Liver and Gallbladder Normal Anatomy

LIVER:

Is the heaviest gland of the body, weighing about 1.4 kg in an average adult. The
liver is inferior to the diaphragm and occupies most of the right hypochondriac
and part of the epigastric regions of the abdominopelvic cavity.

GALLBLADDER:

Is a pear shaped sac that is located in a depression of the posterior surface of the
liver. It is 7-10 cm long and typically hangs from the anterior inferior margin of
the liver.

The liver is almost completely covered by visceral peritoneum and is completely

covered by a dense irregular connective tissue layer that lies deep to the
peritoneum. The liver is divided into two principals lobes ---- a large right lobe
and a smaller left lobe---- by the falciform ligament, a fold of the peritoneum.
Although the right lobe is considered by many anatomist to include an inferior
quadrate lobe and a posterior caudate lobe, based on internal morphology, the
quadrate and caudate lobes more appropriately belong to the left lobe. The
falciform ligament extends from the undersurface of the diaphragm between the
two principal lobes of the liver to the superior surface of the liver, helping to
suspend the liver in the abdominal cavity. In free border of the falciform ligament
is the ligamentum teres (round ligament), a remnant of the umbilicus. The right
and left coronary ligaments are narrow extension of the parietal peritoneum that
suspend the liver from the diaphragm.

The parts of the gallbladder include the broad fundus, which projects inferiorly
beyond the inferior border of the liver; the body, the central portion;and the neck,
the tapered portion.
 HISTOLOGY OF THE LIVER AND GALLBLADDER

The lobes of the liver are made up of many functional units called lobules. A
lobule is typically a six-side structure that consist of specialized epithelial cells,
called hepatocytes, arranges in irregular, branching, interconnected plates around
a central vein. In addition, the liver lobule contains highly-permeable capillaries
called sinusoids, through which blood passes. Also present in the sinusoids are
fixed phagocytes called stellate reticuloendothelial (Kupffer) cells, which destroy
worn-out white blood cells and red blood cells, bacteria, and other foreign matter
in the venous blood draining from the gastrointestinal tract.

Bile, which is secreted by hepatocytes, enters bile canaliculi, narrow intercellular

canals that empty into empty into small bile ductules. The ductules pass bile into
bile ducts at the periphery of the lobules. The bile ducts merge and eventually
form the larger right and left hepatic ducts, which unite and exit the liver as the
common hepatic duct. The common hepatic duct joins the cystic duct from the
gallbladder to form the common bile duct. The functions of the gallbladder are
to store and concentrate the bile produced by the liver (up to ten folds) until it is
needed in the small intestine. In the concentration process, water and ions are
absorbed by the gallbladder mucosa

ROLE AND COMPOSITION OF BILE

Each day, hepatocytes secrete 800-1000 mL of bile, a yellow, brownish, or olive-

green liquid. It has a pH of 7.6-8.6 and consist mostly of water, bile salts,
cholesterol, a phospholipids called lecithin, bile pigments, and several ions. The
principal bile pigment is bilirubin. The phogacytocis of aged red blood cells
liberates iron, globin, and bilirubin. The ion and globin are recycled; the bilirubin
is secreted into the bile and is eventually broken down in the intestine. One of its
breakdown products stercobilin that gives feces their normal brown color.

BLOOD SUPPLY OF THE LIVER

The liver receives blood from two sources. From the hepatic artery
it obtains oxygenated blood, and from the hepatic portal vein it
receives deoxygenated blood containing newly absorbed nutrients,
drugs, and possibly microbes and toxins from the gastrointestinal
tract. Branches of the hepatic portal vein, hepatic artery, and bile
duct typically accompany each other in their distribution through
the liver. Collectively, these three structures are called a portal
triad. Portal triads are located at the corners of the liver lobules.

FUNCTIONS OF THE LIVER

CARBOHYDRATE METABOLISM

When blood glucose is low, the liver can break down the
glycogen to glucose and released the glucose into the bloodstream.
When the glucose is high, as occurs just after eating a meal, the
liver converts glucose to glycogen and triglycerides for storage.

LIPID METABOLISM

Hepatocytes store some triglycerides; breakdown fatty

acids to generate ATP; synthesize lipoproteins, which transport
fatty acids, triglycerides, and cholesterol to and from body cells;
synthesize cholesterol; and used cholesterol to make bile salts.

PROTIEN METABOLISM

Hepatocytes deaminate amino acids so that the amino acids

can be used for ATP production or converted to carbohydrates or
fats.

PROCESSING OF DRUGS AND HORMONES

The liver can detoxify substances such as alcohol and

excrete drugs such as penicillin, erythromycin, and sulfonamides
into bile. It can also excrete thyroid hormones and steroid
hormones such as estrogens and aldosterones.

EXCRETION OF BILIRUBIN

Most of the bilirubin in the bile is metabolized in the small

intestine by bacteria and eliminated in feces\

SYNTHESIS OF BILE SALTS

Bile salts are used in the small intestine for the

emulsification and absorption of lipids.

STORAGE
 Liver is a prime storage site for certain vitamins (A, B12,
D, E, and K) and minerals (iron and copper), which are released
from the liver when needed elsewhere in the body

PHAGOCYTOSIS

The stellate reticuloedothelial (Kupffer) cells of the liver

phagocytize aged red blood cells, white blood cells, and some
bacteria

ACTIVATION OF VITAMIN D

The skin, liver, and kidneys participate in synthesizing the

active form of vitamin D.