Accessory Organs in
Digestion
MODULE 5
OBJECTIVES
By the end of this section, you will be able to:
1. State the main digestive roles of the liver,
pancreas, and gallbladder
2. Identify three main features of liver histology
that are critical to its function
3. Outline the functions of the liver.
4. Discuss the composition and function of bile
5. Identify the major types of enzymes and
buffers present in pancreatic juice
INTRODUCTION
Chemical digestion in the small intestine relies on
the activities of three accessory digestive organs
which are: The liver, pancreas, and gallbladder
The digestive role of the liver is to produce bile
and export it to the duodenum.
The gallbladder primarily stores, concentrates,
and releases bile.
The pancreas produces pancreatic juice, which
contains digestive enzymes and bicarbonate ions,
and delivers it to the duodenum.
Accessory Organs in Digestion
The Liver
It is the largest gland in the body, weighing about
1.5 kg.
It is located in the right upper quadrant of the
abdominal cavity immediately inferior to the
diaphragm and receives protection from the
surrounding ribs
In addition to being an accessory digestive organ,
it plays a number of roles in metabolism and
regulation.
Its upper and anterior surfaces are smooth and
curved to fit the under surface of the diaphragm
while its posterior surface is irregular in outline
Organs Associated with the Liver
Superiorly and anteriorly – Diaphragm and
anterior abdominal wall
Inferiorly – Stomach, bile ducts, duodenum,
hepatic flexure of the colon, right kidney and
adrenal gland
Posteriorly – Oesophagus, inferior vena cava,
aorta, gall bladder, vertebral column and
diaphragm
Laterally – Lower ribs and diaphragm.
The Liver…
The liver is enclosed in a thin inelastic capsule and
it is incompletely covered by a layer of peritoneum.
It is connected to the abdominal wall and diaphragm
by five peritoneal folds referred to as ligaments.
These are the falciform ligament, the coronary
ligament, two lateral ligaments, and the ligamentum
teres hepatis. (3LFC)
NB: The falciform ligament and ligamentum teres
hepatis are actually remnants of the umbilical vein,
and separate the right and left lobes anteriorly.
Hepatic Lobes
The liver has four lobes. The two most obvious
are the large right lobe and the smaller, wedge-
shaped, left lobe.
The other two are an inferior quadrate lobe and a
posterior caudate lobe
Anterior Surface of Liver
Posterior Surface of Liver
Portal Fissure/ Porta Hepatis
This is the name given to the region on the posterior
surface of the liver where various structures enter
and leave the gland (“gate to the liver”) .
The portal vein enters, carrying blood from the
stomach, spleen, pancreas and the small and large
intestines.
The hepatic artery enters, carrying arterial blood. It
is a branch from the coeliac artery, which branches
from the abdominal aorta.
Nerve fibres, sympathetic and parasympathetic, enter
here.
The right and left hepatic ducts leave, carrying bile
from the liver to the gall bladder.
Lymph vessels leave the liver, draining lymph to
abdominal and thoracic nodes
Blood Supply
Hepatic artery delivers oxygenated blood
from the heart to the liver.
The hepatic portal vein delivers partially
deoxygenated blood containing nutrients
absorbed from the small intestine
In addition to nutrients, drugs and toxins are
also absorbed.
After processing the blood borne nutrients
and toxins, the liver releases nutrients needed
by other cells back into the blood, which
drains into the central vein and then through
the hepatic vein to the inferior vena cava.
Blood Supply…
With this hepatic portal circulation, all blood
from the alimentary canal passes through the
liver.
This largely explains why the liver is the most
common site for the metastasis of cancers that
originate in the alimentary canal
Scheme of Blood Flow Through the Liver
Structure of the Liver
The lobes of the liver are made up of hepatic lobules,
which are the structural and functional units of liver
There are about 50,000 to 100,000 lobules in the liver.
The lobule is a honeycomb-like structure (hexagonal
in outline) and it is made up of liver cells called
hepatocytes, arranged in pairs of columns radiating
from a central vein
Between two pairs of columns of cells are sinusoids
(blood vessels with incomplete walls) containing a
mixture of blood from the tiny branches of the portal
vein and hepatic artery.
This arrangement allows the arterial blood and portal
venous blood (with a high concentration of nutrients)
to mix and come into close contact with the liver cells.
Structure of the Liver…
Amongst the cells lining the sinusoids are hepatic
macrophages (Kupffer cells) whose function is to
ingest and destroy worn out blood cells and any
foreign particles present in the blood flowing
through the liver.
Blood drains from the sinusoids into central or
centrilobular veins.
