1.

Discuss the functions of the liver:

The liver is the largest gland in the body,
contributing 2% of the total body weight.
The liver has many functions and they are
the following:
The liver is an expandable organ and can store
large quantities of blood in it its blood vessels,
about 450 mL or 10% of the bodys total
blood volume.
Storage of large amounts of glycogen
Gluconeogenesis
It plays an important role in detoxifying
excretion of drugs, hormones, and other
substances present in the blood
It forms the blood substances used in
coagulation like fibrinogen, prothrombin and
other several factors.
Formation and secretion of bile (500 mL/day)
Excretion of bilirubin, cholesterol and alkaline
phosphatase
2.Discuss the lobulation based on function









Anatomically the liver can be divided into
right and left lobes by the attachment of the
peritoneum of the falciform ligament with the right
lobe being larger. The liver can be divide also based
on function. The left and right lobes can be divided
by an imaginary line by the presence of the
gallbladder and inferior vena cava with having the
caudate and quadrate lobe being included as a part
of the functional part of the left lobe.
3.Discuss the secretion and storage of bile.




Bile is formed in the liver and it is secreted
through ducts that eventually lead to the small
intestines to aid in the digestion of food especially
lipids. During digestion, the liver secretes bile into
the 2
nd
part of the duodenum by passing through the
right and left hepatic duct which joins to form the
common hepatic duct. The cystic duct from the
gallbladder joins the common hepatic duct to from
the common bile duct. At the terminal end of this
duct joins the main pancreatic duct of Wirsung
which opens to the duodenal ampulla of Vater that
is guarded by the sphincter of Oddi.
The gallbladder serves as a storage of bile where
it is being concentrated by the absorption of water.
The liver continuously produces bile even when it is
not needed. So the bile flow be directed towards the
gallbladder through the cystic duct which is
maintained patent by the spiral valves of Heister.
When food is ingested, gastrin and cholecystokinin
stimulates the gallbladder to contract and secrete
bile following the common bile duct into the small
intestines.
4.Role of bile in digestion.
Bile plays an important role in digestion
especially the digestion and absorption of lipids.
The fats in the ingested foods are insoluble in water
and aggregate into large lipid droplets in the upper
portion of the stomach. Since pancreatic lipase is a
water-soluble enzyme, its digestive action in the
small intestine can take place only at the surface of
a lipid droplet. Therefore, if most of the ingested fat
remained in large lipid droplets, the rate of lipid
digestion would be very slow. The rate of digestion
is, however, substantially increased by division of
the large lipid droplets into a number of much
smaller droplets thereby increasing their surface
area and accessibility to lipase action. This process
is known as emulsification, and the resulting
suspension of small lipid droplets is an emulsion
through the action of bile salts.
Another action of bile is the formation of micelles
which are similar in structure to an emulsion but are
much smaller. This plays a role in the absorption of
the water-insoluble products of lipid digestion.



5.Discuss the degradation and excretion of bile.
Breakdown of RBCs
-Approximately 126 days after the emergence from
the reticuloendothelial tissue, red blood cells are
phagocytized and hemoglobin is released.
-Hemoglobin is broken down into heme, globin, and
iron.
-The iron is bound by transferrin and is returned to
iron stores in the liver or bone marrow for reuse.
-The globin is degraded to its constituent amino
acids, which are reused by the body.
-The heme portion of hemoglobin is converted to
bilirubin in 23 hours.
Uptake into the liver
-Bilirubin is bound by albumin and transported to
the liver. It is referred to as unconjugated or indirect
bilirubin and is insoluble in water therefore cannot
be removed from the body until it has been
conjugated by the liver.
- Once at the liver cell, unconjugated bilirubin flows
into the sinusoidal spaces and is released from
albumin so it can be picked up by a carrier protein
called ligandin. -Ligandin, which is located in the
hepatocyte, is responsible for transporting
unconjugated bilirubin to the endoplasmic
reticulum, where it may be rapidly conjugated.
Conjugation
-The conjugation (esterification) of bilirubin occurs
in the presence of the enzyme uridyldiphosphate
glucuronyl transferase (UDPGT), which transfers a
glucuronic acid molecule to each of the two
proprionic acid side chains of bilirubin to form
bilirubin diglucuronide, also known as conjugated
bilirubin. This form of bilirubin, is water soluble
and is able to be secreted from the hepatocyte into
the bile caniliculi.
-Once in the hepatic duct, it combines with
secretions from the gallbladder through the cystic
duct and is expelled through the common bile duct
in to the intestines.
Bile breakdown by gut bacteria
-Intestinal bacteria (especially the bacteria in the
lower portion of the intestinal tract) work on
conjugated bilirubin to produce mesobilirubin,
which is reduced to form mesobilirubinogen and
then urobilinogen (a colorless product).
Stercobilinogen excretin via feces
-Most of the urobilinogen formed (roughly 80%) is
oxidized to an orange- colored product called
urobilin (stercobilin) and is excreted in the feces.
The urobilin or stercobilin is what gives stool its
brown color.
Reabsorption of urobilinogen
-There are two things that can happen to the
remaining 20% of urobilinogen formed. The
majority will be absorbed by extrahepatic
circulation to be recycled through the liver and re-
excreted.
Urobilinogen excretion via kidney
-Other very small quantity left will enter systemic
circulation and will subsequently be filtered by the
kidney and excreted in the urine
6.Discuss the development of jaundice in this
patient.

Jaundice occurs when bilirubin accumulates
in the blood, and reaches a certain concentration
and diffuses into the tissues which then become
yellow. The accumulation is caused by the altered
degradation and excretion of bile in the liver due
to damaged parenchyma.

7.Will Acetaminophen aggravate the liver condition
of the patient?
Yes, acetaminophen is hepatotoxic in nature
especially in over dosages. The liver functions drug
metabolism and excretion and since the patients
liver function is already compromised due to acute
hepatitis infection, the metabolism and excretion of
acetaminophen is hindered which can contribute to
the hepatic injury.
Normally, acetaminophen is metabolized to
phenolic glucuronide and sulfate in the liver by
glucuronyltransferases and sulfotransferases and is
excreted in the urine. Cytochrome P450 metabolizes
it as well into N-acetyl-p-benzoquinoneimine
(NAPQI) which is a highly reactive molecule that
causes harm by forming covalent bonds with other
intracellular proteins. However this reaction is
prevented by conjugation with glutathione, which
functions to detoxify drugs and other substances, to
generate water soluble products that is excreted into
bile.
But with acetaminophen over dose or altered
hepatic function glucuronyltransferases and
sulfotransferases are saturated, diverting the drug to
be metabolized by cytochrome P450 and generating
large amounts of NAPQI which in turn depletes
glutathione causing accumulation in the
hepatocytes. NAPQI can now form covalent bonds
with important cell proteins and alter their
structures causing cell death. This in turn activates
blood components like NK cells performing
cytotoxic activity that further aggravates hepatic
injury.
8.Explain why the urine is darker than usual while
the stool is lighter.
Conjugated bilirubin is water soluble, because
of its solubility and weak association with albumin,
excess conjugated bilirubin in plasma can be
excreted in urine.

9. Explain the presence of Heaptosplenomegaly
Hepatosplenomegaly can be observed in this
patient because there is persistent necrosis, there is
a steady accumulation of fibrous scar tissue within
the organ, and so the organ enlarges and tends to
become firmer than normal