Liver

Liver is a dual organ having both secretory and

excretory functions. It is the largest gland in the
body, weighing about 1.5 kg in man. It is located in
the upper and right side of the abdominal cavity,
immediately beneath diaphragm.
 STRUCTURE

• The lobes of the liver are made up of tiny

functional units, called lobules.
• The lobule is a honeycomb-like structure and it
is made up of liver cells called hepatocytes.
• Hepatocytes are arranged in columns, which
form the hepatic plates. Each plate is made up
of two columns of cells.
• In between the two columns of each plate lies a
bile canaliculus.
• In between the neighboring plates, a blood space
called sinusoid is present.
• The cells lining the sinusoids are hepatic macrophages
(kupffer cells).
• Portal Triads-Each lobule is surrounded by many
portal triads. Each portal triad consists of three
vessels:
• 1.A branch of hepatic artery
• 2. A branch of portal vein
• 3. A tributary of bile duct.
• Branches of hepatic artery and portal vein
open into the sinusoid. Sinusoid opens into
the central vein. Central vein empties into
hepatic vein.
• Bile is secreted by hepatic cells and emptied
into bile canaliculus.
• From canaliculus, the bile enters the tributary
of bile duct.
 BLOOD SUPPLY TO LIVER
• Liver receives maximum blood supply of about
1,500 mL/minute.
• It receives blood from two sources, namely the
hepatic artery and portal vein.
• HEPATIC ARTERY-
• Hepatic artery arises directly from aorta and
supplies oxygenated blood to liver.
• After entering the liver, the hepatic artery divides
into many branches. Each branch enters a portal
triad.
• PORTAL VEIN-
• It brings deoxygenated blood from stomach,
intestine, spleen and pancreas.
• Portal blood is rich in monosaccharides and
amino acids.
• It also contains bile salts, bilirubin,
urobilinogen and GI hormones. The oxygen
content is less in portal blood.
• Flow of blood from intestine to liver through
portal vein is known as enterohepatic
circulation.
• The blood from hepatic artery mixes with
blood from portal vein in hepatic sinusoids.
Hepatic cells obtain oxygen and nutrients from
the sinusoid.
• HEPATIC VEIN-
• Substances synthesized by hepatic cells, waste
products and carbon dioxide are discharged into
sinusoids.
• Sinusoids drain them into central vein of the
lobule.
• Central veins from many lobules unite to form
bigger veins, which ultimately form hepatic veins
(right and left) which open into inferior vena cava.
 PROPERTIES AND COMPOSITION OF BILE