These then merge with veins from other lobules,
forming larger veins, until eventually they
become the hepatic veins, which leave the liver
and empty into the inferior vena cava.
Portal Triads
Each lobule of the liver 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.
Tributaries of bile duct from canaliculi of neighbouring
lobules unite to form small bile ducts.
These small bile ducts join together and finally form left and
right hepatic ducts, which emerge out of liver
The Liver Lobule
Hepatic Lobule
Microscopic Anatomy of the Liver
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, which are
summarized below.
1. Metabolism: Liver is the organ where
maximum metabolic reactions such as metabolism
of carbohydrates, proteins, fats, vitamins and
many hormones are carried out.
2. Storage: Many substances like glycogen,
amino acids, iron, folic acid and vitamins A, B12
and D are stored in liver.
Functions of Liver…
3. Synthetic function: Liver produces glucose
by gluconeogenesis.
It synthesizes all the plasma proteins and other
proteins (except immunoglobulins) such as
clotting factors, complement factors and hormone
binding proteins.
It also synthesizes steroids, somatomedin and
heparin.
Functions of Liver…
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
faeces or urine.
Functions of Liver…
5. Excretion: 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
It stores vitamin B12 necessary for erythropoiesis
and iron necessary for synthesis of hemoglobin.
Liver produces thrombopoietin that promotes
production of thrombocytes.
Functions of Liver…
8. Breakdown of Erythrocytes: Some of the
senile RBCs after a lifespan of 120 days are
destroyed by reticuloendothelial cells (Kupffer
cells) of liver.
Although breakdown of red blood cells also takes
place in the spleen and bone marrow
9. Inactivation of Hormones and Drugs: Liver
catabolizes hormones such as growth hormone,
parathormone, cortisol, insulin, glucagon and
estrogen.
It also inactivates the drugs, particularly the fat
soluble drugs which are converted into water
soluble substances, which are excreted through bile
or urine.
Functions of Liver…
10. Defensive and Detoxification Functions:
Reticuloendothelial cells (Kupffer cells) of the
liver play an important role in the defense of the
body. Foreign bodies such as bacteria or antigens
are swallowed and digested by these cells of liver
by means of phagocytosis
Liver cells are involved in the removal of toxic
property of various harmful substances in a
process known as detoxification
Gall bladder
The gall bladder is a pear-shaped sac attached to
the posterior surface of the liver by connective
tissue.
It has a fundus or expanded end, a body or main
part and a neck, which is continuous with the
cystic duct.
Structure of the Gall Bladder
The wall of the gall bladder has the same layers
of tissue as those of the basic structure of the
alimentary canal, with some modifications.
Peritoneum: This covers only the inferior
surface because the upper surface of the gall
bladder is in direct contact with the liver and held
in place by the visceral peritoneum that covers
the liver.
Muscle layer: There is an additional layer of
oblique muscle fibres.
Mucous membrane.
This displays small rugae when the gall bladder is
empty that disappear when it is distended with
Blood supply
The cystic artery, a branch of the hepatic artery,
supplies the gall bladder.
Blood is drained away by the cystic vein that joins
the portal vein.
Functions of the Gall Bladder
Reservoir for bile
Concentration of the bile by up to 10- or 15-fold,
by absorption of water through the walls of the gall
bladder
Release of stored bile
When the muscle wall of the gall bladder contracts,
bile passes through the bile ducts to the duodenum.
Contraction is stimulated by the hormone
cholecystokinin (CCK), secreted by the duodenum by
the presence of fat and acid chyme in the duodenum.
Relaxation of the hepatopancreatic sphincter (of
Oddi) is caused by CCK and it is a reflex response to
contraction of the gall bladder.
Bile
Recall that lipids are hydrophobic, that is, they do not
dissolve in water.
Thus, before they can be digested in the watery environment
of the small intestine, large lipid globules must be broken
down into smaller lipid globules, a process called
emulsification.
Bile is a mixture secreted by the liver to accomplish the
emulsification of lipids in the small intestine.
Hepatocytes secrete about one litter of bile each day which
is a yellow-brown or yellow-green alkaline solution (pH 7.6 to
8.6)
Bile is a mixture of water, bile salts, bile pigments,
phospholipids (such as lecithin), electrolytes, cholesterol,
and triglycerides.
The components most critical to emulsification are bile salts
and phospholipids, which have a nonpolar (hydrophobic)
region as well as a polar (hydrophilic) region.
Bile …
The hydrophobic region interacts with the large
lipid molecules, whereas the hydrophilic region
interacts with the watery chyme in the
intestine.
This results in the large lipid globules being
pulled apart into many tiny lipid fragments of
about 1 µm in diameter.
This change dramatically increases the surface
area available for lipid-digesting enzyme
activity.
