximally the liver can form 15 to 40 g of
protein per day. Unlike fats and carbohydrates proteins are not stored, and the size of
the amino acid pool is the result of the actual turnover of the body proteins and amino
acids from exogenous or dietary sources.
SYNTHESIS OF AMINO ACIDS
The liver takes up amino acids from the nutrient- rich portal blood converts them various proteins. The amino
acids are relatively strong acids that rarely accumulate in the bloodstream. Most amino acids are actively transported
through the cell membranes and then converted into cellular proteins after an enzymatic reaction. These cellular
proteins can be transported out of the cells to the bloodstream. The amount of amino acids in blood remains fairly
constant but may vary slightly with diet and the individual person. After the cells have reached their capacity for
storing proteins the excess amino acids can be degraded and used as energy or changed into fat or glycogen and
stored.

AMINO ACID METABOLISM


The liver is the major site of amino acid metabolism and the process called deamination of amino acids results
in the formation of ammonia. Deamination of amino acids is required before they can be used for energy or for
conversion to fats or carbohydrates. Large amounts of ammonia are formed from amino acids and also from bacterial
action in the large bowel. The ammonia formed in the bowel is transported to the liver in the bloodstream. The liver
normally removes 80 % of ammonia as blood passes through the portal system. The liver then converts the ammonia
to urea which is much less toxic to the nervous system and is more readily excreted by the kidneys than is ammonia

SYNTHESIS AND METABOLISM OF PLASMA PROTEINS


Plasma proteins mainly synthesized in the liver are large molecules that circulate for the most part in the
blood. Albumin the most abundant plasma protein is made in the liver. It serves many function including binding
substances such as bilirubin and barbiturates in the plasma. Albumin is the principal protein necessary for maintain
colloid osmotic pressure. Also binds hydrogen ions alters serum pH.
When the amino acids in blood are decreased the plasma proteins are split to make new amino acids to
maintain equilibrium. Decreased levels of amino acids stimulate the liver to increase it’s production of plasma
proteins. The concentrations of plasma proteins normally remains at a constant ration with more albumin in plasma
than globulin. The globulins consist of about 15 % plasma protein and are protein group to which antibodies
produced by B lymphocytes belong.
The liver also synthesizes most of the plasma proteins necessary to coagulate blood including prothrombin ,
the liver uses Vitamin K , the absorption of which depends on the production of bile. Fibrinogen is a large molecule
protein formed entirely by the liver and is part of the coagulation cascade.
FAT AND LIPID METABOLISM
The liver oxidizes fatty acids through beta oxidation in the mitochondria. This process
provides energy for other cells through the formation of acetylcoenzyme A which enters the citric
acid cycle and releases large quantities of energy . the liver also forms ketone bodies which provide
energy in certain conditions such as diabetes mellitus and starvation.
The liver synthesizes almost all of the fat from carbohydrates and protein. The fats are mostly
in the form of triglycerides which consist of three molecules of fatty acid and glycerol. Once formed
these are transported to fat cells in the form of very low –density lipoproteins (VLDL). When lipids
are released from VLDL, their structure changes and they become low-density lipoproteins (LDL)
and returned from the liver. The LDL is the form of all most of the total cholesterol of the form of
plasma. Cholesterol, synthesized in the liver, is used to form bile salt which is important in the
absorption of fats in the small intestine. Cholesterol is also used to form steroid hormones.
Additionally, phospholipids consisting of phosphoric acid and fatty acids are synthesized in the
liver. Both cholesterol and phospholipids are used by the body to form cellular structures and
membranes. High-density lipoproteins (HDL) are formed by the liver to scavenge excess cholesterol
and triglycerides.

CARBOHYDRATE METABOLISM
Carbohydrate may be released by the liver in its usable form, glucose, after it has been stored
in the form of glycogen. About 5% to 7% of normal liver weight is stored glycogen. When blood
glucose increases above normal, glycogens is stimulated, this promotes the release of glucose level.
Glycogenolysis is the breakdown of glycogen into glucose.
PATHOPHYSIOLOGY OF ASCITES
The mechanism responsible for the development of ascites are not completely
understood. Portal hypertension and the resulting increase in capillary pressure and
obstruction of venous blood flow through the damaged liver are contributing factors.
The failure of the liver to metabolize aldosterone increases sodium and water retention
by the kidney. Sodium and water retention, increased intravascular fluid volume, and
decreased synthesis of albumin by the damage liver all contribute to fluid moving from
the vascular system into the peritoneal space. Loss of fluid into the peritoneal space
causes further sodium and water retention by the kidney in an effort to maintain the
vascular fluid volume, and the process become self-perpetuating.
As a result of liver damage, large amounts of albumin-fluid, 15L or more, may
accumulate in the peritoneal cavity as ascites. With the movement of albumin from the
serum decreases. This combined with increased portal pressure, results in movement of
fluid into the peritoneal cavity.

CLINICAL MANIFESTATION
Increased abdominal girth and rapid weight gain are common presenting symptoms
of ascites. The patient maybe short of breath and uncomfortable from the enlarged
abdomen, and striae and distended veins maybe visible over the abdominal wall. Fluid
and electrolyte imbalances are common.