• PROPERTIES OF BILE-
• Volume Reaction : 800 to 1,200 mL/day
• Reaction: Alkaline
• pH : 8 to 8.6
• Color : Golden yellow or green
• COMPOSITION OF BILE-
• Bile contains 97.6% of water and 2.4% of solids.
Solids include organic and inorganic substances.
• SECRETION OF BILE-
• Bile is secreted by hepatocytes.
• STORAGE OF BILE-
• Most of the bile from liver enters the gallbladder,
where it is stored. It is released from gallbladder
into the intestine whenever it is required.
• When bile is stored in gallbladder,it undergoes
many changes both in quality and quantity such
as:
• 1.Volume is decreased because of absorption of
a large amount of water and electrolytes (except
calcium and potassium)
• 2. Concentration of bile salts, bile pigments,
cholesterol, fatty acids and lecithin is increased
because of absorption of water and electrolytes.
• 3. The pH is decreased slightly.
• 5.Mucin is added to bile.
• FUNCTIONS OF BILE SALTS-
• Bile salts are required for digestion and absorption of
fats in the intestine. The functions of bile salts are:
• 1. Emulsification of Fats
• Emulsification is the process by which the fat globules
are broken down into minute droplets and made in the
form of a milky fluid called emulsion in small intestine,
by the action of bile salts.
• Lipolytic enzymes of GI tract cannot digest the fats
directly because the fats are insoluble in water due
to the surface tension. Bile salts emulsify the fats by
reducing the surface tension due to their detergent
action. Now the fats can be easily digested by
lipolytic enzymes.
• Unemulsified fat usually passes through the
intestine and then it is eliminated in feces.
• Emulsification of fats by bile salts needs the
presence of lecithin from bile.
• 2. Absorption of Fats-
• Bile salts help in the absorption of digested fats
from intestine into blood. Bile salts combine
with fats and make complexes of fats called
micelles. The fats in the form of micelles can be
absorbed easily.
• 3. Choleretic Action
• 4. Cholagogue Action
• 5. Laxative Action
• BILE PIGMENTS-
• Bile pigments are the excretory products in
bile. Bilirubin and biliverdin are the two bile
pigments and bilirubin is the major bile
pigment in human beings.
• Bile pigments are formed during the
breakdown of hemoglobin, which is released
from the destroyed RBCs in the
reticuloendothelial system.
• FORMATION AND EXCRETION OF BILE
PIGMENTS-
• NORMAL PLASMA LEVELS OF BILIRUBIN-
• Normal bilirubin (Total bilirubin) content in
plasma is 0.5 to 1.5 mg/dL. When it exceeds
1mg/dL, the condition is called
hyperbilirubinemia. When it exceeds 2 mg/dL,
jaundice occurs.
• FUNCTIONS OF BILE-
• 1. DIGESTIVE FUNCTION
• 2. ABSORPTIVE FUNCTIONS
• 3. EXCRETORY FUNCTIONS
• Bile pigments are the major excretory products of
the bile. Other substances excreted in bile are:
• i. Heavy metals like copper and iron
• ii. Some bacteria like typhoid bacteria
• iii. Some toxins
• iv. Cholesterol
• v. Lecithin
• vi. Alkaline phosphatase.
• 4. LAXATIVE ACTION
• 5. ANTISEPTIC ACTION-Bile inhibits the growth
of certain bacteria in the lumen of intestine by
its natural detergent action.
• 6. CHOLERETIC ACTION
• 7. LUBRICATION FUNCTION-The mucin in bile
acts as a lubricant for the chyme in intestine.
• 8. CHOLAGOGUE ACTION
 FUNCTIONS OF LIVER
• Liver is the largest gland and one of the vital organs
of the body. It performs many vital metabolic and
homeostatic functions.
• 1. METABOLIC FUNCTION-Liver is the organ where
maximum metabolic reactions such as metabolism
of carbohydrates, proteins, fats, vitamins and many
hormones are carried out.
• 2. STORAGE FUNCTION-Many substances like
glycogen, amino acids, iron, folic acid and vitamins
A, B12 and D are stored in liver
• 3. SYNTHETIC FUNCTION-Liver produces glucose by
gluconeogenesis. It synthe sizes all the plasma proteins and
other proteins (except immunoglobulins) such as clotting
factors, complement factors and hormonebinding proteins.
It also synthesizes steroids, somatomedin and heparin.
• 4. SECRETION OF BILE-Liver secretes bile which contains
bile salts, bile pigments, cholesterol, fatty acids and lecithin.
• The functions of bile are mainly due to bile salts. Bile salts
are required for digestion and absorption of fats in the
intestine. Bile helps to carry away waste products and
breakdown fats, which are excreted through feces or urine.
• 5. EXCRETORY FUNCTION-Liver excretes
cholesterol, bile pigments, heavy metals (like
lead, arsenic and bismuth), toxins, bacteria
and virus (like that of yellow fever) through
bile.
• 6. HEAT PRODUCTION –Enormous amount of
heat is produced in the liver because of
metabolic reactions. Liver is the organ where
maximum heat is produced.
• 7. HEMOPOIETIC FUNCTION-In fetus (hepatic
stage), liver produces the blood cells (Chapter
10). It stores vitamin B12 necessary for
erythropoiesis and iron necessary for synthesis
of hemoglobin. Liver produces thrombopoietin
that promotes production of thrombocytes.
• 8. HEMOLYTIC FUNCTION-The senile RBCs
after a lifespan of 120 days are destroyed by
reticuloendothelial cells (Kupffer cells) of liver.
• 9. INACTIVATION OF HORMONES AND DRUGS-Liver
catabolizes the hormones such as growth hormone,