NOTE: This is the same way dish soap works on
fats mixed with water.
Bile …
Bile salts act as emulsifying agents, so they are
also important for the absorption of digested
lipids.
While most constituents of bile are eliminated in
faeces, bile salts are reclaimed by the
enterohepatic circulation.
Once bile salts reach the ileum, they are
absorbed and returned to the liver in the hepatic
portal blood.
The hepatocytes then excrete the bile salts into
newly formed bile. Thus, this precious resource is
recycled.
The Biliary System
The biliary tract refers to the path by which
bile is secreted by the liver then transported to
the duodenum, the first part of the small
intestine.
The biliary tract is often referred to as a tree
because it begins with many small branches
which end in the common bile duct, sometimes
referred to as the trunk of the biliary tree.
The duct, the branches of the hepatic artery,
and the portal vein form the central axis of the
portal triad.
Bile flows in the direction opposite to that of
the blood present in the other two channels.
Biliary Tract
The right and left hepatic ducts join to form the
common hepatic duct just outside the portal fissure.
The hepatic duct passes downwards for about 3 cm
where it is joined by the cystic duct from the gall
bladder.
The cystic and hepatic ducts merge forming the
common bile duct, which passes downwards behind
the head of the pancreas.
This is joined by the main pancreatic duct at the
hepatopancreatic ampulla
It opens into the duodenum, at the duodenal papilla,
which is controlled by the hepatopancreatic sphincter
(of Oddi).
The common bile duct is about 7.5 cm long and has a
diameter of about 6 mm.
Direction of Flow of Bile from the Liver to the
Duodenum
PANCREAS
The pancreas is a pale grey gland weighing about
60 grams.
It is about 12–15 cm long and it is situated in the
epigastric and left hypochondriac regions of the
abdominal cavity
It consists of a broad head, a body and a narrow
tail.
The head lies in the curve of the duodenum, the
body behind the stomach and the tail lies in front
of the left kidney and just reaches the spleen.
The abdominal aorta and the inferior vena cava
lie behind the gland.
The pancreas is both an exocrine and endocrine
The Exocrine Pancreas
This consists of a large number of lobules made
up of small acini, the walls of which consist of
secretory cells.
Each lobule is drained by a tiny duct and these
unite eventually to form the pancreatic duct,
which extends along the whole length of the
gland and opens into the duodenum.
Just before entering the duodenum the pancreatic
duct joins the common bile duct to form the
hepatopancreatic ampulla.
The duodenal opening of the ampulla is
controlled by the hepatopancreatic sphincter (of
Oddi) at the duodenal papilla
The Exocrine Pancreas…
The function of the exocrine pancreas is to
produce pancreatic juice containing enzymes,
some in the form of inactive precursors, that
digest carbohydrates, proteins and fats.
As in the alimentary tract, parasympathetic
stimulation increases the secretion of pancreatic
juice and sympathetic stimulation depresses it
The Endocrine Pancreas
Distributed throughout the gland are groups of
specialised cells called the pancreatic islets (of
Langerhans).
The islets have no ducts so the hormones diffuse
directly into the blood.
The endocrine pancreas secretes the hormones
insulin and glucagon, which are principally
concerned with control of blood glucose levels
Exocrine and Endocrine Pancreas
Pancreas in Relation to the Duodenum and Biliary
Tract
Blood Supply
The splenic and mesenteric arteries supply the
pancreas
Venous drainage is by veins of the same names
that join other veins to form the portal vein
Pathophysiology
Jaundice
Symptom NOT disease
Yellow discoloration of the skin and mucosa
secondary to hyperbilirubinemia
Common causes
Hemolysis
Hematoma
Viral hepatitis
Alcoholic liver disease
Drug-induced liver disease
Cirrhosis
Gallstones
Cancer
Pathophysiology…
Normal functioning liver and spleen break
down old RBC into haeme and globin
Haeme broken into bilirubin
Bilirubin excreted in urine or recycled by
liver
Abnormal functioning liver:
Bilirubin builds up in the blood
Becomes toxic to the body
Pathophysiology…
Liver Cirrhosis
Loss of normal liver structure and function
Chronic fibrosis of liver
May lead to complete liver failure
Liver initially enlarges due to
inflammation, then reduces in size due to
fibrosis
Liver loses functional ability to detoxify
body
Caused by: Alcohol abuse; Hepatitis B,C,D
Hereditary; Autoimmune; Biliary
obstruction; Drugs
Pathophysiology…
Symptoms
Poor digestion of food
Diarrhea
Malnutrition
Fatigue
Splenomegaly
Decreased blood clotting
Jaundice
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