Sei sulla pagina 1di 8

ANATOMY AND PHYSIOLOGY

HEPATOBILLARY TREE

LIVER

A. Location and size of the liver- largest gland in the body, weighs

approximately 1.5 kg; lies under the diaphragm; occupies most

of the right hypochondrium and part of the epigastrium.

B. Liver lobes and lobules- two lobes separated by the falciform

ligament

1. Left lobe- forms about one sixth of the liver

2. Right lobe- forms about five sixths of the liver; divides into

right lobe proper, caudate lobe, and quadrate lobe

3. Hepatic lobules- anatomical units of the liver; small branch

of hepatic vein extends through the center of each lobule

C. Bile ducts
1. Small bile ducts form right and left hepatic ducts

2. Right and left hepatic ducts immediately join to form one

hepatic duct

3. Hepatic duct merges with cystic duct to form the common

bile duct, which opens into the duodenum

D. Functions of the liver

1. Glucose Metabolism

-after a meal, glucose is taken up from the portal venous

blood by the liver and converted into glycogen

(glycogenesis), which is stored in the hepatocytes.

Glycogen is converted back to glucose (glycogenolysis)

and release as needed into the blood stream to maintain

normal level of the blood glucose.

-glucose can be synthesized by the liver through the

process gluconeogenesis

2. Ammonia Conversion

-use of amino acids from protein for gluconeogenesis result

in the formation of ammonia as a by product. Liver

converts ammonia to urea

3. Protein Metabolism

-Liver synthesizes almost all of the plasma protein

including albumin, alpha and beta globulins, blood clotting

factors plasma lipoproteins


4. Fat Metabolism

-Fatty acid can be broken down for the production of

energy and production of ketone bodies

5. Vitamin and Iron Storage

-stores vitamin A, D, E, K

6. Drug Metabolism

7. Bile Formation

-bile is formed by the hepatocytes

-composed of water, electrolytes such as sodium,

potassium, calcium, chloride, bicarbonate, lecithin, fatty

acids, cholesterol, bile salts

-collected and stored in the gallbladder and emptied in the

intestine when needed for digestion

a. Lecithin and bile salts emulsify fats by encasing them in

shells to form tiny spheres called micelles

b. Sodium bicarbonate increases pH for optimum enzyme

function

c. Cholesterol, products of detoxification, and bile pigments

(e.g. bilirubin) are wastes products excreted by the liver

and eventually eliminated in the feces

GALLBLADDER
The gallbladder (or cholecyst, sometimes gall bladder) is a small
organ whose function in the body is to harbor bile and aid in the
digestive process.

Anatomy
• The cystic duct connects the gall bladder to the common hepatic

duct to form the common bile duct.

• The common bile romero duct then joins the pancreatic duct, and

enters through the hepatopancreatic ampulla at the major

duodenal papilla.

• The fundus of the gallbladder is the part farthest from the duct,

located by the lower border of the liver. It is at the same level as

the transpyloric plane.

Microscopic anatomy

The different layers of the gallbladder are as follows:


• The gallbladder has a simple columnar epithelial lining

characterized by recesses called Aschoff's recesses, which are

pouches inside the lining.

• Under the epithelium there is a layer of connective tissue

(lamina propria).

• Beneath the connective tissue is a wall of smooth muscle

(muscularis externa) that contracts in response to

cholecystokinin, a peptide hormone secreted by the duodenum.

• There is essentially no submucosa separating the connective

tissue from serosa and adventitia.


Size and Location of the Gallbladder

The gallbladder is a hollow, pear-shaped sac from 7 to 10 cm (3-

4 inches) long and 3 cm broad at its widest point. It consists of a

fundus, body and neck. It can hold 30 to 50 ml of bile. It lies on the

undersurface of the liver’s right lobe and is attached there by areolar

connective tissue.

Structure of the Gallbladder

Serous, muscular, and mucous layers compose the wall of the

gallbladder. The mucosal lining is arranged in folds called rugae,

similar in structure to those of the stomach.

Function of the Gallbladder

The gallbladder stores bile that enters it by way of the hepatic

and cystic ducts. During this time the gallbladder concentrates bile

fivefold to tenfold. Then later, when digestion occurs in the stomach

and intestines, the gallbladder contracts, ejecting the concentrated bile

into the duodenum. Jaundice a yellow discoloration of the skin and

mucosa, results when obstruction of bile flow into the duodenum

occurs. Bile is thereby denied its normal exit from the body in the

feces. Instead, it is absorbed into the blood, and an excess of bile

pigments with a yellow hue enters the blood and is deposited in the

tissues.

The gallbladder stores about 50 mL (1.7 US fluid ounces / 1.8

Imperial fluid ounces) of bile, which is released when food containing


fat enters the digestive tract, stimulating the secretion of

cholecystokinin (CCK). The bile, produced in the liver, emulsifies fats

and neutralizes acids in partly digested food.

After being stored in the gallbladder the bile becomes more

concentrated than when it left the liver, increasing its potency and

intensifying its effect on fats. Most digestion occurs in the duodenum.


BILIRUBIN PRODUCTION AND ELIMINATION

Bilirubin is the substance that gives bile its color. It is formed

from senescent red blood cells. In the process of degradation, the

hemoglobin from the red blood cell is broken down from biliverdin,

which is rapidly converted to free bilirubin thru biliverdin reductase.

Free bilirubin, which is not soluble in plasma, is transported in the

blood attached to plasma albumin. Even when it is bound to albumin,

this bilirubin is still called free bilirubin. As it passes through the liver,

free bilirubin is released from its albumin carrier molecule and moved

into the hepatocytes. Inside the hepatocytes, free bilirubin is converted

to conjugated bilrubin thru glucoronyl transferase, making it soluble to

bile. Conjugated bilirubin is secreted as a constituents of bile, and in

this form, it passes through the bile ducts into the small intestine. In

the intestine, approximately one half of the bilirubin is converted into a

higly soluble substance called urobilinogen by the intestinal flora.

Urobilinogen is either absorbed into the portal circulation or excreted

in the feces. Most of the urobilinogen that is absorbed is returned to

the liver to be re-excreted into the bile. A small amount of

urobilinogen, approximately 5% is absorbed into the general

circulation and then excreted by the kidneys.

Usually, only a small amount of bilirubin is found in the blood;

the normal level of total serum bilirubin is 0.1 to 1.2 mg/dL. Laboratory

measurements of bilirubin usually measure the free and the


conjugated bilirubin as well as the total bilirubin. These are reported as

the direct (conjugated) bilirubin and the indirect (unconjugated or free)

bilirubin.

Potrebbero piacerti anche