Anatomy and Physiology

The liver is a reddish brown organ with four lobes of unequal size and shape. A human liver normally weighs 1.441.66 kg (3.23.7 lb), and is a soft, pinkishbrown, triangular organ. It is both the largest internal organ (the skin being the largest organ overall) and the largest gland in the human body. It is located in the right upper quadrant of the abdominal cavity, resting just below the diaphragm. The liver lies to the right of the stomach and overlies the gallbladder. It is connected to two large blood vessels, one called the hepatic artery and one called the portal vein. The hepatic artery carries blood from the aorta, whereas the portal vein carries blood containing digested nutrients from the entire gastrointestinal tract and also from the spleen and pancreas. These blood vessels subdivide into capillaries, which then lead to a lobule. Each lobule is made up of millions of hepatic cells which are the basic metabolic cells. Lobules are the functional units of the liver. The gallbladder is a hollow system that sits just beneath the liver. In adults, the gallbladder measures approximately 8 centimetres (3.1 in) in length and 4 centimetres (1.6 in) in diameter when fully distended. It is divided into three sections: fundus, body and neck. The neck tapers and connects to the biliary tree via the cystic duct, which then joins the common hepatic duct to become the common bile duct. At the neck of the gallbladder is a mucosal fold called Hartmann's pouch, where gallstones commonly get stuck. The angle of the gallbladder is located between the costal margin and the lateral margin of the rectus abdominis muscle. When food containing fat enters the digestive tract, it stimulates the secretion of cholecystokinin. In response to CCK, the adult human gallbladder, which stores about 50 millilitres (1.7 U.S. fl oz; 1.8 imp fl oz) of bile, releases its contents into the duodenum. The bile, originally produced in the liver, emulsifies fats in partly digested food. During storage in the gallbladder, bile becomes more concentrated which increases its potency and intensifies its effect on fats.

The duodenum is largely responsible for the breakdown of food in the small intestine, using enzymes. Brunner's glands, which secrete mucus, are found in the duodenum. The duodenum wall is composed of a very thin layer of cells that form the muscularis mucosae. The duodenum is almost entirely retroperitoneal. The common bile duct (ductus choledochus) is a tube-like anatomic structure in the human gastrointestinal tract. It is formed by the union of the common hepatic duct and the cystic duct (from the gall bladder). It is later joined by the pancreatic duct to form the ampulla of Vater. There, the two ducts are surrounded by the muscular sphincter of Oddi. The sphincter of ampulla or sphincter of Oddi is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the ampulla of Vater into the second part of the duodenum. It is named after Ruggero Oddi. The sphincter of Oddi is relaxed by the hormone Cholecystokinin (CCK) via vasoactive intestinal polypeptide (VIP). When the sphincter of Oddi is closed, newly synthesized bile from the liver is forced into storage in the gall bladder. When open, the stored and concentrated bile exits into the duodenum. This conduction of bile is the main function of the common bile duct. The hormone cholecystokinin, when stimulated by a fatty meal, promotes bile secretion by increased production of hepatic bile, contraction of the gall bladder, and relaxation of the Sphincter of Oddi. The hepatic duct is part of the biliary tract that transports secretions from the liver into the intestines. It carries more volume in people who have had their gallbladder removed. The cystic duct is the short duct that joins the gallbladder to the common bile duct. It usually lies next to the cystic artery. It is of variable length. It contains 'spiral valves of Heister,' which do not provide much resistance to the flow of bile.