Liver- Position

Liver Introduction
Also called hepar
Largest gland in the body
Weighs about 1600 gm in males,1300 gm
in females
Occupies the right hypochondrium,
epigastrium & left hypochondrium
Most part of the liver is covered by ribs &
costal cartilages
External Features
Wedge shaped, resembles four sided
pyramid.
3 surfaces - Superior, posterior & inferior.
Inferior surface is well defined -also
called visceral surface
Inferior border is well defined & the other
borders are rounded
External featuresEx
Superior surface is attached to the
diaphragm and anterior abdominal wall by
falciform ligament and the free margin
contains ligamentum teres (obliterated
umbilical vein).
Inferior and posterior surfaces are divided
into four lobes namely right lobe, left lobe,
quadrate lobe & caudate lobe.
External Features
Lobes of Liver
Liver is divided into right & left lobes by
falciform ligament ,fissure for
ligamentum teres & fissure for
ligamentum venosum.
Right lobe is larger than left and has
caudate & quadrate lobes.
Lobes of Liver
Left lobe
Caudate lobe
Right lobe
Quadrate lobe
Porta Hepatis
Portahepatis, is the hilum
of the liver transmitting the
hepatic ducts, hepatic
artery and portal vein in
that order from before
backwards.
Lesser omentum extends
between porta hepatis and
the lesser curvature of
stomach.

Porta hepatis
Lobes of Liver
Liver is divided into right & left lobes by
falciform ligament ,fissure for
ligamentum teres & fissure for
ligamentum venosum.
Right lobe is larger than left and has
caudate & quadrate lobes.
Lobes of Liver
Left lobe
Caudate lobe
Right lobe
Quadrate lobe
Porta Hepatis
Portahepatis, is the hilum
of the liver transmitting the
hepatic ducts, hepatic artery
and portal vein in that order
from before backwards.
Lesser omentum extends
between porta hepatis and
the lesser curvature of
stomach.

Porta hepatis
Biliary Apparatus
Gall bladder.
Cystic duct.
Right and left hepatic ducts which unite to form
common hepatic duct.
Bile duct formed by the union of cystic duct
and common hepatic duct.
DUCT SYSTEM
Bile secreted by
liver carried to the
gall-bladder by the
cystic duct or
poured directly
into the duodenum
by the common
bile duct to aid
digestion
Functional Unit of Liver
Hepatic lobules
Hexagonal structures,
with six portal triads at
the corners of the
lobules and a central
vein in the middle
Connective tissue
capsule (Glissons
capsule) is scanty

Functional Unit
Each lobule is made of cords of liver cells
(hepatocytes) separated by sinusoids

Cells are arranged in plates which branch
& anastomose

Periphery of each lobule has angular
intervals called portal canals containing
branch of portal vein, hepatic artery &
interlobular bile duct forming a portal triad

Hexagonal lobules of liver with hepatocytes

21
Portal triad

22
Cell Types in Liver

Central vein: In the
center of the lobule.
Receives blood from
the sinusoids.
Kupffer cells:
Reticuloendothelial
cells in the walls of the
sinusoids of the liver
The Kupffer cells are
phagocytic cells which
destroy worn- out wbc,
rbc , bacteria &
foreign matte

24
Central vein
Kupffer cells:
Pathway of bile within the liver
Bile originates as secretions from the hepatocytes, which
collect in channels called
Bile canaliculi (tiny passages contained within each cord.)
Canal of Hering, bile ductules at the periphery of classic
liver lobules
Bile duct- located in the portal areas
CoH: Canal of Hering.
Functional Units of Liver

Classic Lobule
Portal Lobule
Hepatic Acini (Rappaport)
- a direct correlation between
blood supply and metabolism

