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gianatomy4 - GI ANATOMY PART 4 LIVER LIVER GALLBLADDER...

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4/8/2009 1 GI ANATOMY PART 4 LIVER GALLBLADDER PANCREAS D.HAMMOUDI.MD LIVER, PANCREAS
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4/8/2009 2 Liver Largest organ in the body ° Three basic functions • Metabolic • Secretory • Vascular ° Major function • Excretion of waste products from bloodstream by excretion into bile ° Location • Upper right quadrant • Four lobes made up of hepatocytes • phagocytic cells ° Blood supply • One major vein - portal vein • One major artery - hepatic 4 Hepatic Portal System
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4/8/2009 3
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4/8/2009 4 Bilirubine in the urine
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4/8/2009 10 - The liver is divided into many hepatic lobules . Inflow to the liver involves hepatic arteries, which bring oxygenated blood to hepatic tissue, and portal veins, which bring nutrients and other compounds absorbed by the GI tract to be processed and/or stored in the liver. Outflow also involves two routes – hepatic veins which drain into the inferior vena cava and the common hepatic duct which joins the cystic duct and empties bile into the duodenum. - Major characteristics of the liver are portal triads (labeled “portal” in bottom left and shown in the middle) and central veins (labeled in bottom left and shown in the right). Red arrows indicate direction of blood flow within blood sinusoids flanking cords of liver cells. - Note the portal triad contains 1) the portal vein , 2) the hepatic artery , and 3) the bile duct . Each has its typical appearance. The central vein is lined with endothelial cells, with perforations into which the sinusoids empty. - The central veins lead to sublobular veins, which reach collecting veins, hepatic veins, and finally the inferior vena cava. The venous outflow of the liver has no regard to the organization of the lobules. - The liver sinusoids are shown in higher magnification in the bottom left. They are dilated, capillary-like vessels lined by fenestrated, discontinuous epithelium (labeled “e”). Interspersed among the endothelial cells are Kupffer cells (labeled “k”), which are fixed macrophages within the hepatic tissue. They have distinct l h h i id l l d f i lik h h cytoplasm that may enter the sinusoidal lumen and function like other macrophages within the body. They also break down damaged red blood cell hemoglobin. - In the bottom middle panel, there are many spaces between the hepatocytes and sinusoidal epithelial cells marked by arrowheads. They are referred to the space of Disse where exchange between hepatocytes and blood flow takes place. - Once again, in the bottom right, we review the Kupffer cell, endothelial cell of h li i id d h f Di the liver sinusoid, and the space of Disse.
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4/8/2009 11 - The liver lobules can be defined in 3 ways: - 1) Classic lobule – centered around the central vein with the portal triads at each corner. Shown below on the left, the classic lobule may not always be hexagonal in shape.
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