Digestive System support Players: Liver, Gallbladder & Pancreas

LIVER
Function:
all nutrition absorbed from the gastrointestinal tract
are initially conveyed first to the liver by the portal
venous system..

Over 200 different functions!

Synthesis: plasma proteins, clotting factors, bile,

cholesterol

storage: iron, glycogen, blood, fat soluble vitamins

Metabolic functions: convert glucose to glycogen

and glycogen to glucose, convert
carbohydrates to lipids, maintain normal blood
glucose levels

Detoxification of many drugs and poisons

This is an in-situ photograph of the chest
and abdominal contents.

The liver is the largest internal organ,

lying just below the diaphragm.

The right lobe (at the left in the

photograph) is larger than the left lobe.
The falciform ligament is the rough
dividing line between the two lobes.
This is the external surface of a normal liver. The color is reddish-brown
and the surface is smooth. A normal liver is about 3.5-4 lbs

Color is from its great vascularity! All roads lead to the liver.
The livers general
relationship to other
structures in its
region.
 All this blood from the GI tract flows into the liver!
Dual blood flow to liver. Hepatic portal vein and hepatic artery. Hepatic vein takes
blood away from the liver and back to the heart, via inf. vena cava.
via inferior vena cava

Portal Vein-
all blood from intestines
first must pass through
the liver.

The liver receives about

25 % of resting cardiac
output via the hepatic
artery
Liver lobules- the liver is composed of
over1 million individual hexagonal shaped
units called hepatic (liver) lobules.

These are the functional units of the liver

section of liver showing many individual

hepatic (liver) lobules
Hexagonal shaped liver (hepatic) lobules
Histology showing multiple liver lobules with central veins and
portal areas (contain the portal triade: hepatic arteriole, portal venule & bile duct)
Structure of an
individual hepatic lobule
Bile is produced and secreted by
hepatocytes into a special "duct"
called a bile canaliculus.

The bile canaliculi empty into

branches of the bile duct which
eventually empty into the hepatic
duct that carries the bile out of
the liver to the gall bladder for
concentration and storage.
Remember, bile flows in the
direction opposite to the flow of
blood in the sinusoids.

Kupffer cells- those narly

phagocytic cells! “I’m not dead
yet”
sinusoids- spaces in which the blood from portal vein and hepatic artery flows
past the hepatocyes towards the central vein. Cords are just the hepatocytes
lined up , usually just one cell thick. Every hepatocyte “touches” the blood.
The portal triad
Bile produced in the
hepatocytes,
collected into the bile
canaliculi,
then sent to the bile duct
in the portal triade
Blood from
portal vein and
hepatic artery flow
to central vein.

Bile formed by
hepatocytes
flows in the opposite
direction
 hepatic lobule

PC=portal triad
cv=central vein
Hepatocytes are
arranged in rows that
radiate out from the
central vein. These
rows are one cell
wide and are
surrounded by
sinusoidal capillaries
or sinusoids. This
arrangement ensures
that each hepatocyte
is in very close
contact with blood
flowing through the
sinusoids, i.e. bathed
in blood.
Hepatocytes have a great capacity
for cell division
and regeneration.

If half the liver was removed, it

would regenerate
in one week.
This liver is slightly enlarged and has a pale yellow appearance, seen both
on the capsule and cut surface. This uniform change is consistent with
fatty metamorphosis (fatty change).
This is the histologic appearance of hepatic fatty change. The lipid
accumulates in the hepatocytes as vacuoles. These vacuoles have a clear
appearance with H&E staining. The most common cause of fatty change in
developed nations is alcoholism. Diabetes mellitus and obesity are
additional
causes.
Here are seen the lipid vacuoles within hepatocytes. The lipid accumulates when
lipoprotein transport is disrupted and/or when fatty acids accumulate. Alcohol, the
most common cause, is a hepatotoxin that interferes with mitochondrial and
microsomal function in hepatocytes, leading to an accumulation of lipid.
Ongoing liver damage with liver cell necrosis followed by fibrosis and hepatocyte
regeneration results in cirrhosis. This produces a nodular, firm liver. The nodules seen
here are larger than 3 mm and, hence, this is an example of "macronodular" cirrhosis.
Here is another example of macronodular cirrhosis. Viral hepatitis (B or C) is
the most common cause for macronodular cirrhosis
This is an example of a micronodular cirrhosis. The regenerative nodules
are quite small, averaging less than 3 mm in size. The most common
cause for this is chronic alcoholism. The process of cirrhosis develops
over many years.
Here is another example of micronodular cirrhosis. Note that the liver also
has a yellowish hue, indicating that fatty change (also caused by
alcoholism) is present.
What does the mythological medusa have to do with the LIVER?
Portal hypertension:
Restricts blood flow to liver
and blood backs up!
Portal hypertension results from the abnormal restricted blood flow pattern
in liver created by cirrhosis. The increased pressure causes a backup of the
veins that feed into the hepatic portal vein.Seen here is "caput medusae"
which consists of dilated veins seen on the abdomen of a patient with
cirrhosis of the liver.
A much more serious problem produced by portal hypertension results when
submucosal veins in the esophagus become dilated. These are known as
esophageal varices. Varices are seen here in the lower esophagus as linear
blue dilated veins. There is hemorrhage around one of them. Such varices are
easily eroded, leading to massive gastrointestinal hemorrhage.
One of the functions of the liver
is to synthesize the protein ALBUMN.
A major function is the maintainence
of the “osmotic Pressure”. Needed for
proper distribution of body fluids
between intravascular compartments
(ie fluid in your blood vessels) and
body tissues.
Fluid can be in one of 2 places
1. blood vessels
2. in the cells & tissue.

With severe malnutrition albumin

levels fall and the osmotic pressure
is no longer functioning.
Third spacing is when fluid collects in
a space where it does not normally
found, here in the peritoneal cavity.
 Gallbladder
The gall bladder receives bile
from the liver. Bile is
composed of bile salts that
emulsify fats forming water-
soluble complexes with lipids
(micelles) to facilitate the
absorption of fat. Bile salts in
the small intestine also
activates lipases in the
intestine.
Functions of the gall
bladder:
*storage of bile
*concentration of bile
*send bile to the duodenum
 Pancreas
Anatomy of Pancreas
Location:
*Within the curve of the
duodenum.
Function:
* releases secretions
(pancreatic enzymes) in an
exocrine fashion (thru a duct-
pancreatic duct), which it then
secretes into the duodenum
through the
hepatopancreatic Duct
(ampulla) (AKA ampulla of
Vater).
Pancreatic enzymes made by
Acinar cells of panvreas
General Information of Pancreas:
A digestive gland with head, neck, body ,
Endocrine functions:Hormones
tail regions.
Secretion of insulin and
Mixed gland with endocrine and exocrine
glucagon into bloodstream.
functions
Histology of Pancreas- acinar cells make pancreatic enzymes that are secreted into ducts.
Islets of Langerhans belong to the endocrine function of the pancreas and produce the
hormones insulin and glucagon.
Thank you organs of
the Digestive System!