Liver and Biliary tree

Liver and Biliary tree

1. Location: deep to ribs 7–11, most of the right hypochondrium

   • largest gland, weighs 1500 gr
   • Anatomically is divided in 4 segments
     • Right lobe
       • Left lobe
         • Caudate lobe
           • Quadrate lobe
     • Functionally is divided in 8 segments
       • has its own vascular inflow and biliary drainage
   • Covered by the Glisson capsule

2. Ligaments

   • Falciform ligaments
     • joins liver to anterior abdominal wall
     • Coronary ligament
       • Right and left triangular ligaments
     • Round ligament
   • Bare area: direct contact with diaphragm
   • hepatoduodenal ligament
     • portal triad: bile duct, hepatic artery, and hepatic portal vein
   • hepato- gastric ligament

3. Irrigation

   • 75% by hepatic portal vein
     • Formed by: Superior mesenteric artery and splenic
     • nutritive blood supply
   • 25% hepatic artery (right or left)
     • Proper hepatic artery
       • Common hepatic artery
   • Both supplies mix within the hepatic sinusoids
     • Drain: on the central vein
       • Hepatic vein
         • Inferior vena cava

4. Innervation

   • Sympatic: celiac plexus
   • Parasympatic: X nerve

5. Fossa for the gallbladder

   • Gallbladder (7-10cm)
     • Fundus
       • 9th costal cartilage
     • Body
     • Neck
       • joins the cystic duct
     • cystic duct (3–4 cm long)
       • Ends on the hepatopancreatic sphincter
         • CCK
     • Irrigation
       • cystic artery
         • cystohepatic triangle (of Calot)
         • from: right hepatic artery
     • FUNCTION: store and concentrate bile (30 ml to 50 ml)

6. Biliary tree

   • Left and right hepatic ducts
     • Joined by the cystic duct =
       • Common hepatic duct
         • Ampulla of Vater
   • Bile
     • formed by the hepatocyte
       • Modified by: bile duct epithelium
         • secretin stimulates this secretion.
       • consists of 95% water, bile salts, bilirubin phospholipid, cholesterol, amino acids
       • 2 primary bile acids: Cholic acid and Chenodeoxycholic acid
         • conjugated with: glycine and taurine
           • = bile salts (amphipathic)
             • FUNCTION: emulsify fats into smaller particles
         • Micelles: transport lipids, cholesterol and increase their absorption
           • Bile returns to the liver to be recycled via the enterohepatic circulation
             • reabsorbed in: ileum and return via the hepatic portal vein.
     • Bile concentration in the gallbladder
       • sodium ions are exchanged for protons
         • overall sodium ions increas and chloride and bicarbonate diminishes
           • Bile can be concentrated almost 15 times or more
             • Secretion: stimulated by Secretin, vagus nerve and CCK

7. Pauly Carrera Camacho A01364154

   • Guyton, A.C.& Hall, J.E. (1996). "Tratado de Fisiología médica". 9ª Edición. Interamericana-McGraw-Hill. Madrid Moore K.L. Anatomía Humana con Orientación Clínica Editorial Médica Panamericana. Barcelona (1993)

8. Other hepatic functions

   • Detoxify xenobiotics
   • Storage for vitamin A in the Ito cells
     • Storage of vitamin K
   • Bile production
   • synthesis of bile and VLDL
   • convert glucose to glycogen

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