parathormone, cortisol, insulin, glucagon and estrogen.
It also inactivates the drugs, particularly the fatsoluble
drugs. The fatsoluble drugs are converted into water
soluble substances, which are excreted through bile or
urine.
• 10. DEFENSIVE AND DETOXIFICATION FUNCTIONS-
Reticuloendothelial cells (Kupffer cells) of the liver play
an important role in the defense of the body. Liver is
also involved in the detoxification of the foreign bodies.
• i. Foreign bodies such as bacteria or antigens are
swallowed and digested by reticuloendothelial cells of
liver by means of phagocytosis.
• ii. Reticuloendothelial cells of liver also produce
substances like interleukins and tumor necrosis factors,
which activate the immune system of the body.
• iii. Liver cells are involved in the removal of toxic
property of various harmful substances. Removal of toxic
property of the harmful agent is known as detoxification.
• Detoxification in liver occurs in two ways:
• a. Total destruction of the substances by
means of metabolic degradation.
• b. Conversion of toxic substances into non
toxic materials by means of conjugation with
glu cu ronic acid or sulfates.
 GALLBLADDER
• Bile secreted from liver is stored in gallbladder.
The capacity of gallbladder is approximately
50 mL. Gallbladder is not essential for life and
it is removed (cholecystectomy) in patients
suffering from gallbladder dysfunction. After
cholecystectomy, patients do not suffer from
any major disadvantage. In some species,
gallbladder is absent.
• FUNCTIONS OF GALLBLADDER-
• Major functions of gallbladder are the storage
and concentration of bile.
• 1. Storage of Bile
• 2. Concentration of Bile
• 3. Alteration of pH of Bile
• 4. Secretion of Mucin
• 5. Maintenance of Pressure in Biliary System
 JAUNDICE
• Jaundice is the condition characterized by yellow
coloration of the skin, mucous membrane and deeper
tissues due to increased bilirubin level in blood.
• The normal serum bilirubin level is 0.5 to 1.5 mg/dL.
Jaundice occurs when bilirubin level exceeds 2
mg/dL.
• Types of Jaundice-
• 1. Prehepatic or hemolytic jaundice
• 2.Hepatic or hepatocellular jaundice
• 3. Posthepatic or obstructive jaundice.
• 1.Prehepatic or Hemolytic Jaundice
• Hemolytic jaundice is the type of jaundice that occurs
because of excessive destruction of RBCs resulting in
increased blood level of free (unconjugated) bilirubin.
• In this condition, the excretory function of liver is normal.
But the quantity of bilirubin increases enormously.
• The liver cells cannot excrete that much excess bilirubin
rapidly.
• Unconjugated bilirubin is insoluble in water and is not
excreted in urine. So, it accumulates in the blood resulting
in jaundice.
• Causes-Any condition that causes hemolytic anemia can
lead to hemolytic jaundice.
• i. Renal disorder
• ii. Hypersplenism
• iii. Burns
• iv. Infections such as malaria
• v. Hemoglobin abnormalities such as sickle cell anemia or
thalassemia
• vi. Drugs or chemical substances causing red cell damage
• vii. Autoimmune diseases.
• 2. Hepatic or Hepatocellular or Cholestatic Jaundice-
• Hepatic jaundice is the type of jaundice that occurs due to
the damage of hepatic cells.
• Because of the damage, the conjugated bilirubin from liver
cannot be excreted and it returns to blood.
• Causes –
• i. Infection (infective jaundice) by virus, resulting in
hepatitis (viral hepatitis)
• ii. Alcoholic hepatitis
• iii. Cirrhosis of liver
• iv. Exposure to toxic materials.
• 3.Posthepatic or Obstructive or Extrahepatic Jaundice
• Posthepatic type of jaundice occurs because of the
obstruc tion of bile flow at any level of the biliary
system.
• The bile cannot be excreted into small intestine. So,
bile salts and bile pigments enter the circulation.
• The blood contains more amount of conjugated
bilirubin.
• Causes-i. Gallstones
• ii. Cancer of biliary system or pancreas.
 HEPATITIS
• Hepatitis is the liver damage caused by many agents. It is
characterized by swelling and inadequate functioning of
liver.
• Hepatitis may be acute or chronic. In severe conditions,
it may lead to liver failure and death.
• Causes and Types-
1. Viral infection (viral hepatitis: see below)
2. Bacterial infection like leptospirosis and Q fever
3. Excess consumption of alcohol.
4. Excess administration of drugs like paracetamol.
• Viral Hepatitis-
Viral hepatitis is the type of hepatitis caused by
viruses. It is caused by two types of viruses, hepatitis
A and hepatitis B.
Causes of viral hepatitis-
i. Mainly by intake of water and food contaminated
with hepatitis virus
ii. Sharing needles with infected persons
iii. Having unprotected sex with infected persons
Hepatitis caused by hepatitis B virus is more common
and considered more serious because it may lead to
cirrhosis and cancer of liver.
 CIRRHOSIS OF LIVER
• Cirrhosis of liver refers to inflammation and damage of
parenchyma of liver.
• It results in degeneration of hepatic cells and
dysfunction of liver.
• Causes-
1. Infection
2. Retention of bile in liver due to obstruction of ducts of
biliary system.
3. Enlargement of liver due to intoxication
4. Inflammation around liver (perihepatitis)