Classic Lobule
Model- Anatomical

Hexagonal in shape with
the portal triads.at the
periphery and central vein
at the centre.
Portal lobules
Triangular in shape, centered around the portal triad
Based on bile flow
In this concept of liver lobulation, the bile duct is in the
centre of the lobule
Bile duct
Hepatic acinus (of Rappaport)
Based on blood flow
The smallest functional unit of the liver, a mass of liver
parenchyma that is supplied by terminal branches of the
portal vein and hepatic artery and drained by a terminal
branch of the bile duct (portal triad vessels).
Diamond- shaped region encompassing triangular
sections of two adjacent classic liver lobules with apices
that are the central vein.
The liver (portal) acinus
provides the best
correlation among blood
perfusion, metabolic
activity, and liver pathology.
General Metabolic Functions

Carbohydrate metabolism
Maintainence of the blood glucose level:
Glycogenesis (glycogen synthesis), storage
Glygenolysis (glycogen breakdown)
Gluconeogenesis
General Metabolic Functions
Protein Metabolism
Synthesis of most palsma proteins such
as albumin & transport proteins
Deamiation of amino acids & formation of
urea

General Metabolic Function
Lipid metabolism
Oxidation of fatty acid to ketone bodies
Synthesis of cholesterol & cholesterol
esters
Synthesis of
lipoproteins,triglycerides,phospholipids
synthesis of bile acids



Cholesterol metabolism
1. Synthesizes cholesterol and releases it
into the blood
2. Secretes plasma cholesterol into the
bile
3. Converts plasma cholesterol into bile
salts

Synthetic Functions
Hepatocytes synthesize:
plasma proteins except immunoglobulins
most coagulation factors such as fibrinogen
& factorII,V,VII,IX,X XI, XII)
Cholesteterol , lipoproteins (VLDL,HDL)
primary bile acids

Storage of Vitamins
Hydroxylation of calciols to calcidiols,
splitting of carotene to retinol
The liver represent a store of lipophilic
vitamins and cobalamin (B12)
Detoxification and Excretion
Substances that are inactivated & excreted by
the liver include:
Bilirubin
Bile acids
Steroid hormones
Many drugs
Toxins


Transformation of hormones

inactivation of steroid hormones
hydrogenation, conjugation
inactivation of insulin and glucagon
inactivation of catecholamines and
iodothyronines - conjugation
dehydrogenation of cholesterol to 7-
dehydrocholesterol and
25-hydroxylation of calciols play an essential role
in calcium homeostasis
Metabolism of bilirubin
Bilirubin is potentially toxic catabolic
product of heme metabolism.
When Hb degraded- polypetides are
degraded to aminoacids while the heme
group are freed of their iron- salvaged
and converted to bilirubin.
Metabolism of bilirubin
Approximately 300-400 mg of heme are
degraded in the human body/day


Formation & Excretion of bilirubin
Aged & Damaged
RBCs
Haemoglobin
Haem
Globin
Unconjucated
Bilirubinn(UB)
Albumin.UB
BLOOD
RETICULOENDOTHELIAL
SYSTEM
LIVER
LIVER CELL UPTAKE by ligandin
Conjugation with Glucuronyl transferase
Bilirubin glucuronide
GUT
Common Bile Duct
Excretion into the bile
bacterial flora
KIDNEY
Conjugated Bilirubin
Faecal Urobilinogen
Enterohepatic circulation
Urinary
Urobilinogen
BLOOD Albumin.UB
LIVER
Elevation of serum bilirubin cause
jaundice
Hyperbilirubinemia:
Increased plasma concentrations of bilirubin
(> 3 mg/dL) occurs when.?
There is an imbalance between its
production and excretion.
Either unconjugated bilirubin or conjugated
bilirubin or both are elevated
All types of hyperbilirubinemia lead to the
deposition of bilirubin in the tissues, skin
and sclera of the eye which it imparts yellow
colour.
This condition is called jaundice or icterus

Jaundice

The sclera of the eye is affected early-
because of its high content of elastin
for which bilirubin has high affinity.
Types of jaundice:
Prehepatic
Intrahepatic
Post hepatic (obstructive)


Jaundice